Latest / System Speak: Complex Trauma and Dissociation / Guest: Judith Herman

Transcript

Guest: Judith Herman · System Speak: Complex Trauma and Dissociation

• 0:00
  Speaker 1: Welcome to the System Speak podcast, a podcast about dissociative identity disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 2:30
  Speaker 2: Judith Herman is a professor of psychiatry at Harvard Medical School. For thirty years until she retired, she was director of training at the Victims of Violence program at the Cambridge Hospital in Cambridge, Massachusetts. She is the author of the award winning books, father, daughter incest and trauma and recovery. She is the recipient of numerous awards, including Guggenheim Fellowship in 1984 and the 1996 Lifetime Achievement Award from the International Society for the Traumatic Stress Studies. In 02/2007, she was named a distinguished life fellow of the American Psychiatric Association.
• 3:12
  Her new book, Truth and Repair, How Trauma Survivors Envision Justice, was published in March 2023. Welcome, Judith Herman.
• 3:24
  Speaker 3: I'm Judith Herman. I'm a professor of psychiatry at Harvard Medical School, and, I'm the author of a new book called Truth and Repair, How Trauma Survivors Envision Justice.
• 3:41
  Speaker 2: Very excited to have you today. We have the trauma and recovery book is one of the texts in the level one professional training program for ISSTD. And so we have talked about that on the podcast already a lot and referenced that and so appreciate your work. My question just to even get to know your story a little bit, how did you even start focusing or learning about trauma and dissociation? Oh,
• 4:13
  Speaker 3: well, I give full credit to the women's liberation movement. I, started my psychiatric residency in 1970, and a few months before I had joined the consciousness raising group. My classmate and friend, Kathy, who had come up through the civil rights movement and seen there how powerful it was to bring people together to tell their own stories. She changed her name to Sarah Child, rather than the Patrick Nemec, when she joined the women's movement. And she wrote, they an article called consciousness raising where she named this as a method of both political organizing and scientific research.
• 5:26
  She said nobody really knows the truth about women's lives because nobody women don't dare tell the truth. So we need to understand our condition by talking about our own lives with one another. Now that consciousness raising group that I joined was, a very privileged group. Recent mostly recent college grads like myself and white, middle to upper class, highly educated women. But even in that demographic, there were lots of stories about sexual harassment and sexual violence and, general gender based violence as a means of subordination.
• 6:33
  So when I began my residency and my very first two patients were women who had been hospitalized after making suicide attempts. And both of these patients revealed histories of father daughter incest, it wasn't hard for me to make the connection between their, despair And, they're, having been victimized over and over as children. Now the comprehensive textbook of psychiatry at that time estimated the prevalence of all forms of incest as one case per million. So if that were true, what do you suppose my my chances were as a beginner of seeing two cases as my very first two patients? So something didn't compute.
• 7:55
  And with the women's movement behind me, I was able to talk to colleagues and collect some more cases and publish them not in the psychiatric journal, but in a new women's studies journal. And, that became part of, you know, a general movement in the nineteen seventies where crimes of violence against women were publicized, and women began to speak out for the first time.
• 8:31
  Speaker 2: This this is reflected in your book Trauma and Recovery that it's an unprecedented history of trauma and the story of women and even the treatment of trauma beginning with women in some ways, and it's just I want to make sure that listeners understand how powerful of a read that is, that that we as women understand the significance of that history.
• 9:01
  Speaker 3: Yes. I I think the, what I discovered when I started looking into the history was that the prevalence of childhood sexual abuse and its connection to what was then called hysteria, which we now call post traumatic stress disorder, or somatoform dissociation, was discovered in the late nineteenth century independently by Freud and Janet, Freud in Vienna and Janet in Paris, but that Freud retracted his discovery when he realized that nobody would listen, not because he found contrary evidence, but because he was being isolated and ostracized within profession. Nobody wanted to. If indeed he had found the source of denial, the ideology of hysteria, and people understood how common hysteria was, that would imply that sexual abuse of children was endemic in the society and nobody wanted to go there. And so Freud didn't want 80, basically.
• 10:24
  And similar histories have been found every time trauma is studied because you you can't really study it alone in isolation. You need because it documents the consequences of endemic crimes on a, on a widespread level, whether those are war crimes or whether those are our gender based crimes or both, people don't wanna know about it. And so the history of trauma studies has this kind of, periodic oscillation between just discovery and backlash and denial and rediscovery and backlash, and we still see this, of course, today.
• 11:17
  Speaker 2: Part of my career, I worked in war zones, and and it's the women who hold the stories still. When when you want to know what actually happened, there there's what the news says happened, There's what politics or government leaders say happened, and there's what the women say happened. Right. And, by
• 11:48
  Speaker 3: the way, sexual violence is basically used as a method of a tool of war in pretty much any conflict you can name. And it is directed not only at women and girls, but at men and boys as well. Civilians.
• 12:14
  Speaker 2: Can you tell us about your first book, the father daughter incest book?
• 12:19
  Speaker 3: Well, that grew out of those discoveries that I made, as a resident. When I finished my residency training, I went to work in a women's free storefront clinic, that had it was a counter institution like the rape crisis centers and the battered women's shelters. And, that that had been started by a group of feminists. And there I saw more cases and I teamed up with, Lisa Hirschman, who had just gotten her PhD in psychology, who was a friend and colleague. And she was seeing cases in her private practice.
• 13:12
  And that's how we collected the 20 cases and and first published our findings, in the women's studies journal. And the response we got both pre publication and after publication was so affirming. We got letters from all over the country basically saying, I thought I was the only one or I didn't dare tell anyone, but it happened to me too. And so we decided to write a book about it. And then, meantime, we had gotten married and had kids.
• 13:56
  And, that delayed us for a bit. But, at a certain point, Lisa had a second kid and she said, you know what? You go ahead and write the book because, like, you know, don't wait for me. So I did, and it was published by Harvard University Press in 1981. And it followed a string of books like, Susan Brown Miller's book against our will, men, women, and rape, and books about sexual harassment and about domestic violence so that it became clear that that there was a spectrum of violence against women and children, and that this was a method by which male dominance and female subordination was enforced.
• 14:58
  One of the big correlations we found in terms of looking at families where, father daughter incest had occurred was that they were families where the mothers were extremely disempowered either because of domestic violence or because of illness, or addiction, or in some cases, the mothers had died. But so that there was no countervailing power within the family. And there were also families that were isolated socially. And what we realized was that the isolation didn't just happen. It was enforced as a method, of course, of control by the perpetrator in order to protect, his dominance.
• 15:54
  Speaker 2: There's so much in there both for clinicians to understand for the greater context and also for survivors to connect with and relate to in, like you said, that understanding that they are not alone.
• 16:10
  Speaker 3: Exactly. And, of course, we're seeing this now again with the me too movement.
• 16:17
  Speaker 2: Yes. I think I think I've seen that, unfold in new ways in recent years with the lived experience clinicians coming forward and sort of their own coming out process. Not not everyone and everyone also to different degrees, but finding a place to stand and say, I am a really good I am a really good clinician, and also I have lived experience and finding ways to share our voices in healthy, boundaried, effective, advocating ways.
• 17:01
  Speaker 3: Yes. I mean, I think one of the ways that, survivors can really make meaning of their own victimization is to try to help others who have been through the same thing or are at risk of, being similarly abused and exploited. And so whether that is going into one of the helping professions or whether that's as a journalist or whether that joining, with groups to, execute legal reforms or going into the legal profession to advocate for survivors. There are lots of ways to do that. And, there's no reason why survivors can't be as effective as anyone else in that position as long as they take extra care to, prevent burnout, to preserve their own stability and boundaries and, their own social support network.
• 18:45
  Speaker 2: What would you say to young women who maybe are just now emerging adults and were not not just not alive yet I guess even for for some of that early women's liberation and and those women's movements, but also have grown up in a season of education that isn't always even permitted to share some of those aspects of history. And so unless they seek it out intentionally, they may not be aware or may not have it. What what would you want to pass on about what that meant and and what they need to know about it now?
• 19:37
  Speaker 3: Well, I think the the very first message is don't let yourself become isolated. Find someone you can talk with. And if that's not in your and find a friend, find a family member, find a a supportive adult, find, someone who you can open up with because shaming and isolation are what keep victims disempowered. And so as soon as you find an ally, you're beginning your recovery. And as soon as you find a safe environment where you can tell your truth, then you're on the path to recovery.
• 20:39
  Speaker 2: That's so powerful. And and I think that it's it's truth that women in so many cultures and in so many ages throughout time have known and have experienced that connection brings healing and that speaking truth is what empowers us. And also, just now, only just now is science catching up to that and being able to show that neurobiologically even though we've known that for for always.
• 21:13
  Speaker 3: Yes. And by the way, that's not just true for women. It's true for any trauma survivor. It's we the the people who do best in recovery are people who find a good, connection with under supportive people. Whereas isolation is toxic.
• 21:40
  And that's true whether you're a combat veteran or a rape survivor.
• 21:45
  Speaker 2: I I appreciate the emphasis that it's not just for women or cisgender women or,
• 21:54
  Speaker 3: but it's true for all
• 21:55
  Speaker 2: of us just as humans. That's that's that's really important. You have a new book that's just come out this spring. Do you want to tell us about that?
• 22:08
  Speaker 3: Well, I think that we have a followed on from this is really my third book, Truth and Repair, and it really followed on from my second book, Trauma and Recovery, which we've discussed a little bit, made I think I sort of went from writing about incest and violence against women to writing more generally about trauma because it became clear to me that as I was saying just a minute ago, trauma is trauma. Violence is violence, and the effects are the same whether you're talking about the intimate sphere of of sex and family and childbearing or whether you're talking about the political sphere of war and genocide. So what whatever scale you're talking about, the consequences of interpersonal violence and cruelty are the same. And, so I compared the sex in the the sort of basic post traumatic syndrome that we saw in combat veterans to what we observed in rape victims. And by the way, we really owe it to the the Vietnam Veterans Against the War, who came home and testified, that they were home safe, but in their minds, they were still in Vietnam.
• 24:10
  And every time they heard a car backfire, they thought they were under fire and, you know, fell to the you know, duck to the ground. And it was only when there was an anti war movement and veterans spoke out that PTSD became officially recognized in the psychiatric, diagnostic manual. And so just to sort of further the argument that if you're gonna talk about trauma, you need a social movement to validate it. So I compared rape victims and combat veterans, and I compared battered women and abused kids to political prisoners and torture survivors, because the syndromes were the same. And the other thing I did in that second book was to talk about stages of recovery.
• 25:20
  And I I outlined three stages, not as a sort of a fraud march, you know, that you can manualize and get people to comply with. I hate that term, because, that assumes another relationship of dominance and subordination in the medical encounter. But I outlined the first stage as one of safety that have in the present and forming a therapeutic alliance. Safety isn't something you can do in isolation. It's a social matter, but you can't really recover if you're still under threat constantly because then you're gonna constantly have to be alert for threat, and you're constantly gonna be retraumatized.
• 26:15
  So safety was first, and then only after safety was well established, was it useful to move into the trauma focused work of really telling the past story and making meaning out of it and reading the losses. And then that in turn was would lead into a kind of a new trauma narrative that, made sense of the person's life where the, you know, neither trying to avoid and deny it nor allowing it to define the person entirely. And at that point, the person was more able to re engage with the present and the future with more hope and more imagination and more, both capability for self protection and ability to take risks and think about new things. So those were the three stages of recovery that I outlined. And, as in the years following the publication of Trauma Recovery in 1992, I began to think about justice as a fourth stage.
• 27:46
  And so that's what this book is really about. If it's really true, and I think it is really true, that trauma is a social problem and a political problem, not just an individual problem, then this recovery just an individual matter. Or does full recovery really require some measure of social justice? And this book argues that it does, and that if we actually ask trauma survivors what justice would mean to them, we might have a very different vision of and and and a much better vision of justice than what we have now. And so that's what I did.
• 28:38
  I interviewed 30 survivors, and this book is about the visions of justice that come from out of their testimony.
• 28:47
  Speaker 2: I think this is so powerful. Again, that lived experience voice. And what it makes me think of when you're sharing how you describe and write in trauma recovery about those three phases of recovery. I think one thing that's happened culturally and clinically is that it has become a thing where people have taken that framework and tried to apply it to treatment, which is not necessarily the same thing. In some ways, there's that overlap that's kind of obvious in the the clinical context of it, but what it reminds me of is how when Elizabeth Cooper Ross did that research on on dying and came up with those the the stages or phases of of grieving of dying, she was studying the people who were dying and then culturally people started applying it to grief for grieving those who had died, which is not necessarily the same thing.
• 29:52
  And here, you're you're talking about the process that the person goes through as opposed to something clinically that is done to the patient or the client.
• 30:03
  Speaker 3: Absolutely. I mean, I think if trauma results from disempowerment, then empowerment really needs to be the basic principle of recovery. And that means that you can't have a therapeutic relationship that replicates dominance and subordination. A therapeutic alliance really has to be, it isn't one of equality because there's always a power differential between patients and therapy. But it can be very much one of mutuality with informed consent and shared responsibility and shared decision making and, transparency on the part of the therapist about what the therapist is recommending and why.
• 31:02
  And we have lots of good clinical data now that that indicates that regardless of your sort of school of psychotherapy, the therapy the quality of the therapeutic alliances, the single most powerful predictor of good outcome.
• 31:24
  Speaker 2: That's just that's just beautiful. I I just I'm struggling even with words because that's so clearly attentive and attunement and relational and connective, which is the opposite of that, cis med oppressive approach of I know what is best for you and my treatment. I will do this to you. The the it's such a different how how would you explain to clinicians more about that collaborative approach of of empowering someone to be who they are or to tell their story or to experience what they need to process as opposed to a model that is sort of put on them or treatment that is done to them? Well,
• 32:19
  Speaker 3: I think it helps to explore with a clinician his or her own inner conflicts about what to do and what how to be a good therapist. And what you don't, what you don't wanna replicate in the therapeutic relationship is the relationship of coercive control, dominance and subordination. Even if you're coming at it from benign motives, you want to be a rescuer. That's not actually in your power, to do. And, and understanding the limits of your own power and the need for buy in, if you will, and collaboration from the patient, can bring clinicians a long way.
• 33:41
  Speaker 2: So what words do we use to describe that when it is when it is that shared responsibility or informed and consensual and collaborative instead of coercive and control or dominance and subordination?
• 33:58
  Speaker 3: Well, I think it helps to, share anecdotes. I, I remember one of my first dissociative disorder patients that I ever treated. I had first gotten to know her as a teenage runaway street kid on drugs. She'd eventually gotten clean and sober and been engaged in therapy. But she was still periodically actively suicidal.
• 34:39
  And she was savvy enough by this time about the mental health system. So she knew to get how to get herself hospitalized when she was acutely suicidal. But she also knew how to get herself out of the hospital. So at one point, she, gone into an inpatient unit because she had she, you know, had a very clear plan and intent. And then after a few days, she told me that, on the phone that she had given her three day notice and told them, you know, what did they what they wanted to hear about how she no longer was suicidal, but that in fact, she was still intending to carry out her plan.
• 35:52
  And I tried to kind of argue with her and reason with her. We know, you know, we've been through this before and, you know, this happens periodically. And but then after when you're no longer suicidal, you're glad you didn't do it, and you made so much progress in treatment and blah blah blah blah blah. Anyway, it was useless. I was not getting anywhere.
• 36:28
  And finally, I was just out of exasperation and and sort of my own helplessness. I said, well, how do you think I feel about this? You're putting me in an impossible position. If I if I send the police out to, you know, to get you and commit you against your will, I'm acting like a perpetrator, retraumatizing you. And if I don't, I'm acting like your mother who turned a blind eye, and didn't intervene to protect you when your father was abusing it.
• 37:23
  And if you kill yourself, how do you think I would feel? Oh, she said, well, then I'll stay in the hospital. So, she found another word. She valued the relationship and she valued my frankness more than she valued her own life at that point. And so I this is what I tell clinicians.
• 37:55
  Share your dilemma. Don't feel like you are the all powerful God that has to decide what's gonna happen in this therapy because you're not. And share share the conflict. And when that happens, you're approaching the patient with a lot more respect and appealing to, the the their valuing of the relationship. That works a lot better.
• 38:36
  Speaker 2: Thank you for sharing that example. I think that that respecting and appealing to the value of the relationship really in that very specific example reflects what we were saying about the the the value of connection, the healing that comes in connection when when life when when when they when she values in your story, when she values the relationship even more than life, that's so healing from those original trauma layers where our lives depended on those we're harming and now the life depends on those who are healing, but together it's collaborative and it's restorative in a way that isn't even explicitly discussed but is experienced.
• 39:37
  Speaker 3: I think that's right.
• 39:38
  Speaker 2: Anything else that you would like to share with clinicians specifically? Well,
• 39:44
  Speaker 3: I I I think it's important for clinicians always to keep the social and political frame in awareness, even if you're working with an individual one on one with an individual patient, because it turns out that what we find so often clinically, and this was also true in the testimony of the survivors I interviewed for the new book, that what matters more to, the survivors than the attitude of the abuser is the attitude of the bystanders. What what everybody I interviewed said was, I want the truth to be known and not just the facts of the case, but the the harm and the fact that it was wrong. I want that to be recognized by the people who matter to me, because they wanted the shame lifted from their shoulders and put where it belonged on the shoulders of the perpetrator. They wanted the bystanders to step up and acknowledge the facts and to, basically say what happened to you was wrong, and you did not deserve that. And so it's that social validation and vindication that is so meaningful to survivors.
• 42:00
  And, by the way, I think that's why group therapy is so powerful as a vehicle for for survivor recovery. Again, whether you're talking about the rap groups of the victim of the Vietnam Veterans Against the War or the consciousness raising groups of the women's movement. They had a powerful therapeutic effect even though they're they were not designed as therapy groups. But trauma therapy groups are also incredibly powerful. So it's that social validation that survivors are looking for as the foundations of justice.
• 42:47
  That's why I called the book Truth and Repair. Everybody wanted the truth, the acknowledgment of the truth. And beyond that, they they weren't that interested in punishment of the perpetrators. They weren't that interested in forgiveness either. They wanted limits set on the perpetrators so he wouldn't do it again.
• 43:11
  And they wanted the community to step up to do that. And they also wanted the community to step up to help repair the harm that was done. And that didn't necessarily mean money, but it did mean social support in lots of different forms. You know, when, when one of the areas of of gender violence that's been very well studied, as you can imagine, is rape on college campuses, which is highly prevalent, highly, in culturally ingrained. It's part of the tradition of many fraternities and sports teams, and alumni.
• 44:06
  And, but when you ask the victims what they want, a lot of times what they they just don't wanna have to run into him in class and in the dormitory, and they don't want to be cheered by his friends. And if someone has to drop a course or move to a different dorm or someone, why should she be the one? Maybe, so they want limits placed on the perpetrator and some kind of educational, requirement that might prevent him from doing it again. And maybe his whole frat needs to undergo some serious, reeducation. But, and that's the kind of conclusion that, they don't necessarily want him expelled.
• 45:09
  They don't necessarily wanna go to the police. They don't wanna see him in prison. They don't wanna rule in the life of this, quote, unquote, fine young man. They just don't want him to ever do it again, and they don't wanna have to have him in their face all the time. They want the community, the college, to step up and make that happen instead of saying, oh, poor dear.
• 45:32
  Maybe you should just take a leave of absence and make the problem go away.
• 45:37
  Speaker 2: I think that and another that's such a powerful example and a thread of that that I see in the peer support groups or the community groups that's very common is survivors who start therapy and especially with dissociation, struggling with what they're remembering or details of what they're remembering and family either because of Darvo or gaslighting or just those dynamics arguing with them about the details. And I hear so often, more than anything else, that regardless of the details, I'm telling you this was my experience of what happened. And so often, survivors experiencing some sort of punishing or outcast or scapegoating or whatever from the family and then being punished for their trauma responses, when in reality, the trauma responses are the evidence of what the experience of the trauma was regardless of the details.
• 46:54
  Speaker 3: Well, we saw a very good public example of that in the Kavanaugh hearings when, professor Ford testified, to her memory of the sexual assault. And she couldn't give an exact date or an exact location. But she said what she remembered most was the laughter of these boys who were pinning her to a bed and making her fear for her life. And that that was used not just by a family, but by, all of the apologists for Ayatollah Kavanaugh who, basically supported his entitlement, and we saw a beautiful demonstration of Darbo, in his response to her testimony. And the Senate confirmed him.
• 48:00
  So that's what that's a perfect illustration of the community rallying behind the perpetrator instead of the victim and using the victim's traumatic memory to discredit the victim. That's the that's injustice is in some ways more harmful to all of us than the original sexual assault. And that's the visions of justice that I heard in the testimony of survivors would not have the highest court in the in the country, with two credibly accused perpetrators, in robes.
• 48:53
  Speaker 2: It's so heartbreaking. It's so heartbreaking. Before we let you go, what would you want to say to survivors who listen?
• 49:03
  Speaker 3: Find your support. Find your support group. And, what my mama told me, I will pass along one of her pearls. She said, Activism is the antidote to despair. So, you may have been helpless once, but you're no longer helpless.
• 49:28
  So find your support group and change the world.
• 49:32
  Speaker 2: Oh, my goodness. Thank you so much for talking to us today. My pleasure. Thank you for having me. I really, really appreciate you, and, I I am I I appreciate your time.
• 49:46
  Just thank you so much for your work, for your teaching, and all that you have given to both the clinical community and the survivor community.
• 49:55
  Speaker 3: Thank you. This was fun.
• 50:00
  Speaker 1: Thank you for listening. Your support really helps us feel less less alone while we sort through all of this and learn together. Maybe it will help you in some ways too. You can connect with us on Patreon by going to our website at www.systemspeak.org. If there's anything we've learned, it's that connection brings healing.
• 50:20
  We look forward to connecting with you.