Latest / System Speak: Complex Trauma and Dissociation / Guest: Kathleen Adams

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Guest: Kathleen Adams · System Speak: Complex Trauma and Dissociation

• 0:02
  Speaker 1: Welcome to the System Speak podcast. If you would like to support our efforts at sharing our story, finding stigma about dissociative identity disorder, and educating the community and the world about trauma and dissociation, Please go to our website at www.systemspeak.org where there is a button for donations and you can offer a one time donation to support the podcast or become an ongoing subscriber. You can also support us on Patreon for early access to updates and what's unfolding for us. Simply search for Emma Sunshine on Patreon. We appreciate the support, the positive feedback, and you sharing our podcast with others.
• 0:43
  We are also super excited to announce the release of our new online community, a safe place for listeners to connect about the podcast. It feels like any other social media platform where you can share, respond, join groups, and even attend events with us. Go to our webpage at www.systemsbeak.org to join the community. We're excited to see you there! Kathleen Adams has been practicing as a clinical psychologist since 1977.
• 1:37
  She works with children, adolescents, and adults. Her current focus is developmental trauma. She has worked extensively with all forms of trauma and dissociation. She has a book coming out with Rutledge called Attuned Treatment of High Functioning, Non Abused People Living Outside of Time. She recently presented two workshops on shame and abject states at the ISSTD Conference in Seattle.
• 2:08
  The material she is covering today on object states, OSDD and dead states, is available to you on her website, kathleenadamsphd.com. Welcome, Kathleen Adams.
• 2:25
  Speaker 2: Please note that this episode contains a trigger warning as she gives specific examples from case studies of kinds of abuse causing shame. A few of these are rather graphic. As always, please care for yourself during and after listening to the podcast. Thank you.
• 2:48
  Speaker 3: Hi, I'm Kate Adams, aka Kathleen Adams. Kate is either an alter or my nickname, take your pick. At my very first ISTD conference in the eighties, I picked up my materials and they said, oh, you already picked them up. Turns out there's another Kathleen Adams that was at the conference. And so the running joke that that year was that there were there that we each were each other's alters.
• 3:14
  But unfortunately, I'm five foot one, and she's five foot eleven, and so it it didn't fly. We didn't. But they insisted that I had already picked up my materials, and I insisted that I hadn't, and we finally worked it out. So as you can tell, I'm a storyteller and I have lots of stories to tell. And I hope that my stories are informative as well as entertaining.
• 3:35
  So I understand that about half of you are therapists and about half of you are just really interested in the whole topic of dissociation. And so I'm honored. I didn't realize that there was such a large following and I'm so proud of Emma. Emma and I met at ISTD a week ago in Seattle.
• 3:55
  Speaker 2: Well, that's the thing. I I got to meet you there, which was lovely. But also, when I heard you speak, it's so I still don't have words for it. I've gone back to watch part of it twice, and it clearly is touching something I need to address in therapy privately because I can't retain it. It's not staying where I can't access it.
• 4:21
  It just keeps slipping through but it was so profound and this whole concept of abject shame or abject suffering was not something I had even heard of before and so part of me, it was one of those moments where I was irritated that I had my education in these recent decades where it's not as good as the education people used to get but also just this moment of gratitude of discovering what I'm stumbling on and and what you were sharing. And I know you have a book coming and we're gonna talk about all of those things, but where do you even wanna start with that?
• 5:02
  Speaker 3: People aren't gonna be familiar with the term abject experience. I'm I'm gonna talk about how one develops dissociative traits without abuse to start. Many of you are very familiar, more than you wanna be, with abuse, but people developed associative features many, many other ways. And that's what I'm going to be focusing on a little bit today, but then we're going to get into abject and we're going to just do tons of clinical examples. And what I hope to cover today, many of my examples come from group therapy, some come from individual therapy, a few are teens, a whole lot are grown ups in long term therapy.
• 5:39
  But something for therapists to be aware of. Since half of you are a therapist, I want to say why I decided to write a book, and why I decided to start teaching again. Because I've been part of ISTD since the early, early 80s. But I did an invited presentation on group therapy on trauma by senior clinicians, and they all said they didn't have any traumatized people in their practice. And what they meant is they didn't work with DIDs, and they didn't work with rape, and they didn't work with profound abuse, and they didn't work with SRA.
• 6:12
  But what they didn't realize is that they had tons of people with developmental trauma in their practice, and they just didn't know it. So they didn't know it. These were guys with thirty years experience, and they didn't they weren't familiar with any of these concepts. I did not learn about any of this in graduate school. I mean, you did not miss out.
• 6:29
  This all came much, much later. So, therapists frequently encounter patients with characters organized around melancholy, anxiety, entitlement and rage. They're caught off guard when they they run into patients, and the workshop I taught showed that, who developed dissociative defenses to manage powerlessness, shame, and of course terror. My work centers primarily on high functioning non abused people right now with disorganized attachment and mild dissociation. And Judith Herrmann forever ago in her book Courage to Heal, that was the sixties or seventies, she was the first one to point out, I think, that shame is incredibly important to the development of disorganized attachment, and disorganized attachment is incredibly important to the development of dissociative defenses, whether or not you're abused.
• 7:20
  There's a piece of research that nobody knows about because it wasn't allowed to be published, and I don't know why it's secret. Something to do with politics. But it was a brilliant piece of research. It was done in in the early seventies at University of Texas by Mary Seymour. And what she did, and this has profound implications for all of us, therapists and the person in therapy alive.
• 7:48
  What she did is she took mother baby pairs, presumably good mother baby pairs functioning the kids were around six months five, six months old, put them in two separate rooms. They were linked by videotape. The babies were fine as long as the mother was cooling and, you know, sticking out her tongue and saying, you're such a big boy and doing all the things that that mothers do. Even though she wasn't physically touching them and wasn't physically present, the babies were fine as long as she was tuned into their brain. Then she went on tape delay, and the same good mother doing the same good things thing.
• 8:23
  Oh, you're such a big boy and sick he had her tongue was doing the same good thing she did thirty seconds ago, and the babies disintegrated. And you see them disintegrating. Then it went live again, and the babies pulled it together. Then it went on tape delay again, and the babies disintegrated. Why?
• 8:41
  Well, the mother was really not linked into the baby's brain. Even though she was going through the motions of being a good mother. The clinical implications of this are if you even if you try really hard to be a good mother, but if your husband just died, your mother just died, your father just died, you're going through a divorce, you're in a car wreck, you have postpartum depression, I could go on for ten hours on there. If you're just going through the motions of parenting, your baby knows that you're not queued in to to their live brain and they fall apart. Why is this important?
• 9:13
  Well, Tronic in the sixties, I think it was the sixties, maybe it was the seventies, did an experiment called the still face experiment. And in that, which was a very short experiment because the mothers refused to participate after a while, a mother baby couple the mother was instructed, don't laugh or smile in response to your baby, and the baby's disintegrated. Well, pretty soon the mothers just refused to participate because it is way too distressing to the babies. This is how the Amish keep their people in line is by shunning, still face lack of responsiveness is something we can't we are hardwired to not be able to tolerate. We need responsiveness.
• 9:57
  Even a kitten can tolerate way more lack of responsibility than than we humans can, and that's just so important. So, I've worked with maybe 30 DIDs in my lifetime and without fail, no matter how much sadistic abuse, organized sadistic abuse, terrible torture people had, when they get down to the end of their last few years of therapy, say the last year or two, what's way bigger than any awful torture that they endured was not feeling known, not feeling seen, not feeling protected, not feeling cherished. That was harder to work through than all those levels of torture. That's just a a universal. So what I wanna do right now is give you a few clinical examples of what I'm talking about, and then I'm gonna make a a leap into sharing some some clinical material with with you.
• 10:53
  Here's a here's a very short example of what I mean by oppression. In the absence of real maltreatment. No abuse, no cruelty, no evil. A young man I worked with had parents that were in the priesthood, and they just didn't really get young culture. So this would have been in the eighties.
• 11:14
  No. This would have been in the early late eighties, early nineties when video games were just really hitting their stride. And that was the work of the devil according to dad. And so, I'll call him Carl, wasn't allowed to play video games, which isn't is a game changer for a kid if he can't relate to his peers. His father loved him dearly, but did not know how to show it.
• 11:38
  Did not he was a little bit on the spectrum, I think, on the autistic spectrum. He didn't know really how to show it on on the young man's eighteenth birthday. He was supposed to get a special present from his dad as part of the ritual of the church, and he gave him salt with a lecture about Lot and Lot sins, and I and I looked at him. He was in group with me, the father, and I looked at him. I says, what what does he have to do to get your attention?
• 12:02
  This isn't a very good present, and he just got irritated with me. Well, a year later, his son would came in to see me in therapy, And, oh, one one more little clinical vignette, so you really understand about this kid and his dad. When he was 16, he was forced to go to Guatemala, I think, with his dad and the church to do a charity mission. And on the way home, everybody felt so worried about this boy because he'd been a bit of a pain on the trip and smoked weed and such that they prayed for him out loud for the whole drive, which was what, ten hours or something. So I started to work with this young man, and of course we did family therapy, and what he tried to get his parents to understand is that he didn't feel known, seen, and he felt oppressed by the super controlling behavior of him.
• 12:52
  And also he felt shamed by the fact that his peers were encouraged to pray for him for hour upon hour upon hour. It was just awful. Obviously, they ruined his relationship with spirituality. Okay. So that's one example of oppression.
• 13:08
  One thing I write about is I call attachment shock, and there's many different kinds. I'm gonna give you a few examples, but you can read about it later. And we'll tell you where what we saw in the still face experiment experiment and what we saw with the marie sumoer experiment, which has such implications for every one of us who had a parent who had to go through the motions of being a parent but really wasn't glued into our brain. Well, that was attachment shock. There's another kind, there's zillions of kinds of attachment shock, and I write about as many of them as I think of, and I have a whole paper on it.
• 13:42
  But one of them, body therapist back in the seventies, wrote about, and you won't have read about this in graduate school, I promise, called cephalic shock. I heard this term twenty five years ago, and I knew it applied to me. What on earth is cephalic shock? Who's ever heard of such a it's big words, c e p h a l I c. Well, I'm gonna first, I'm gonna tell you a bit about it, then I'm gonna give you a clinical example.
• 14:08
  Cephalic shock is a term that's given to someone who like in tronics experiment, like in nursing words experiment, was raised by primarily a mother who didn't know how to hold her baby so that the baby could relax and melt. If you if you look at a really good functioning mother baby pair, the baby just doesn't have to hold himself up at all. He just melts into his mom and dad's arms. But if you grew up with parents that were slightly misattuned, physically awkward, not clued in. The examples he gave where he's in a shopping mall and he sees a mother holding a kid under her arm, you know, with her left arm and her purse, and that kid that was awkward.
• 14:51
  Being held in such a way that you have to use your own muscles to support yourself long before you're ready to do that, that is what cephalic shock is, and it manifests in chronic tension in the neck and shoulders. Well, doesn't apply to anybody you know or love or live in that body, does it? All of us have a little bit of that, but people who grew up with cephalic shock have a lot of it. They also feel a little bit worthless. So let me tell you about, I have to think of her name, Jenny.
• 15:20
  Obviously, not using real names here. Jenny grew up very beloved, you know, family that just very bonded, super close to her sisters. But her mother had had postpartum psychosis while she was recovering in the hospital, and her mother, her the mother's mother died during that period. So Ginny grew up with a mother who was a very nice person, but she's come to realise, and I'm going to tell you how, that her mom couldn't have been clued into her. She went through the motions of being a good mom, but she was not clued into her.
• 15:56
  Jenny has terrible pain in her shoulders and her neck. She's very insecure. She has the boyfriend of all boyfriends. He's awesome. They're gonna get married at some point.
• 16:09
  But she has to stop herself because she wants to launch into it. Why do you love me? I'm worthless. I'm not lovable. I'm too much for everybody.
• 16:16
  She's too much for me. She's too much for him. And we're getting close to abject territory here, but I'm gonna hold off on that for just a little bit. She grew up with her mother conveying to her that her crying was too much, holding her was too much. And so she has terrible neck pain, terrible shoulder pain.
• 16:34
  She had to hold her own head up way before she was supposed to be able to do that because her mom really could not put her at ease. So even in a very loving family, no abuse whatsoever, This young woman grew up convinced that she was worthless, unlovable. She managed to catch this incredible great guy and he's very appreciative of who she is as well. She's a very talented professional. I'll just leave her field out of it.
• 17:02
  But her level of insecurity is vastly higher than most people's, and she's had to she's had to learn. She's she's just slightly dissociative in that she never remembers after one of her out outbursts until later, and then she's just mortified. And the outbursts are always, you don't love me. You're not gonna wanna marry me. I'm I'm a piece.
• 17:25
  Well, I don't wanna say that. That's a four letter word. I'm a piece of garbage. She's bordering on abject there. She's now self aware about that.
• 17:34
  She's working on her neck and shoulders with a chiropractor who's really great at muscles, and she's just wonderful to work with in psychotherapy, but the notion of cephalic shock blew her out of the water. So that's one kind of chronic shock. Another clinical vignette, and then we're gonna go into object. But you'll notice I'm tippy toying around object because object is going to be sort of relevant to almost all of my clinical examples. Another kind of chronic shock is called soul I call soul shock.
• 18:01
  I made that term up and here's an example of developmental trauma and how it can evolve into very dangerous situations. Frank was a young man who grew up in a wealthy family that was just incredibly dysfunctional and also sort of troubled. The mother had, I I think it was cerebral palsy, it might have been MS, it was long ago and I don't remember, but she lost the ability to move her face at six months, when he was six months, and he had a recurring nightmare of being right up against a wall. You can't see me gesturing, but I've got my hands right in front of my eyes. He grew up right with his dream of being facing this wall that wouldn't move, and he'd wake up screaming all the time from from that.
• 18:46
  She didn't know how to be clued into him and she couldn't use her voice somehow to to compensate. She had trouble talking as well. The father had massive strokes. This young man frank didn't have a bedroom of his own. He watched his dad go through stroke after stroke.
• 19:02
  The family had to move multiple times. He never knew why everybody was moving. He felt like the family cat who was just thrown in a carrier and moved from from house to house. So anyway, when he was around 10, getting back to soul shock, the point here, he was walking home from school with one of his buds and older kids. You know, he was probably fifth grade, and these were, like, old, really cool kids, seventh graders or something.
• 19:26
  They said, hey. We got a spaceship in our basement. You wanna see? Well, he said, sure. So they said, why don't you and your friend come on over?
• 19:33
  So they did, went down to the basement, only to spend the next half hour, he and his friend, watching each other be tied down and shocked. Somehow this chair was wired to electricity and so they got shocked. It wasn't lethal. Wasn't even quite at the level of torture, for those of you who are very familiar with that. But it was still horribly terrifying and unpleasant.
• 19:54
  And watching each other was almost as bad. Well, I I think he tried to tell his family about that, but they didn't do anything about it. So fast forward about ten years, maybe a little bit more, eleven, twelve years, and he's he's in a he's in a fraternity at college. Very smart kid, engaging. One of his frat brothers invited a friend over, and the friend said, hey, wanna have a really cool experience?
• 20:19
  There's this thing called acid. I'm gonna drive you out to the lake, and I'm gonna really take care of you. It's important that your first trip be very safe so that you can just explore your internal world. He said, well, that sounds really fun. Okay?
• 20:32
  He said, I'll take great care of you. Well, the guy was a sociopath. So what he did was to, basically mind rape poor Frank for the next twelve hours. He told him god didn't love him anymore. His mother didn't love him.
• 20:45
  He was gonna go to hell. And he since Frank was tripping, he he couldn't reality test. And he was sort of in this guy's clutches for twelve hours. And just the structure that the serial killers use. And these boys in the spaceship adventure and also in the mensicide, the acid mensicide, used the same techniques that serial killers use to entice their victims.
• 21:09
  It's just fortunately Frank wasn't murdered, but he certainly experienced really terrifying stuff, and the soul was shocked right out of his body. I he was mildly desensitive, and you can read about him in, falling forever, the chronic shock. It's on my website. Emma will give you that later. So he didn't present as abject.
• 21:29
  I'm gonna give you an example of abject, but he certainly felt abject a lot of times. Abject is Emma was bemoaning the fact that she didn't learn about this in school. This is such a complex topic. The woman who wrote about abject was named Christopher. She wrote a book called The Power of Horror.
• 21:47
  Don't buy it. There's only about two pages in it that are comprehensible. It's it's a really, really hard read. My article, although it's a hard read, is an easier read than hers. She wrote right after World War two.
• 22:00
  The meaning of she was trying to describe working with holocaust survivors. And the the whole thing about abject is it's growing up with an absolute conviction that there is an unbridgeable space between you and what you really long for, which of course early on is is the mother's face and the mother's breast. But there's an absolutely unbridgeable face, and you are doomed to be abandoned and to suffer forever. That's where the feeling abject comes from. Christopher talks about it as feeling like a piece of flotsam, jetsam, garbage, thrown away, rejected profoundly.
• 22:36
  People struggling with abjection, for those of you who are therapists, simultaneously plead for connection yet aggravate intimacy. All that is life enhancing is perceived to be in the other because the abject self was overwhelmed or emptied out by being ignored by active violation by being terrorized or being just drowning in shame, not feeling loved, not feeling known. Therapists often mistake people that are abject for masochists because they can look masochistic. I'm gonna read you a clinical example and you'll understand why they irritate people. But masochists suffer to gain attention and care.
• 23:13
  Abject people suffer not to get care. There's no masochism in them. They're just certain that they're doomed. Christopher Bolas again wrote a book called Fate versus Destiny, And it's all about whether you have a sense of of agency inside and you can move towards your destiny or whether you are fated or doomed as the abject people feel to be unlovable and unworthy. It's a great book.
• 23:39
  I highly recommend you buy it. Okay. Here's a clinical example. Sarah drags in thirty minutes late for group. She freezes outside the group perimeter, hovering anxiously as if to beseech the group's permission to enter.
• 23:52
  Arms wrapped about an enormous tote bag, she imagines herself to be a hermit crab, toting her security around with her. She's been repeatedly late to group lately. The group knows she's still being harassed by her boss and dares not leave the office with work unfinished. Still, her hovering and being so late is annoying. She's a seasoned group member.
• 24:10
  She's been in therapy forever, and she really knows the ropes of group protocol. I buy back two competing urges to snap at her, sit down already, and to smile and welcome. Doing neither because I wasn't sure which one was right, I ignore her until someone else growls in exasperation. For god's sake, sit down. Sarah flinches and whines piteously that she hadn't wanted to interrupt what was obviously an important conversation.
• 24:34
  She added that she wasn't sure whether she should come in and slip away. As she crept into her seat, she whispered, please don't look at me. I'm trying to be invisible. Somebody quipped, you couldn't have found a more effective way to bring everything to a halt than to make such a scene. Sinking more deeply into a slump, she murmured, who was so so looking forward to being here?
• 24:54
  I'm so sorry. But within a few moments since she was OSDD, she recovered her aplomb and launched into the back and forth of the group process seemingly seamlessly inserting herself into the fray. Most of the time, she presented with a beguiling smile or rapier wit and wicked repartee. She was hysterically funny. Yet, her young self presented as a timid, confused young girl who expects to be rejected, mumbles and whispers, and inspires contempt.
• 25:22
  The group just witnessed Sarah in a moment of self abjection. Now that's a key point here. You don't feel abject sitting in front of Netflix. Abject only comes out when you're around somebody. It's a relational dynamic, and therapists would use the term enactment, which means it's it's a physical and visceral experience between two people rather than just in a one person solo experience.
• 25:49
  You don't sit at home and feel abject, but you might feel abject when you try to have coffee with a friend. Sarah had a foot in two worlds. One part of her was able to negotiate conflicts. Those of you who are really comfortable with parts, you get this. But a second less well functioning side of her emerged periodically at moments of embarrassment, yearning, and acute vulnerability.
• 26:07
  During those episodes, Sarah would present in a self state that was markedly tremulous, brow beaten, and collapsed. She had no abuse. Her parents just fought constantly. Dad was an alcoholic, and she didn't get a whole lot of it attention, really. She's a very she was a very high functioning dissociative patient who can be triggered into low road functioning.
• 26:25
  You know, the high road and the low road. That's Dan Siegel. When she loses her typical self position possession, she feels young, whispers and becomes frozen in dread and uncertainty. It's so important for therapists to know these people are not masochists. Even if you get irritated, that's part of the enactment.
• 26:42
  You're supposed to feel like rejecting them because they expect to be rejected because they will always have rejected. And your job is to understand that this is not a masochist because masochists you confront, but these folks need a therapy that is dense with safety. While many such folks present with a history of abuse, other just others just grew up with disorganized attachment like Sarah and some emotional neglect and a lot of shame. So the essence of the abject experience is feeling really unworthy and doomed, fated, to be alone, to be abandoned, to be rejected. Sarah wouldn't date because she knew nobody would like her.
• 27:20
  Another woman I worked with who was in a different group and was I'd write about somewhere. She was also very abject. She was a delightful woman. I loved working with her. I saw her twice a week in group and probably for about ten years in in individual.
• 27:37
  No, twice a week in individual and for about ten years in group. Got that backwards. She grew up, I don't know what it's called medically, but she had a hole in her brain at birth that caused her legs to not develop correctly. So she had to endure multiple, multiple surgeries in her first eighteen years of life. And so many of her earliest memories were hearing other kids scream because that was back in the fifties when parents weren't allowed to room in.
• 28:05
  Medication didn't control pain very well, and she just remembers agony and lots of screaming and lots of aloneness. And she would she would whine in group constantly and then call me up after group, and then whine an individual also that this is when I was in my thirties, guys, so she might have been a tiny bit accurate, but probably not. She would whine that I was beautiful. Well, maybe I was. Maybe I wasn't.
• 28:28
  I'm old now. But, anyway, she she would go on and on about how ugly she was and she wasn't at all. How ugly she was and how no one was ever gonna love her. Well, she didn't suffer from a dearth of love, but her parents were practical people and their love was we're gonna get you orthotic orthopedic shoes. We're gonna help you do your exercises.
• 28:49
  But she essentially grew up with her face pressed against the glass watching everybody else have fun. She didn't know how to she couldn't play foursquare. She couldn't play volleyball. She couldn't go dancing. She couldn't even hardly go for a walk.
• 29:03
  She had all these medical apparatus on her legs. Her early life was really despairing. And so she would present with me in an abject state and keep that going over the phone for as for as long as as she could. What happens in group, and there are a lot of group experts who would swear by this, I'm not sure this is true, but I'll tell you what they say, is that the group experts say that you cannot heal shame without a group. I'm not sure that's true, but I do know that if you struggle with a lot of shame, it really helps to have others around you who also struggle with shame, who can help you work your way out of it.
• 29:43
  There needs to be a we, and most people who feel abject and who grow up feeling worthless don't ever experience we. Their family wasn't a we. There was never I can't wait to get home. There was no safe place. Sarah used to ask, what if what if there's nothing between the frying pan and the fire?
• 30:01
  What if there's just no safe place at all? The presence of the abject, Christopher says, causes us to flinch away, recoil, and reject. The black hole, the abyss, the place in which all meaning collapses. In the grip of abject feelings, you feel unworthy, unlovable, and in despair, utter despair about the situation ever changing. Implicit memories of helplessness, dread, horror, rejection, things going wrong are activated neurologically and communicated via posture, voice, words.
• 30:27
  Objection is a powerful neural network combining cognitive, behavioral and neurophysiological components, sensory images of past experience, recollection of strong aversive emotions and over arousal. But self objection, like I said, it's an interpersonal communication. It's an enactment of impossible need. The underlying worldview of abject self states is based on the realization, and many of the DID folks that I loved and worked with, I love my patients, but had parts with names like worthless, ugly. I'm sure you all can relate.
• 31:01
  The underlying worldview of abject self states is based on the realization that once the being was formed in the face of the impossible, the unnatural, the unthinkable, and the unspeakable, Objection of the self repels the other as ardently and adamantly as it simultaneously seeks connection. The object individual defines himself by a certainty of unbridgeable space between himself and an unattainable stupid psychoanalytic word object. An unattainable connection, I'll say. During enactments, the odd the person that has longed for is perceived only as a movement of rejection or dejection of himself, the intangible ghost of a profoundly familiar rejecting other who inhabits oneself and becomes indistinguishable from it. Past blurs with presence as helpless yearning and embodied recoil from old objections oscillate in a rhythm of doom.
• 31:53
  Sarah finally healed and was no was no longer object. She had a a group that just really got her. And despite their annoyance with her, she really grew a whole, whole, whole lot over a number of years. One of the things that happens, particularly if you grow up with a level of shame that would make you abject, and shame by the way is just finally coming into its own. For those of you who are clinicians, there's a new book out just two months ago by Orin Epstein, he's the editor, called Shame Matters.
• 32:29
  It may be too technical for those of you who aren't therapists, but it's it's it's a great read. But they don't talk about the Gita chapter on dead voices and dead states. So let's let's talk about dead states and dead thoughts for a second. When I meet new patients, one of my standard questions, I take a very detailed history, I have them talk right about everything they've ever experienced that was traumatic, including the death of, you know, their pet poodle when they were two? I mean, tell me everything.
• 33:00
  Write it all down. Dead voices in the group. Well, we're gonna be reading we're I'm gonna be reading to you some some really interesting clinical examples about this, and some clues for understanding about dead states. First, ask about it. I ask new patients, do you ever wish you wake up would wake up dead?
• 33:20
  And they get really scared. I get this look that says, you gonna put me in the hospital? Am I supposed to tell you the truth? If I tell you the truth, what's gonna happen to me? Maybe she won't work with me if I I tell her yes.
• 33:33
  Maybe I should just say no. I mean, all sorts of that question provokes all sorts of stuff. But truth is, dead thoughts are totally different than suicidal ideation. I can wish I would wake up dead but not be remotely inclined to buy a gun or try to cut myself the right way, not the wrong one. Dead thoughts are completely distinguishable from suicidal stuff, but a lot of therapists don't take that into consideration.
• 34:01
  So if somebody said I wish I was dead, oh god. I sometimes ask people, please stay alive to our next session, please. So let's look at a tiny bit of a of a clinical example. In a different group than the one I just read to you about, Lucera, there was a woman who was sort of an ice queen. I mean, tried to connect with her and it never worked.
• 34:25
  She'd always reject me, and I didn't know exactly what was going on. Then she brought in a dream, and we're gonna be paying attention to dreams here as how and those of you who are therapists and those of you who are just working your ass off in therapy, know that your dreams can be incredibly potent and powerful in helping your therapist understand you. So this woman who was basically a therapist term help rejecting complainer any anytime I tried to that was a very unkind way to think about her, nonetheless, therapists think that way sometimes. It seemed like everything I tried with her was wrong until she brought in the street. Then everything changed.
• 35:04
  A botanical garden had a rare and beautiful species of tree, lush with multilayered flowers and delicious fruit. The tree was slowly dying, however. Unbeknownst to the caretakers of the botanical garden, the ground beneath this apparently healthy tree was frozen. The roots beneath the tree were rotting, starving and desperate for nurturing attention. This dream heralded a shift in my work with this particular group.
• 35:29
  Not only did this patient have a starving dying baby self that had been almost entirely dissociated, she was OSDD, but so did many of the other high functioning patients in this group. As the group began to work with dead thoughts, dead states, feeling dead, having dreams about dead parts, recurrent dreams and dream series they found would sometimes bear very useful clues to underlying states of emotional starvation and abject self states as the story of Moriah will illustrate. But let me just make a comment to you about dream series. When if you're lucky enough, it may not feel like luck, to have a dream that keeps coming back and coming back and coming back, Track it and look for tiny shifts that are positive. I'll just give you a personal example.
• 36:16
  I had a recurring nightmare that just went on for years, and it's kind of just almost a trope at this point. I'm in grad school and I forgot to buy the books for the test, or I bought the books for the test, but they're in German, which I don't read. Or I forgot to buy the books and I go to the bookstore and the bookstore is out of the books and the test is in two days and there's not enough time to cram, I can't even find the books to cram. Or I can't find out where the test is being held or I get to the test and it's in Japanese. Well, anyway, I had variations on that dream that went on for years and years and years.
• 36:48
  I guess grad school was kind of rough. But eventually, little changes began to happen in this dream series that I had. The first change that happened is somebody appeared in the bookstore to help me find the books I needed. And she said, oh yeah, these are in German, but I can find you the ones in English are over here, and started laughing like that. And just in the interest of time, I'm gonna cut to the end.
• 37:10
  The very last one in this dream series, which had lasted a good twenty five years, I think, was I'm checking out with my books at the cash register and gal looks at me and she says, hey, don't you already have your doctorate? You don't need these books. And that was the end of that dream. So pay attention to little shifts in in your dreams that are part of a a dream series. So Mariah, despite her liveliness and vitality under other circumstances, Moriah had wept wordlessly and silently in group since her entry.
• 37:42
  She had always felt desperate, abject, and alone. A history of early childhood deprivation was activated most recently by the death of her cat just before she entered group. Her bonding figure had been a current cat as her mother had had she was not abused. As her mother had had intermittent psychotic states and was emotionally rejecting and chaotic. As she listened to the dead self subgroup, subgroup is just a portion of a group that identifies with one feeling as opposed to a different feeling that they're bonding around co experiencing.
• 38:13
  She finally began to understand about the dead part of herself. Her face began to animate for the first time and she stopped crying. She suddenly remembered a piece of history she hadn't thought about in years. As a toddler, she had stopped speaking when her mother went away again to a psychiatric facility. She was left in the care of not very nurturing grandparents for several years.
• 38:36
  Her vitality had withered on the vine until the family cat began to share her crib with her. So fast forward to the present of this writing. Her vitality had withered on the vine until the family of course, she was now decimated since the death of her 20 year old cat. Her psychic skin, that's a concept by Anjou, a French guy. Reading it in the original is impossible, but just kinda get the idea that your our psychic skin is a container that holds our mental contents together, and she didn't have much of one.
• 39:05
  Although her dead self did not vanish with this realization, she began to make room for this part of herself without becoming her or enacting her any longer, and she had compassion for the shock silence of the toddler within. This is a recurring dream series from Moriah that illustrates the prominence of her dead set self states. In an early version of the dreams, it's just verbatim. I kept turtles on terrarium. No matter how hard I tried, the turtles turned black until I find them dead.
• 39:32
  I feed them the wrong food or too much raw meat, and the water turns poisonous and murky, and they shrivel up and die. In another version of the dream, I reached into the China cabinet only to find a shriveled up dying baby on the plate. It's suffering so much I can hardly stand to touch it or even look at it. I pick it up in horror and it looks at me chastising me with its eyes, turns black and dies. I'm in an aquarium filled with giant sea urchins, heedless of my existence.
• 39:57
  I'm a little fish, and all I'm trying to do is desperately stay out of the sea urchins way. No matter where I turn, there are more giant sea urchins bobbing about. There is no safe place. So abject affects are so difficult to tolerate. They make us feel bad, and they're encased in sort of dissociative islands that interfere with intimacy.
• 40:22
  Objection is an unbearable preverbal state in which only need exists along with an active sense of being jettisoned, repelled, and repellent. To feel object is to plunge relentlessly into the horror of the black hole of meaninglessness of nonexistence. Or to quote a famous analyst named who used to write about stuff called the black hole, an awesome force of powerlessness, a defect, of nothingness, of zeroness expressed not just as a static emptiness, but as an implosive centripetal pull into the void. The black hole of objection embodies relentless despair about the possibility of being helped or soothed. I'm gonna reread that sentence because it's probably the key sentence.
• 41:06
  The black hole of objection embodies relentless despair about the possibility of being helped or soothed. Since abject experience tends to be a closed loop, reiterative and autonomous from any actual positive experience, the challenge becomes timing and the creation of a pathway inside. Therapists must weave their way through the maze of alienation and despair. So psychotherapy narratives featuring themes of suffering horror communicate powerfully the nation, the nature of traumatized existence. The private catastrophe of childhood deprivation and attachment chaos is largely suffered in despairing isolation.
• 41:44
  Early in life, the personal meaning of abject experience, just like with Jenny, is established in implicit procedural memory as essential truth. Remember, she's the woman who has a great boyfriend, and she's a high functioning professional, and she feels worthless and unlovable and convinced that he's gonna just throw her away and break up with her. She says, I am utterly, wretchedly alone. This is the way things are, we're meant to be, and will be forevermore. Not true, but it sure felt that way.
• 42:13
  For those of you who a therapist, there's this really cool book, the first half of it anyway. The second half, I hate it, by Thomas Ogden, who's a brilliant but hard to read analyst. But this book is the first half is not that hard to read, and everybody's gonna relate to this, I think. Although he's doing a lot of complicated stuff, one of the things he talks about is how we use our body pre bonding. So this is like before or alongside what we have a good mother or not a not a good mother, how we lose our our bodies for self soothing.
• 42:44
  And one of the ways that we use our body for self soothing is to have a container, and I'm gonna give you physical examples. Annihilation anxiety hits all of us. Whether you're loved, not loved, abused, not abused. We all, all of us as infants have annihilation anxiety, and there's two ways to cope with that other than being soothed. But when we're alone and having to deal with stuff, one is to do things that as we grow up, we would label them soothing.
• 43:11
  So the warmth of a bath, the feeling of a weighted blanket on you, the feeling of a teddy bear, the purring of a cat. These are all physical experiences that we would as adults call, yeah, that's soothing. That's having a container. So your mental contents are not just gonna dribble out all over everywhere. We have a psychic skin and we're we're contained.
• 43:33
  Well, if we can't do that, or alternatively, if it's not working, and I'll give you an example in a sec, if I remember, there's also the experience of making sure we exist by having an edge. So that's not a container, but that is a boundary between us and the outside world. So you bite your lips, you pull your hair, you bite your fingernails, you jog really hard, you work out really hard. Procrastination actually is an edge thing that Thomas writes about because there's a there's a finality, you know, if it's due in three days, then there's an edge. And the whole point of having an edge is to know that we exist and that we're not just gonna explode and melt and dissipate into nothingness.
• 44:15
  So either having a container that holds us together or having an edge that keeps us from completely imploding and exploding is really, really important. One young woman came into her first session, it was it was Austin in August, that was probably a hundred and eight. She was wearing, Doc Martin boots, really hot, and she was wearing about four layers. She was, layering herself up because the idea of starting therapy with this new therapist, that was me, was just too scary. So abject enactments are a way to show rather than tell about experiences with rejection, neglect, and profound deprivation.
• 44:55
  And the telling about abject experience is often incomprehensible because of cognitive interference, flashbacks and over reliance on metaphor. Metaphor allows complex threads of nonverbal experience to be woven together and offers a roadmap to inner experience that's inscribed in a personal language. But if you've got disorganized attachment and use metaphors, you can come across as sort of ditzy or nuts. It takes really careful listening to deal with chaotic narrative discourse derived from a lifetime of disorganized attachment trauma that metaphor Like poetry can be difficult to follow but it's so important sarah who you heard about she's the one who came in like the hermit crab She would break down in frustration and people complained that they couldn't understand her She was great with metaphor Listening to her sharing in group was a bit like winding one's way through a complicated maze. Eventually, one was bound to reach the exit, but it was difficult to sort out blind alley from the direct path.
• 45:53
  She'd start in one place and end up in another. I'm really good at following people, connect the dots, but not everybody is. Her words either captivating or confusing the listening the listener depending on their tolerance for right brain communications. Her words were eloquent with visual image and metaphor, always shared with earnest vulnerability and purpose, often laden with dialogue and scenes from classical books and movies. She says, I think in pictures.
• 46:19
  I can't connect them until I tell you about all of them. Well, the group members she'd go on and on, and group members would just say, get to the point. I don't get it. When group members would express their confusion about what exactly she was trying to talk about, she'd flinch and pull away, collapse into an abject alienated humiliation that's all too familiar to her from her school days. Her mother would send her to school refusing to pay for the class photos until the teacher sent them home.
• 46:46
  The teacher would yell at Sarah for not bringing money and wouldn't send them home until the mother sent money. I mean, you get Okay. So let's look at metaphor as a powerful communication just like we looked at dreams a minute ago. Although metaphor can sometimes be as difficult to follow as poetry, it can also capture and convey the essence of a dilemma in a way that straight discourse might evade. Doctor Shafetz, who I think has probably spoken with you, wrote, I long for a time when clinicians routinely consider the potential for the existence of unspoken words, images, sensations, and more that are the unwanted property of people rendered speechless by inescapable painful experience.
• 47:23
  End quote. Life metaphors, which condense the thematic narratives of a life into poetic symbolism or concretized visceral implicit memory, poignantly articulate nonverbal experience. Life metaphors abound in personal narratives, but could easily be overlooked if the therapist isn't alert. Metaphors describing abject experience typically involve a level of preverbal fear, alienation, and or deprivation for which there's no real coherent language available. Some life metaphors are quite straightforward.
• 47:53
  The ice queen who had the dream about the botanical garden and was really OSDD. I just didn't know it. She loved talked of loving to read books and watch movies about survival after shipwrecks or other catastrophes like Robinson Crusoe. Other kinds of life metaphors can be difficult to decipher because of the gaps and tangles extend in incoherent narrative. Metaphorically rich language like Sarah's or Moriah's can appear psychotic or grossly disorganized when all it really signifies is abrupt changes in self states and or the underlying presence of dissociative process.
• 48:26
  Moriah experienced frantic anxiety states that tended to alienate her peers. She used to make up stories about herself, especially in college, in an attempt to coerce empathy from others, such as describing a time she nearly died in a house fire. Well, that never really happened. Not really. But she came to understand her compulsive lying as abject enactments in communication because, no, she was never in a fire, but she might as well have been.
• 48:53
  The rest of her life felt like that. So it was true and not true at the same time. She was attempting to bridge the gap between herself and others to convey her lifelong suffering and horror. Even if the stories weren't factually accurate, the underlying aspects of desperation, terror and horror I mean, she grew up with a psychotic mother, pretty horrifying. It could that her metaphoric stories conveyed absolutely captured the nature of her emotional existence.
• 49:19
  Listen to the following life metaphors. These are her creations in an attempt to make me understand what it was like to be her. I am blindfolded stumbling through a cactus cactus forest. I'm stabbed by needles no matter where I turn in this cactus forest. It hurts.
• 49:37
  I can't get away. Another, I'm in the ocean choking on water and pummeled by waves, terrified I'm going to drown. I can't catch my breath, but then I find myself collapsed on a really nice beach. I cling to the warmth and solidity of the beach, digging my fingers into the sand to reassure myself that I can stay put. This is the best metaphor for disorganized attachment I've ever heard.
• 49:59
  But then the waves come again and drag me out in the water. So sand, water, sand, water, sand, water, sand, drown, sand, drown. Comfort, danger. Comfort, danger. And here's another one.
• 50:10
  Remember I said it can sound psychotic? She wasn't remotely psychotic. Nonetheless, when she was distraught in couples therapy, she'd say, birds are flapping around and screams are trapped in my head. Sounds nuts, but it wasn't. She was just conveying franticness of disorganized attachment.
• 50:26
  Bibian Lachman did a study with moms and kids years and years ago, probably in the sixties, about mother baby dyads where the mother, instead of soothing the baby who gets frantic, gets frantic herself. And what happens is they escalate, then they escalate, then they escalate, then they escalate, then they escalate. So, mother and child get dysregulated. That's probably a mother with disorganized attachment and a baby who's developing a whole lot of disorganized attachment, and it just keeps on escalating. We're gonna see an example of that in a minute, I hope.
• 51:03
  Birds are flapping around. Screams are trapped in my head that when we covered. I was making chicken soup and was overcome by horror when the backbone of the chicken disintegrated in my hands. What was holding me together? Could I disintegrate like that?
• 51:17
  Or here's the BB and Lachman story I was hoping we'd get to. Only this is Mariah. When my husband and I fight, everything just keeps getting worse. We're in a particle accelerator chamber going faster and faster and faster until we're smashed like atoms, and I hear glass break inside my head, and we shatter into shards. Sounds psychotic, but it isn't.
• 51:38
  It was just a metaphor that really captured the essence of her husband didn't know how to soothe. She didn't know how to really ask for soothing other than just to get frantic. For those of you who are therapists or looking to have a good therapist, the transformation of you have a problem and do we have a problem to figure out together is a profound difference in perspective that really helps. One of the only things that really helps along with having other people struggling with shame and oppression. Overwhelming pain in early childhood get encapsulated within an individual's implicit body memories, and they can't get work through without effective emotional resonance from a therapist who can tolerate immersion and primitive experience.
• 52:19
  And a lot of therapists aren't comfortable with primitive experience. I'm sure those of you who've been to three or four therapists know this. When we are called upon to witness unbearable experience, we sometimes put up a wall to protect ourselves a bit from the rawness of horror using experienced distant language, describing from an outside perspective. That was cohort in the seventies. Instead of using experienced near language, if we describe it from the outset, you must feel like this.
• 52:46
  Well, that's not gonna fly. That's not gonna go anywhere. The consequences that our most vulnerable patients end up feeling more abject and alone. With people who experience little attunement or interactive repair in childhood, it's vital to discover that someone's available who's interested in knowing what it likes to be you. So now we're gonna talk about Scott for a little bit.
• 53:05
  Scott is a teenager who actually just graduated from therapy this week, but I've worked with him for about four years. His parents are super cool. They're well known here in Austin. They're really loving people. When he was six months, four months, six months, 12 months for about two years in the toddler stage, for unknown reasons, he was subjected to well over a hundred spinal taps, and they all failed.
• 53:36
  They couldn't get what they needed from him, and they kept repeating it and repeating it. The mother, who's very sensitive emotionally, she was just so tortured by her son's suffering that she just left the room and at one point passed out. I mean, was just so overwhelming for her. So this kid had had become what looked like a juvenile delinquent. I mean, he was a master thief.
• 53:57
  He was great at creeping into his parents' bedroom. He'd crawl up like Spider Man on the side of the house and wait till they weren't in their bedroom and drop through a way up high window. You can't see me gesturing, but way up high window. And he had memorized the code to their safe, and he'd write down a credit card number and order stuff off of Amazon. At first, was stuff like knives, but then it was stuff like video games and stuff.
• 54:22
  And they were at their wits end with him. So they sent him to me, cause I've known that I I can well known for for dealing with complicated people. And I worked with them for a minute before I would meet him. I wanted to find out what had happened to this kid early in life. Nobody had asked them that.
• 54:39
  And please ask people about what happened to you early in life or what happened to your child early in life. I mean, sometimes they'll say nothing, but this was pretty big deal, the spinal tap thing. It turns out he was also lactose intolerant, and so any of the formulas or anything he was given, he was highly allergic to, so he also had chronic colic. So what's going on with this kid? I tested him.
• 55:00
  I do the Rorschach and the TAT, and his results were so alarming. I was shaken to my core. It was essentially the results I would get from a serial killer to be, except that he'd grown up with this really loving family. So I'm known for my authenticity, and this youngster was kinda shaky about being in therapy and begrudgingly took the test, but he gave it a good effort. And I talked with him about the results, and I said, you are the angriest kid I have ever tested, and I've probably tested thousands.
• 55:33
  And I said, I think if you'd had different parents, you'd end up a serial killer. Well, that really formed a bond between us. He said he said, I've never felt so understood before. Over the course of four years, this kid evolved into being an an active leader in his peer in his peer community. He wasn't a delinquent.
• 55:49
  He just had memories of being tortured. Granted, there were no bad guys in this picture, but nonetheless, he had memories of the body memories of being tortured, and he was darned if he was gonna have anybody in control of him. And his father had had a slightly emotionally abusive father himself, so he was prone to yelling and shaming and contempting. Once threw the kid on the floor and rolled him over like you do a dog, I think, when he was being disobedient. But essentially, no no abuse or anything like like that in this family, and he was deeply loved.
• 56:20
  But Viola was always frustrated with him until we began to understand what was really going on with this kid's insistence on being in control. So, testing for me was a way into this youngster's psyche, and I don't I don't think he really would have been willing to work with me if we hadn't had that testing experience and if I hadn't told him what I found. He felt so understood. So, although he doesn't get formally abject, he's just terrified of anybody taking control of him. People struggling with this kind of experience don't simply want to be understood.
• 56:50
  They need to be met and understood. Famous analyst named Akhtar in the nineties said, while frustration of wishes might promote growth, frustration of real need results in structural disintegration of the self. In abject enactments, both patient and therapist or husband and wife, are stirred up at the same psychic level. Both are invited to endure the terror and dread of annihilation. When our work begins to slide, that's talking about therapists, when our work begins to slide into the abyss despite our best efforts, we may fail our patients in three primary ways, dropping them, you all know that one, withdrawing from them, you know that one too, or trying to get them to stop suffering.
• 57:33
  Famous man who just died named Philip Romberg wrote a wonderful chapter. Everything he wrote is wonderful. When we offer our reality of a problem treating messes as mere potholes that the therapy must bump across, we ignore the abyss that our patients were falling into. Sarah and I had had a falling out over billing. She just got hysterically frustrated with me and it turns out I just wasn't understanding and listening to her as well as I should have.
• 57:59
  Well, I I wanna end on a really positive note. This has been a tough podcast to listen to. I understand why Emma had to listen to my talk over and over again because it's it's it's pretty dense. But what I find most helpful besides really being there emotionally is to comment on really small positive shifts that people are making. It's so easy to feel I'm not getting anywhere.
• 58:29
  I'm just trapped in this. Or as a friend of mine said, yeah, you're trapped in a tunnel. It's a long, twisty tunnel, but there's still light at the end of the tunnel. You just can't see it yet. And I think it's my job to see that there's gonna be light at the end of the end of that tunnel and to notice the really small shifts that you are making in your efforts to grow.
• 58:49
  Psychic growth occurs at a snail's pace. I don't care how evidence based treatment was their successes. You don't change this kind of stuff in two months of cognitive behavioral therapy. Psychic growth psychic growth occurs at a snail's pace. We need to envision our patients' future selves until they can actualize bits of their true destiny.
• 59:12
  We spotlight hope and perseverance. Now our patients are no longer forlorn, abject, and alone. They're part of a we that's paying attention. It's important to be part of a we. I think in forming the system speak, Emma created a we for all of us, and I wish you all the best.
• 59:30
  If you all are captivated, intrigued, interested, alarmed, or curious about all this stuff, I have a website, kathleen adams p h d dot com, and the two group articles that I wrote that I read to you a little bits of are on there. They're also coming out in a book that'll come out later this year called Attuned Treatment of Developmental Trauma in Non Abused High Functioning People Living Outside of Time. It's been an honor to be with you today. I hope I covered the right amount of material, and I wish you all the best. And I'm so proud of this work that you've accomplished, Emma.
• 1:00:04
  This is amazing.
• 1:00:05
  Speaker 2: Thank you so much.
• 1:00:17
  Speaker 1: Thank you for listening. Your support really helps us feel 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 and join us in our new online community by going to our website at www.systemspeak.org. If there's anything we've learned, it's that connection brings healing.
• 1:00:40
  We look forward to connecting with you.