Latest / The Trauma Therapist / Mark Epstein, MD. Buddhism, Psychotherapy and Trauma: from the archives

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Mark Epstein, MD. Buddhism, Psychotherapy and Trauma: from the archives · The Trauma Therapist

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Or today we even another episode from the archives with one of my incredible guests.
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Enjoy alight, guys, welcome back to the Trauma divers podcast. I
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am very excited to happen to my guests today, Doctor Mark Epstein, Mark,
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welcome, Hey, thank you nice. All right. So, doctor
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Epstein is a psychiatrist and private practice in New York City and the author of
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a number of books about the interface of Buddhism and psychotherapy, including Thoughts Without
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a Thinker of Going to Pieces without Falling Apart, The Trauma of Everyday Life,
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and his latest work, Advice Not Given, a Guide to Getting Over
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Yourself. Can you see you dis undergraduate in medical degrees from Harvard University.
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Mark, Again, it's a pleasure to have you on here. As I
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said, you know before we started recording this, You've been someone who I've
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wanted to get on here for a long time, specifically because I feel the
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work you do, uh, epitomizes what I hope This podcast is about bringing
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together um a variety of fields, but in particular Eastern Thought, Buddhism in
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particular, and trauma. But before we get going here, um, first
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share are the listeners where you're from? And where you're calling from. Sure,
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well, I'm a I'm a psychiatrist. I mostly do psychotherapy in New
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York City, Lower Manhattan. Um, right now, I'm in Woodstock,
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New York, where where we sometimes I spend time. I've written a bunch
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of books, as you mentioned. All those books, I've written one day
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a week because mostly I see patients. So when I'm when I'm in Woodstock,
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that's my writing time. So one day, what is that? Like
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a zillion pages during that one day or No, it's like one page or
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two pages over two years makes money. So I have to say the trauma
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of everyday life, this whole idea, just something about it just calls to
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me, makes a lot of sense. I want to kind of get to
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that. But would you do as a favorite kind of how did you get
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to this point? Yeah? Sure, Well I had the kind of unusual
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circumstances, and I would say lucky circumstances of being exposed to Buddhist psychology,
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learning about Buddhist philosophy, learning to meditate, all in my early twenties,
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before I knew I was going to be a therapist, and before I knew
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really very much about anything else. Somehow, I was drawn to the Buddhist
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thing, and I got as deep into it as you know someone in their
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early twenties is able to do. I met a number of American Buddhist teachers,
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Jack Hornfield and Joseph Goldstein, among them, names that would be familiar
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to people if they're at all interested in the field. I became friends with
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them, I studied with them, I did retreats with them, I traveled
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in Asia with them. And then, after a sufficient amount of time,
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I decided I would give in to all the demands of my family and go
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to medical school, take the premed courses that I hadn't taken in college,
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and applied to medical school with the idea of actually becoming a psychiatrist because that
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appealed to me as a kind of work that wasn't really work, but that
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I thought I might be good at because I like talking with people, I'm
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interested in people, I'm curious about people, and so on. So I
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did all that and trained as a psychiatrist. But my pre existing interest in
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Buddhism served as a kind of lens or filter for me. So as I
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learned about Western psychology and psychoanalytic theory and psychodynamics and trauma and everything. I
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was always looking at it through the perspective of Buddhist thought, and I started
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writing trying to figure out what I understood and what I didn't understand. Whether
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the concepts of ego and ego listeness and emptiness and attachment and desire that were
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common to both fields were the same. You know, was the ego and
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Buddhism the same as the ego and psychology or not. I didn't really know.
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I knew I needed an ego, but it was I supposed to get
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rid of it. Also, you know, those kinds of questions were preoccupying
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me. So I began to write to try to figure out what I understood
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and what I didn't understand, and that led me into writing all of those
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books that you mentioned. And at the same time, I mostly I'm a
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therapist, and I see people, you know, from various walks of life,
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a lot of creative people. I'm married to an artist, so the
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people who found me at the beginning tended to be in the creative fields.
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Um, and I've been trying to figure out how to blend what I have
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understood, or hope I've understood from the Buddhist world with what I've understood or
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hope I've understood from the psychotherapy world. So that's that's where I am okay,
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thank you for sharing that. You know. One of the things that
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kind of struck me in in in the book, specifically The Trauma of Everyday
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Life, was I mean, trauma is and I'll obviously I'll let you kind
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of explare you can say trauma is ubiquitous. Well, it is ubiquitous,
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but it's portrayed in and looked at in very different ways, and especially on
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the continuum of how what we know of trauma um and you know, coming
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to terms with that when you read your book, I think can be a
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cold bucket of ice over someone's head. How when you how did you begin
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to look at trauma in both of these worlds? Well, that book,
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The Trauma of Everyday Life started out for me. I wanted to write actually
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a psychobiography of the Buddha along the lines of Eric Ericson's famous work about Luther
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and about Gandhi. I was intrigued in my study of Buddhism. There's a
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little it's a well known fact, but no one ever did anything with it.
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That the Buddhist mother dies when he's a week old, so he's raised
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by his father and his aunt, his mother's sister. And that always intrigued
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me as a as a therapist. You know, here's this, you know,
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this figure who probably was a real person who lived, you know,
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twenty six hundred years ago, became the Buddha. His mother dies when he's
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a week old. Why why is that in the story, you know,
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in the traditional accounts, what said is that because the Buddha, when he
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was twenty nine years old, was going to renounce his background and leave home,
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that that would be too much for his mother to bear, so to
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spare her broken heart, they take her out when when the Buddha is just
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a baby, so that she can watch over him from the heaven realms,
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you know. But that that seemed plausible, but not enough of an explanation
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for my psychotherapy mind. And I began to wonder if maybe, you know,
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in our line psychodynamic language, we have this idea of of big tea
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trauma like major trauma like in war or traffic accidents or hurricanes or whatever,
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but also little tea trauma, developmental trauma, trauma that takes place when we're
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young children, either because of intrusive parenting, you know, alcoholic abusive parents,
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or depressed parents, or or else abandoning parents where nothing happens when something
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maybe should have happened. So I thought, oh, maybe the Buddha's mother
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dying when he's a week old could be like a stand in for what we
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call developmental trauma. And then I started to look at the Buddha's life history
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and his teachings where his first proclamation after his enlightenment he uses this word duca.
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You know, life is duca, which is traditionally translated as suffering.
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That there's a sense of unsatisfactoriness that permeates human life. If you take the
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word duca apart, it actually means hard to face. They have a word
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suka, which means sweet to face, which is like the pleasurable aspect of
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things. But duca means difficult to face. And I begin and to think
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that, oh, that's like trauma. They didn't have a word for trauma.
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But but trauma is what's difficult to face in all of our lives,
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namely that we're going to die, that the people we love die, that
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there's an old age, that there's illness, that there's separation from the beloved,
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that there's too much closeness with people we don't love. That those are
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all the things the Buddha itemized as duca, and that started me thinking about
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the traumatic undercurrent in everyday life. And so that's what the book turned into.
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How do you recommend or probably that's not even a good word, But
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people come into your office and they've suffered trauma. They might not even know
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they suffered trauma. This blending of Buddhist thought, Asian thought, Eastern thought
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rather and Western idea of trauma. Talk to us about that understanding where that
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lends that you through what you look at it well. The Western definition of
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trauma is basically events occur. Difficult events occur which create what we call unbearable
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affect or unbearable emotion. Affect is the word that gets used instead of feelings,
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But traumatic events evoke unbearable feelings in us as young children or as adults
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when we face the death of those around us or difficult things of all sorts.
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And the instinctive reaction to the specter of unbearable affect is to what we
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call dissociate, which means to push away the ego needs to preserve its own
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structure. So to do that, it pushes away that which threatens to overwhelment,
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which are the unbearable feelings. So there's this kind of dissociation that happens
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in trauma, which we know from discussions of post traumatic stress syndrome and so
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on PTSD veterans who come back who have pushed away their their intense traumatic experiences.
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But you can push it away, you can put it in a closet,
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you can suppress it, but it comes out. It comes out in
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dreams, it comes out in intimate relationships, it comes out when the smell
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of the air evokes the feeling that you're trying not to allow. And so
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that strategy of dissociation is imperfect. So there are levels or gradations of dissociation.
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We all used association to deal with the stresses and strains, the traumas
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of just being a person in a body, you know, trying to make
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sense of being in the world. So when people come into the office,
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I have one one ear out or one eye out, or if some feelers
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out for where those aspects that are hard to face, you know, where
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are they? How are they going to manifest? And some you know,
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not everyone has that, but most people have some some version of it,
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and in a trusting relationship, that is what we try to create in psychotherapy,
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and I think that's analogous to what we try to do in meditation.
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We try to create a trusting inner relationship. In meditation, we try to
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create a trusting interpersonal relationship in psychotherapy. In when that relationship is created,
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a relational home we call it, then those feelings naturally present themselves. So
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there's a kind of impulse towards healing, towards wholeness that we all have,
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and when it's safe enough, people will start to reveal what's actually going on
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inside of them. So when that relationship is created, you say, these
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feelings will naturally kind of evince themselves. They'll show themselves one way or another,
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maybe not literally. That that's where dreams, you know, in the
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traditional Freudians or Jungian sense are important. Sometimes sometimes they'll manifest in the way
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that people actually relate to you as a therapist, or the way they relate
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to their own minds. People may act out the feelings rather than actually be
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able to say, oh, you know, this was so upsetting to me.
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But one way or another, the feelings start to show themselves, and
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a skilled therapist or a skilled meditator can be sensitive to those feelings and make
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sense out of them. In the West, we tend to very much kind
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of qualify these traumas in a sense. I mean, trauma is bad.
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Trauma is something that's you know, quote unquote bad that's happened to us in
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a Buddhist perspective, in an Eastern religious or a psychological perspective. We'll talk
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to us about that different perspective. Is it a different perspective? Well,
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that's why I said at the beginning, trauma is ubiquitous. You know,
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we have this idea of post traumatic stress, and I like to say that
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if we're not suffering from post traumatic stress, we're suffering from pre traumatic stress,
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because it's going to happen to all of us great in one way or
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another. I really learned about trauma, you know. I didn't have any
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special training in it. I was just doing therapy with whoever came into the
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office. But a patient of mine found me. A new patient found me
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after losing her entire family in the two thousand and four tsunami. She was
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in Asia vacationing with her husband and her two young children and her parents at
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an equal resort in nature resort on an island, and the tsunami came and
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swept them all up in the waters, and everyone died but her. She
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survived by holding onto a tree branch, you know, as she got washed
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up by the waves. And somehow she met the daughter of someone I had
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treated after the World Trade Center, who said, oh, you know,
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you should maybe come and see this person, maybe he could help you.
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And she ended up in my office in Lower Manhattan, and I had no
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I didn't know how to help, other than sitting across from me. You
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know, she had two children, and my wife and I have two children,
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and I so I know what it is to have two children. And
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in the office, it didn't make that much difference if they were alive or
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dead. I still wanted to know about her children, so I started to
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ask her questions about her children and that and that was the beginning, because
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even you know, she hadn't been able to go back to her house in
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England, she hadn't been able to look at any of the photo grass.
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Just getting her to talk about her children was the beginning of allowing the unbearable
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feelings of loss to mix with her pre existing feelings of love. And over
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over many years I learned so much from her about uh, you know,
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we tend to see people like her as suffering from a kind of singularity,
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you know, like, oh, I can't there's no way I could understand
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what you're going through. You know that That's what people would always say.
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You know, there's note but it's not hard to understand even that kind of
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trauma. We all are going to face, the death of the people were
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closest to either we die or they die, you know. So it's a
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it's actually a extremely common experience. She just had it all compressed into one
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moment. So and in terms of you know, walking through that or the
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healing process, what did that look like. I mean, we can talk
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about that person that's okay, or talk more generally, but sure it looks
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the same in anytime there's a anytime there's any kind of what we call healing,
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it has to do with it not following some kind of prescribed path,
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you know, like the the ideas that we have coming out of Elizabeth coolbl
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Ross's work about death. You know that there's a progression of stages, first
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denial and then anger and then bargaining and then acceptance, you know. And
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so people are like looking at themselves like, oh, it should I should
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be at acceptance now at a year or two years or whatever. And my
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experience is that it doesn't. You know. That's a nice schema. And
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then their scheme is like that in the meditation in world for how you're supposed
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to get enlightened. You know, first you experience impermanence and then you experience
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suffering and then you're released. It doesn't the path, the maps don't do
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justice to what the actual experience is. So my experience with people who have
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suffered big traumas like we're talking about now, is that the pain doesn't go
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away, you know, the intensity of the loss doesn't go away. But
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the feelings of love, which in the initial shock people feel like they have
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to push, you know, push down because it's too scary to still be
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vulnerable in that way, those feelings start to come back. So in terms
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of acceptance, the acceptances of the entire mix of intense emotion that is part
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of the experience of love and loss, part of the experience of being human,
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and it's analogous to people who come to terms in some kind of way
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with the pain of their childhood. You know that they're able to incorporate those
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difficulties into who they have become without raging in some kind of violent way against
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the injustice that was done to them. You know, they're able to use
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the traumas of daily life as as portals or windows into something greater about themselves.
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You know what we call in Buddhism, their their true nature. Is
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that a different way of looking at the healing process. And generally speaking,
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in the Western world where we do try to like ah, push it down
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and well, and I think in the Western world we're mostly trying to get
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people better as therapists, and the general mindset is to you know, what
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does resilience mean? It means to keep going. It means, you know,
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if you've lost your husband or your wife, like what, okay,
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when are you going to find your next? One? Kind of thing.
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But I think if you read, if you read the like the really good
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therapists who are doing work around this, some of them trained in Eastern thought,
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and many of them not that they are coming from the same place.
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They understand this idea of there's no simple cure for everybody. You know,
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you have to help people find their own way. That the relational home that's
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established one way or another is critical for that kind of healing. That the
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ability to make sense out of complicated, conflicting, mixed feelings is important for
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a sense of maturity and being able to go on, you know, in
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a in a grown up way, whatever that might mean. I think you
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see these elements even without the Eastern influence. So you mentioned this idea of
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helping, How how do you define that in a sense. I mean,
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you're walking into your office and lord, you know, Laura Manhattan, you're
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sitting there, how are you defining helping? And that might that look different
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for each patient that walks into Well, it's definitely different for each patient that
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walks in, But in terms of what I'm trying to do, it's pretty
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much the same. And I like to use the language. There was a
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famous British pediatrician and psychiatrist named Donald Winnicott who started out treating children and then
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mostly in his day the forties and fifties, mothers and their children. And
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he originated the phrase the good enough mother, you know, one who's not
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too intrusive or too abandoning. We would say the good enough parent now.
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But but when Winnicott talked about what that meant, he was using parenting as
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a way of talking about therapy. Also what is a therapist doing? And
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he talked about the holding environment. You know that what a mother does for
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a baby is hold the baby in a way that's sensitive to what the baby
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is going through. So by holding, he's talking about a physical holding,
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but also an emotional or a mental holding that a parent instinctively is sensitive to
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the emotions the feelings of the infant. Even while the infant for the first
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three years or so doesn't have the cognitive or the mental capacity to say to
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themselves to understand what they're feeling, they're completely dependent on the parent to in
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a kind of mirroring way, you know, to make it okay what they're
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feeling. They're they're you know, they're hungry, and they're screaming and they
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and the parent is able to say, you know, it's it's okay,
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it's going to be okay. That kind of they communicate that. So the
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holding environment of the therapy office is very important. So I'm trying to put
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myself into that place which I also have learned from meditation, where where I'm
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not being the the aloof blank screen, you know, nineteen fifties psychoanalysts.
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I'm I'm I'm there with the person. We sit face to face, you
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know, they're not lying on a couch or anything. I'm there, but
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I'm present, but I'm hopefully not intruding too much with my own agenda,
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either trying to get them better or trying to talk about my own experience.
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You know, I'm there when I got used to talk about being used,
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that being used as a parent or as a therapist as the most fulfilling kind
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of thing. You know, we want to be used properly. So I'm
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trying to make myself available to be used in whatever way will be helpful for
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that particular person at that particular moment. And that requires a kind of improvisational
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dance, which which I find very satisfying. You know, we have a
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lot of people who are listening to this who are a therapist of various kinds
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and with various levels of experience. But for those newer clinicians, maybe they're
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just starting out, or maybe they're even in school, talk a little bit
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mark about how this this is a big question here, but what what what
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your what the arc of your presence was like from when you first started out
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and to now. I mean that's I would imagine that that might have been
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very looked very different. Um it's hard for me to say. To me,
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it looks totally the same. Um. I remember when I when I
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was first you know, I was trained coming out of medical school. So
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in medical school, you do you know, two months of surgery and three
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months of medicine and a month of dermatology, a month of psychiatry, and
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the training is all the same in most of the fields. You know.
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You you watch the doctors do whatever they do, do a procedure, uh,
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and you learn how to do it, and then they let you do
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it. You know, for the first time in in psychiatry and psychotherapy there's
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there aren't any procedures. So uh. In my first rotations as a therapist,
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at some point, they just hand you a patient and you go into
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the room and it's just you and the patient and you're the therapist, you
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know, even if you're a medical school or an intern or a resident,
25:52
a fellow whatever it is. So and they don't really give you any training
25:57
and how to be a therapist. And if you're coming up as a psychologist
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or a social worker, or if you go to a psychoanalytic institute, you
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might get more actual kind of at least theoretical training. As a medical doctor,
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you get hardly any. A little bit, but hardly any. So
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that no one was there watching me with my patients, and I didn't really
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know what to do. I had two things to draw on. One my
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meditation experience, which was already very well established, so I knew how to
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be in relationship to my own mind. And I figured, oh, well,
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if I can pay attention to this person's mind the way I've learned to
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pay attention to my mind, maybe that will be quote unquote therapeutic. And
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I had been in therapy already, so I did have the experience of being
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the patient. And I had been in therapy with a gestalt therapist who was
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very present with me. You know. Gestalt therapy uses the intricacies of the
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present moment to try to look at what's the person avoiding or how is the
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person avoiding being present with me the therapist. So I had those two things
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to draw on, and I basically had to learn how to deploy those techniques,
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you know, and I'm still learning how to it's the same process.
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So I was always more comfortable as the therapist than I was as as a
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person, uh in the real world. So when you say, when you
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first started out, Mark, why did you want to get into therapy or
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why did you want to become a therapist? Right? I want to become
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a Yeah. As I think I mentioned at the beginning, it seemed like
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work that wasn't really work. Um, so I was looking I was looking
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for something I could do, you know what going to be. I wasn't
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going to be good at at surgery or at making things, you know,
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whatever talents I might have had a lee and they in the interpersonal and in
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terms of your your idea of helping you. I want to get into this
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fuel. Yeah, what what was that? I mean? I guess I'm
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curious about how that might be different from from now because a lot of times
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people get into the field because they want to help, they want to fix,
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right, they want to I think it was a little different for me.
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I grew up in an academic family and my father was a professor of
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medicine. He was at first at Yale and then he was at Harvard his
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whole life. He loved being a doctor, a researcher. Um. He
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there was. I had a lot of pressure and subtle but real pressure from
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him to follow in his footsteps. Uh. He was a kidney doctor.
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He would always draw like pictures of the kidney for me and my mom.
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I would associate that was roma. I could never understand the kidney, you
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know. Um. But so when I when I found Buddhism and meditation,
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it was like, oh, this is mine, you know um And and
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I real something in me really relaxed, and that let me then instead of
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resenting uh, my father's input, it softened me around that and I realized,
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oh, this is sort of what I have been bred to do.
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You know, I knew how I wasn't intimidated by professors of medicine at Harvard
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Medical School. You know. I knew and somehow I was good at the
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uh you know, the math and the chemistry and whatnot. And I knew
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how. I knew I could get in. I knew how to play that
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game. Um and Uh, I think becoming a psychiatrist was as far away
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as I could get. You know, while still being within the field,
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and and that worked for me. That was like, I don't know what
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what I Without that pressure and help from my father, I probably would have
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gone, you know, and some other maybe I would have been an academic
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Buddhist professor or something. When I first got to medical school, I thought
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this is horrible, you know, like you just have to memorize all this
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endless material and regurgitate it. And I started having trouble sleeping, and I
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tried to drop out. I went to the Simmons School of Social Work and
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talk to the admissions people there and said, you know, I just want
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to be a therapist. I'm interested in Buddhism. I want to try to
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bring Buddhism into the world of therapy. I don't need this. I don't
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want to go this whole medical route. And they looked at me like I
30:44
was crazy, you know, like you're going to drop out of Harvard Medical
30:47
School to come to our social work school. And my father had me go
30:52
around and talk to a couple of well known psychiatrists who were very time to
31:00
me and reinforce this idea that turned out to be true, that I would
31:06
have a lot more autonomy to do the kind of work I already knew I
31:10
kind of wanted to do, bringing the Buddhist you know, translating Buddhism into
31:15
psychological language, that I'd have a lot more autonomy if I completed the path,
31:21
you know, and put my time in. So I listened to them,
31:22
and they were right. I just want to remind everyone that I was
31:26
speaking with doctor Mark Epstein. His website is Mark Epstein MD dot com.
31:32
I'll have everything linked up here at show notes page um Traumapist podcast dot com.
31:37
So, Marks, as we kind of closed down here, what would
31:40
you say to uh, you know, those younger therapists listening, those people
31:45
just starting out in terms of learning about trauma, even learning how to sit
31:53
with trauma. When someone's patient, a client is sitting across from you,
31:59
what would you say to them? I could talk about it in a couple
32:02
of different ways. You know, if you're if you're drawn at all to
32:07
the world of Buddhist thought, if you're interested in meditation and mindfulness, etc.
32:14
Then or even in the practice of yoga physical yoga, then learn about
32:19
that for yourself. Because what they're trying to teach you about how to relate
32:24
to your own mind is going to help you in relating to other people's minds.
32:30
So first work on yourself. That's that that I think is almost goes
32:36
without saying it's not It's not right for everyone. But if you feel it
32:40
inside of you as something you're drawn to, then let yourself pursue it and
32:45
learn about it, not by surrendering to some teacher, some guru. You
32:50
don't have to swallow everything, but take what seems good for you and use
32:54
it for yourself. M Secondly, I think there's a lot there's very evolved
33:00
conversation happening now in the psychotherapy world about trauma and about what does it mean
33:07
to be a therapist, And I would say, don't neglect the psychoanalytic world.
33:15
I'm not a psychoanalyst, but I've learned so much from the world of
33:21
psychoanalysis. And there's a real tendency now that mindfulness has come in and dialectical
33:27
behavioral therapy and cognitive therapy, you know, or really on the upswing.
33:31
And people got disillusioned with psychoanalysis and it's often not even taught anymore. But
33:39
I would say there's so much to be learned, so much that people understood
33:45
about the complexities of the therapist client relationship. That's so helpful. And you
33:53
know, there's a psychoanalyst named Robert Stolero Stolo r Ow who has a beautiful
34:00
little book about trauma that I reference in my trauma book Trauma and Human Trauma
34:08
and Human something. It's called That's just It's a tiny little book. It's
34:14
excellent. There's a compilation of Winnicott's writings for lay people, you know,
34:22
talks he gave to like breastfeeding leagues, and radio talks called Babies and Their
34:28
Mothers by Winnicott that I look at all the time. There's a little biography
34:32
of Winnicott by Adam Phillips. Adam Phillips is a wonderful writer. His most
34:37
famous book is on Kissing, Tickling, and Being Bored. But he has
34:42
a little biography of Winnicott. That was the first thing I ever read about
34:45
Winnicott. There's a book by Michael eigen eig And called The Psychoanalytic Mystic,
34:53
which a lot of people don't know about, but is a beautiful description of
34:59
what it means to try to use these ideas and psychotherapy, drawing on Lacan
35:04
and Winnicott and beyond. So those are some places that people could start.
35:09
Awesome, awesome all how those linked up, Mark, who was a honor
35:14
having you on here. I'm thrilled and I'm really excited to get this out
35:17
to water my audience. Want to thank you so much for joining me today.
35:22
Pleasure all right, take care of thanks. Bye,