Latest / System Speak: Complex Trauma and Dissociation / Guest: Frank Putnam

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Guest: Frank Putnam · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over:
• 0:11
  Speaker 2: Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to longtime listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 0:58
  Speaker 3: Our guest today is Doctor. Frank Putnam, a professor of clinical psychiatry at the University of North Carolina School of Medicine. When Doctor. Putnam studied patients with MPD at the National Institute of Mental Health Intramural Research Program in Bethesda, Maryland, he noticed large numbers of his patients had been abused as children. This led him to complete a fellowship in child and adolescent psychiatry and to focus his research on the psychological, biological, and social effects of child abuse.
• 1:32
  He co founded the thirty five year longitudinal female growth and development study still ongoing to assess the consequences of childhood sexual abuse on female development. In his new book, Old Before Their Time, Doctor. Putnam gathers FGDS findings for the first time in a narrative accessible to survivors, parents, therapists, medical practitioners, first responders, community leaders, and policymakers. We are so excited to have Doctor. Putnam with us today.
• 2:04
  And in addition to this bio, I would say, and you will hear at the very end of the episode, Doctor. Putnam also helped start ISSTD. Welcome Doctor. Frank Putnam. Hello.
• 2:20
  Okay.
• 2:21
  Speaker 1: Hi. Frank Putnam here.
• 2:22
  Speaker 3: That is enough of an introduction. I am so excited to talk with you. I have met with you a little bit working in the ISSTD office also with Bethany and Mary Pat. And so I am just glad to get to talk about your work today.
• 2:38
  Speaker 1: Oh, thank you. Thank you. I'm actually in a lot of contact with Bethany in particular.
• 2:43
  Speaker 3: I love her so much. She's been very kind to me.
• 2:46
  Speaker 1: She is great. You know? It's quite a story that she has.
• 2:51
  Speaker 3: A safe person in the world I'm grateful for. Okay. Where do you wanna start? Usually we just keep this very conversational. I want to get to your book, of course, but that has so much history in it, too.
• 3:04
  I was just talking about it the other day. Let's start the usual question we have is, in the beginning, how did you even begin to learn about trauma and dissociation?
• 3:15
  Speaker 1: Okay, well, I mean, I'm going go way back. I did it when I was doing my psychiatry residency at Yale, I spent a lot of time at the VA system. This was in the about 1975, and then we were just seeing a lot of Vietnam veterans coming back from Vietnam. And at that time, the diagnosis of PTSD didn't exist. It didn't actually become a diagnosis officially until 1980.
• 3:45
  And, of course, it took another decade at least before it was accepted by much of mainstream psychiatry and psychology. But I got I really saw a lot of trauma there, and it was not something that I was particularly going to study, but it certainly opened my eyes to the effects of trauma. I was interested in rapid cycling bipolar patients, people who went back and forth between mania and depression, and particularly understanding what that mechanism was that could really almost in the blink of an eye change somebody from depressed state to a manic state or vice versa. And, so I went to the National Institutes of Mental Health where I was doing a fellowship in clinical psychiatry research on a ward that specialized in rapid cycling bipolar disorder. And there I sort of knowingly met my first case of DID.
• 4:46
  You know? In retrospect, I had seen other cases also. I just didn't understand what I was seeing. I sort of thought it was a seizure disorder that that the people of the rapid changes I was seeing were were some sort of temporal lobe seizure or something. But I saw my first case.
• 5:04
  Very shortly thereafter, I saw another case. Very shortly after that, I saw a third case. I said, this is incredible. I need to really begin to study this else's. So I began working with adult cases.
• 5:19
  And, often with the help of other people, we'd bring in three, four, DID patients and their therapists for about a week, and we would go through a whole battery of tests. They were psychophysiological tests, some brainwave tests, some cognitive tests, etcetera. And in the downtime, I spent a lot of time talking to the multiples there and learning sort of about their lives and and what had and they all told me they had been multiples since they were children and and really always as far as they were aware. And, so I thought, well, if that's really true, I should be able to find v I d cases. So I'm I created a profile and used, really worked with a number of the subjects in our studies.
• 6:12
  We got, their report cards so that I could read the teacher's notes. In some couple of cases, I got, social work notes or foster care notes, from them. Sometimes we would get, school records and pediatrician records and put together a profile, and that profile ultimately turned into a dissociative the child dissociative checklist and the adolescent dissociative experiences scale, which is where a lot of the items came from. And I circulated these checklists to therapists working with children to there was a child, hospital, child psychiatric hospital. I circulated the foster care at an adoptive, parent organizations saying I was looking for children who displayed these, behavioral problems, particularly we were looking for, but really along the line of dissociation.
• 7:16
  I didn't think I'd seen many cases, but actually I had a large number of children come in. I spent a fair amount of time with them, many of them I saw multiple times over the years, and really appreciated that how much this had impacted their lives. And not only was I behavioral problems, but I felt I was seeing biological dysregulation. And that made me convinced that you couldn't study this sort of backward retrospectively, a kind of reverse engineering, working with adults and figuring out how it happened had to be studied in a prospective forward longitudinal way. I was fortunate to connect with a developmental psychologist named Penny Trickett.
• 8:01
  Unfortunately, Penny died about ten years ago. But we together worked out a lot designed for a longitudinal study to look at the impact of sexual abuse, particularly what would we call incest by family members, forward in time with a cohort of sexually abused girls. They were ages six to 15 when they came into our study. We followed them for more than thirty five years at this point in time. Now they're in their 40.
• 8:35
  He's in fifties, early fifties, middle fifties. At this time, we saw them eight times for a fairly intensive evaluation. So typically, two visits for each time came back, one for psychological testing and histories and one for biological studies, including getting hormone levels, looking at heart rates and and a variety of brain waves and and a variety of other things like that. And so that became known as the female growth and development study. And we had a matched group of comparison girls who were matched on socioeconomic status and race and ethnicity and when they came from one or two parent family homes.
• 9:24
  And we followed both groups for a time. There was roughly a 100 in each group. There were times when we had over the years a number of additional people. So, ultimately, we had about a 120 of a 130 sexually abused girls in this. And so we watched them grow At time six, we saw their children of of the original girls.
• 9:51
  And then at from times one through three, we most of them were minors, and so then we had their mothers come in generally or caretaker come in. And so we we took histories of the caretakers or mothers, particularly mostly non abusing mothers, also completed forms about their lives and their childhoods and and their histories of abuse. So we had data on three generations. We really felt that the book was necessary to pull it all together because of the papers are scattered over literally thirty five years. They're published in journals that range from child developmental journals to gerontology journals.
• 10:34
  And and you would have to spend a lot of work to sort of pull it all together. So the intention of the book is to pull it all together and and talk about the lessons learned over thirty five years and and how these experiences have impact printed themselves biologically, biologically, embedded themselves biologically, how they're expressed over time in somebody's lifespan, but also how they're expressed across generations.
• 11:02
  Speaker 3: So not just taking some populations that have been studied, like the Holocaust population or these, the intergenerational, but literally looking at the children and then their mothers because they were available and able to participate, and then later their children giving this generational study in real time.
• 11:27
  Speaker 1: Yes, yes.
• 11:28
  Speaker 3: Wow. Going
• 11:29
  Speaker 1: forward, and we had a cross section. So when I say six to 15, we were interested in spanning puberty and then following that cross section forward in time. And so if we we could look at if we were interested, say, in age 12, 13, which is a very critical time off in in development for females, that this was we would have 12 and 13 year olds who came in, but also children who turned 12 or 13 during over the course of the study. So we would have a larger pool of thirteen twelve, 13 year olds, which gave us more statistical power as as we did that kind of thing. So we it's called a cross sequential design.
• 12:14
  And so it it tells you not only something that's correlated, but what came first, what followed. So you get a better sense of what's causality. And that was very important because over time, we really saw how something like changes in stress hormone was connected to changes in in body, exchanges in in menarche, and changes in, ultimately aging. So so we really saw connections that you wouldn't see if you just looked one time or if you looked retrospectively.
• 12:49
  Speaker 3: And and just restating that to make sure it's really clear, even for listeners who are not clinicians, rather than looking at this moment in time and the outcomes because of that moment of time, it really shows us also the effects that continue to unfold over time.
• 13:07
  Speaker 1: -: That's correct. That's exactly right. And that's very important because this isn't static. It's a dynamic process, and it plays itself out over time. And that's very important, I think, both for treatment, but also for prevention.
• 13:24
  And that over time also includes transmission across generations, transmission of risk across generations.
• 13:32
  Speaker 3: There's so much in there even, not just about intervention but also prevention. But I have so many developmental consequence questions too. Where do you want to go with all this?
• 13:44
  Speaker 1: Well, let's start with your questions.
• 13:46
  Speaker 3: So, okay, so if we're taking some of these layers, like emotional development and self organization just because dissociation for the context of the podcast, one of the things that I'm understanding is that it looks at shame and disgust and emotional expression with the findings from those interviews and the facial affect coding, with the diff like, it's it's just so it's so much what you've done with the difference between those who disclosed and those who didn't. And there's this piece about those who did not disclose showing more shame and, what we might call masking, like false social smiling, but those who disclosed showing more disgust and more internal organizations differently. How do you wanna talk about that piece?
• 14:47
  Speaker 1: Well, we're we're very interested in in what things may make things better or worse in in terms of what should we be, for example, aiming at in therapy. Should we be talking about these things? How do we handle these things in therapy? So we're very interested in what the girls said about their own experiences. And so we asked them to talk about in one of the the many kind of behavioral scenarios that they were in, we asked them to talk about the most traumatic events in their lives, and that was self selected.
• 15:22
  We didn't say talk about this, talk about that. We just said think about sort of the worst thing and talk about that. And and a fair percentage of the abused girls talked about the sexual abuse, but others did not. And all the time we were videotaping them, and there's a system for coding facial emotions called the Eckman system. I think called the facial action something or other system, but everybody calls it the Eckman system, based after Paul Eckman, who was famous for looking at particularly what they call microexpressions So we could stop the tape and and and catch these discussions the expressions of disgust or or fear or shame or or whatever.
• 16:09
  And we did see this real difference in those who talked about their maltreatment as the worst experience and those who talked about other experiences and didn't reveal their their maltreatment or didn't follow their maltreatment. I think that's important because we have other data that says it is important to talk about what happened and put words on things and to and we've found that that's particularly important in prevention, that when we look across generations that that mothers particularly who are able to acknowledge their own history and their own abuse and say, I don't want anything like that to happen to my children. They're much more protective and vigilant, and their children have less experiences of maltreatment than somebody who doesn't talk about it or, you know, does it's not brought up because it's considered shameful or or disgusting or something like that. So we were just that's one example of that. We also saw that reflected in their heart rates, and in particular things like vagal tone changes.
• 17:21
  So it's talking about it or not talking about it is not only sort of emotionally important, but it turns out actually they have physiological consequences that we can pick up in when people are talking about it. As you know, these are very emotional things to talk about.
• 17:39
  Speaker 3: The other thing that it really shows is the impact on physiological development with earlier puberty in abused girls, the dysregulation of cortisol and stress hormones, and that being such a particularly vulnerable window? What what has come out of that? I mean, I know that's like the whole book in some ways, but
• 18:04
  Speaker 1: I don't know. The it is it's it's very important. We were interested in a couple of questions there. What happened to the stress response systems in them? But also both Penny and I felt we were seeing evidence of accelerated aging in them.
• 18:23
  And, you know, if you look into our everyday language, there's a kind of things that, you know, they've seen such things that they grew up too fast. Makes you old before your time. These experiences give you gray hair. Those sorts of comments are in our language in a way, and and we felt we were seeing evidence of acceleration in behavior and in biology. And so we were interested in systems that had trajectories, meaning that they showed a growth trajectory.
• 18:55
  So once puberty, you start, you know, prepubertal and you end up with menarche and and puberty. And so that's actually a series of stages that you can measure, both with hormones and with physical changes and secondary sex characteristics. We were interested in cognitive development because that also shows a curve where you have a kind of a peaking of your IQ and it actually starts to decline. We were interested in autoimmune processes because they also antinuclear antibodies and evidence of autoimmune disorders accumulate over time. We were interested in physical development, so we looked at body mass index, for example.
• 19:41
  So we looked at a number of of processes that we could follow essentially a developmental curve in. And we were seeing in these processes evidence of accelerated aging relative to our comparison girls. So example, in the puberty case where we were measuring Tanner stages, which is a sexual maturity measure, we were able to show that the sexually abused girls were about a year ahead of the comparison girls. And that's after you control for poverty and and race and a number of other things that affect maturation. That's not a good thing for girls that early developers, in fact, are at much higher risk for using alcohol, drugs, for having earlier consensual intercourse for teenage much earlier teenage pregnancies.
• 20:44
  A lot of social things are a consequence of of early maturation kind of things. So we were following these. Now what's come to us over time is the DNA technology. We didn't have that when we started back in 1987. And what's we now can measure actual aging in the impact on the DNA through a and there are a number of processes we can look at which are sort of fall under the label of epigenetics.
• 21:20
  And one of the epigenetic processes we look at is called methylation, and that is a, the attachment of methyl groups to certain areas on the DNA, changes the expression of the DNA. It doesn't change the coding of the genes, but it changes whether those genes are turned on or off. And we can compare that methylation with sort of chronological methylation. And what we could see, excuse me, again, is that the maltusidrosis are have accelerated aging to actual physical aging by by considerable it depends on the organ systems you're looking at because your organs age at different rates. So your heart ages at a different rate than your brain, and individuals vary in that.
• 22:12
  But what we saw across the board was evidence biological evidence in the DNA of accelerated biological aging.
• 22:23
  Speaker 3: It's so much that is showed and so much put together. It really is so epic. That's stress biology sharing common developmental roots, even with mental health, as well as those physical pieces you just spoke of. So like the increased rates and earlier onset of things like depression, anxiety, PTSD, dissociation, also that being chronic or chronicity instead of just episodic illness, but then dissociation becoming that psycho biological adaption. And then that also linking even with substance use and risk behaviors, which maybe is a different thing, but what would you say about the mental health pieces?
• 23:12
  Speaker 1: Well, I'd say it's pretty much all part of the same thing. It's the dissociation in particular, and we measured it at every point. And you could use the first values that we measured when the kids came into the study, and that was predictive of all sorts of negative outcomes years and years later. It it really has a very powerful impact on on child development, and particularly was also very predictive of who was gonna get secondary secondary kinds kinds of of traumatization, traumatization, who who was was gonna gonna be be revictimized, revictimized, who who was was gonna be, victims of rape, who's gonna experience more domestic violence, etcetera. So it set people up for additional cumulative trauma, and trauma is cumulative.
• 24:04
  There's no no question about that. We also saw I'm so sorry about my throat. It's just really a few a couple of podcasts too many. We also saw things like changes in the stress hormone and how initially our maltreated girls were had higher levels of cortisol than our comparison girls. And high levels of cortisol are associated with a number of sort of damaging things, particularly to the the brain.
• 24:39
  And how over time around age 18, they changed and they now had lower levels than the abused or the comparison girls. The abused girls had lower levels than the comparison girls. And that switch turned out to be very predictive of changes in metabolism that affected weight gain and changes in the body. And then that also turned out to be very predictive of the accelerated aging. So we were seeing, for example, this change in the stress hormone responses from higher to lower in the maltreated girls ended up predicting changes in their gaining weight and and more likely to increase obesity.
• 25:30
  And then that down the line is associated with accelerated aging biologically in terms of the epigenetic genome. So we were really seeing this play out in in how one system that's been disturbed or dysregulated echoes itself through growth and development.
• 25:51
  Speaker 3: So then that playing into what so many survivors report of having in common this lived experience of having cardiovascular disease, autoimmune disorders, inflammatory stuff, chronic pain, that all becoming part of literal medical morbidity.
• 26:12
  Speaker 1: That's right. And I think this is really important that this is a validation of what they have been experiencing for years and years and years. I mean, if you've been involved either as a clinician or as a as a survivor, you know about this, for example, increased autoimmune process. And you see this also play out in other things like depression, anxiety, but particularly in biological phenomena like the autoimmune issues. And, so it's it's really, I think, validating that what people have been saying happened to their body really has happened to their body.
• 26:59
  I mean, I found that when I talk about this in public, I'm often surrounded by women who say, you know, you've really validated for me what I've always believed that this changed my body. Now I can't, obviously, on a one to one basis support that, but I can say, in general, we're clearly finding evidence that this is biologically altering experiences and development, that these are biological systems coming online in young children. They're distorted, disturbed, dysregulated by the trauma, and that has all sorts of consequences as that child grows up and becomes an adult.
• 27:39
  Speaker 3: The accelerated biological aging then, what, again, just making sure that people who are not clinicians are hearing, It's not just that trauma is a developmental injury, which is great that we understand that, but we're also now understanding with these studies over almost four decades that it's literally compressing the life course with allostatic load cellular and hormonal aging markers, which even my own doctor from lived experience, my own doctor has talked about with autoimmune stuff and these cellular and hormonal aging markers, he's like, We need to be careful with you because And this weathering of the stress system that's happening, literally, that's where we get back to the title with old before their time.
• 28:33
  Speaker 1: That's correct. That's that's absolutely correct. And that that and that's why I think one of the major lessons that has to be taken from this study, and it's there in other data too. We're not saying that we're the only ones who found this by any means. It's really a history of the study in which we did find this, but other people have found this in in their own ways, in different ways, and we're beginning, I think, as a medical and and psychologically approve Appreciate the fact that this is really altering and aging.
• 29:06
  And one of the reasons what we see is that there's a higher mortality rate for people who've had these experiences and the the adverse childhood experiences studies, which I'm sure you're familiar with, the ACE studies, have shown, for example, that there's a higher much higher rate of pre premature mortality in individuals who have, six or more ages. For example, their lifespans are about twenty years shorter on average. They're more than twice as likely to die before age 66. So that we really have evidence that these things are life altering in many, many ways, including, unfortunately, associated with premature mortality.
• 29:54
  Speaker 3: I so appreciate this coming into the broader conversation because we hear things like we might go to an annual checkup or those of us with an autoimmune something or I haven't had a heart attack yet or a stroke yet or this or that. So to try to explain to someone why my doctor is saying that my life is literally in danger, or that more trauma is making that worse, like why it is so important to care for myself and to find as much safety, create as much safety as possible, that that's not just a mental thing, but literally is a physical thing. When we're working with our clients who are reporting physical symptoms or autoimmune stuff or even somatic stuff of why caring for their body is so important, not just to embody in a healing theoretical kind of way, but in this very literal way. How would you explain that piece to other clinicians?
• 30:55
  Speaker 1: Well, that's what we're trying to do. You know? I mean, I think you stated it exactly right. That's one of the big problems I think that survivors have is trying to explain that this has embedded its the trauma has embedded itself in the their biology and is, in this case, prematurely aging them, and it puts them at risk for things like heart disease, stroke, probably dementia, probably cancers, and certainly autoimmune diseases. That this is something that they should be alert to and the clinicians should be alert to very much.
• 31:35
  It's, you know, that's the big question. How you bring something like this knowledge into practice. And and the history of that is one that it does happen. We certainly, medical practice is influenced by these kinds of discoveries, but it's sadly very slow process. I sort of see kind of a stage integration of this knowledge.
• 32:01
  The first sort of stage has to do with just really this validation piece that this is a real deal. It is a risk factor for going forward in the future that that that this trauma has embedded itself. It may give us a chance to identify people at risk for developing all sorts of problems down the line. I think sort of the medium way area, maybe three years out or more, we hopefully will have actually biomarkers of the amount of trauma looking at particularly this genetic methylation and perhaps other measures of epigenetic changes that we may actually be able to recognize people who have been traumatized to the point where their their systems are really, disordered, dysregulated. We were able to pick up the dysregulation because we followed them over time.
• 33:02
  But if you walk in and and just at one point in time when they draw your blood, they can't necessarily know what's happening other than what the values are at that moment. But if you look now at the DNA epigenetics, you may well be able to see that this person has been seriously traumatized. So we I think in the medium length, I sort of, say, three years out, we might have some pretty good biomarkers of, the amounts of trauma. And then really what needs to happen is we need to be replicating these data. I mean, we're one study.
• 33:39
  We produced it after this labor of thirty five, forty years, and we need other studies to come and replicate it because our findings don't become established fact until they're independently replicated by others. That's gonna be a challenge. But with these epigenetic markers, at least we have a chance of we don't necessarily have to follow the cortisol metabolism. We can look at some of these biomarkers and follow those. There are already one study showing that if an adult walks into an emergency room after a traumatic experience, say, an automobile accident, and you draw their blood and look at, are they having accelerated aging as measured by the epigenetics?
• 34:28
  That's a pretty good predictor whether that person is gonna develop PTSD from that accident. So while we're having the potential to actually develop predictors using these epigenetic markers.
• 34:42
  Speaker 3: It becomes so practical so quickly, even with the little information we have already. The difference between when I first got cancer and it was like, Oh, we see this, Something is wrong. We have to do surgery right now. Let's get it all out. And the difference between that and now when they say, These levels are looking like this.
• 35:05
  This is what that means. It's not happening right now, but it's ready to happen. The conditions for it to happen. It feels to me like the ecology inside my body reflects the ecology of the weather. Like the different I'm from Oklahoma, so the difference between a tornado warning and a tornado watch and clear skies, they can see that now.
• 35:29
  My doctors, if you have good doctors who know what they're looking for, even though some of these more predictors that we're still wanting to develop, or research that's still down the line a little bit, some of this, it's already like that, where we're on tornado watch or this is tornado warning, but it's in my body. Yes.
• 35:48
  Speaker 1: And and, I mean, this is what has to happen much more broadly in in medicine is the people becoming alert to these markers. And I think by giving them, epigenetic markers that are relatively easily obtained, it will be much easier to establish the amount of trauma and the risk that that certain people have as a result of these experiences. So I think I think that may really help in the acceptance of of trauma as a biologically impactful experience in that sense over time. And I expect that, you know, I say three years away, something like that.
• 36:33
  Speaker 3: Wow. That that really brings us to the other piece of your book that is about sort of the public health version with the politics and systems and institutional denial, the political hostility, obviously funding is always an issue. Professionals, we've already talked about how willing people are to look at this or talk about this. What does your book say about these pieces?
• 37:02
  Speaker 1: Oh, boy. A lot to learn, a long way to go, and there's pushback. Some of it is just ignorant, and some of it, I think, is malicious. Sort of if you haven't been there and been a survivor talking trying to tell people about your story or you haven't been somebody trying to study this or whatever, you you don't appreciate how much pushback there is. But I think even right now with when you look at something like the Epstein files, there's just a massive pushback against acknowledging what what's going on.
• 37:41
  And, certainly, that's happened politically. There are a lot of people fighting to bring out the truth and and to improve justice for victims and prevention. And I think there are real possibilities for much broader, bigger prevention programs ultimately in the future. We have a couple of good models that need to be deployed on scale. The problem is there really isn't any prevention programs on scale.
• 38:14
  The best are a county or two at this point in time. They've been shown to work at a population level, which is important when you're doing prevention. But we haven't, you know, done state, for example, state at level, much less regional or national. The the knowledge is there. It's just not being used or funded by many of the powers that be.
• 38:40
  And so advocacy is very, very important at this time. But the fact that we have better tools to demonstrate the impact, I think, will help with the advocacy.
• 38:51
  Speaker 3: What else do clinicians need to know about the book?
• 38:57
  Speaker 1: Well, well, I but do they know I mean, I think one one one of the things I tried to build into the book was a better understanding of the child protection sort of system that how that really works. Because I I know from experience that many or how it really works. And that's not a surprise given that if you don't interact with it, you really don't have much experience with it. And even if you do interact with it, generally, clinicians only have a small part of that mostly mandated reporting. But it's a very complicated system.
• 39:40
  I tried to give a sense about what the people are who work there, what the caseworkers are, what the roles of the police are, what the roles of the social workers are, what the roles of the doctors are, the prosecutors. So people had a better sense of the system. And then I talk about things that we know make the system better, like child advocacy centers, which are extremely important ways of of helping decrease the stress of for families and children where there's allegations of sexual abuse. And also differential response is another one where there are families that don't need intensive investigations but need immediate care, and that's can be done with differential response. A lot of times, so the system is locked into mandated investigations or you need to take ninety days to do this.
• 40:38
  Well, not you know, that's not the best way to do things. I also hope it helps with foster care system. A lot of the children that I saw were in the foster care system, and I saw a lot of foster care parents, very, very wonderful individuals trying to help these children, really struggling with the behavior and with the precocious biology in a sense that was getting these kids into trouble. Probably the most common reason for the kids being kicked out of a foster care placement was hypersexuality, not aggression. Most people aggression is sort of number two, but it was really the hypersexuality, particularly if there were other kids in the system.
• 41:26
  And and so I'm trying to help understand that process as well as the dissociation and the very rapid changes in these children and how difficult it is to to help them really deal with the all the different things that are going on in their lives, and they're often bombarded with flashbacks and reminders and feeling unsafe and those sorts of processes.
• 41:57
  Speaker 3: What about the folks who are listening who are not clinicians? What would you add for them to understand?
• 42:07
  Speaker 1: Well, again, I go back to the validation piece of it, that if you've experienced this and you feel like this really did change me in some very profound way. And this is this is validation. And I've experienced that validation is a very important part of really the whole healing process that that people recognize that this really was true. It's not all in your head. It really is in your body, and it did affect how you grew up and how you think about things and and to some extent how well you can manage out there as a result of the experiences and the dissociation.
• 42:51
  Speaker 3: I think it's really one of the most important things that comes out of the book is that honoring of what is already known to us and experienced, and that that comes out of those self selected responses in the original studies because that was lived experience speaking when it wasn't always an option in research back then or even considered necessarily. But the way that it was people were self selecting what they shared really means the study was based so much in lived experience. So coming full circle to also feel how the results of it really affirm what experiences are is so, so important, and I'm so grateful. Thank you.
• 43:38
  Speaker 1: Thank you. I mean, I really, the book is dedicated to the subjects and to the students and and staff and the scientists who made this possible. I mean, it was a real real effort. It we struggled to find money to keep something like this going for really close to forty years. Not not an easy thing to do.
• 44:01
  We were very lucky and fortunate our subjects stayed with us even when we weren't in a position, for example, to pay their travel or to pay to to compensate them for their time. They continued coming. They cooperated with us. I mean, we all shared sort of in that experience of the people doing the work and and the subjects. It was a very strong sort of sense of identity with this study that you were part of something important.
• 44:32
  Speaker 3: Thank you so much. Was there anything else you wanted to share today that we did not get to cover?
• 44:38
  Speaker 1: Yes. I think one of the questions that often gets asked to me about the sooner generational piece is if I was abused as a child, does it mean that my children are gonna be abused? That that's a a concern that I encounter continuously when I'm talking to survivors. And then the answer is no. I mean, you that's not inevitable by any means.
• 45:04
  What we see in in terms of not just our study, but looking across all the studies I could find that looked at intergenerational transmission, and that is really in since my current research interest is understanding the what goes into the transmission of risk across generations was about seventy percent of of children who were maltreated as children and then grew up to become parents do not stress, do not become maltreaters, do not abuse their kids. Of the thirty percent who do, and mostly I could speak primarily about the women, the mothers, well, most of the time, often, they're not the primarily abusers that say they have associated with people who are abusive towards their children sort sorts of things. So we're looking more at this idea of what is associated with the intergenerational transmission of maltreatment. And it I certainly want people to understand it is not inevitable that if you were maltreated that you maltreat your children. That that does happen about 30% of the time, but more than three quarters of the time or 70% plus of the time, it's it does not happen.
• 46:27
  And so that's really an important thing, and I think because I know a lot of parents really worry about how these experiences have affected their parenting. And they do. I mean, it's not just whether your child is maltreated, but due to depression, sometimes the substance abuse, the PTSD. That all does impact on on child your children as they see their parents go through that.
• 46:53
  Speaker 3: I think that that is a huge piece. I also hear a lot, or get a lot of questions about, really also indicative of how important our healing becomes, not just for caring for our bodies or preventing that from continuing to the next generation in those ways, but so that it's not coming out sideways with that reenactment or abandoning ourselves or being complicit because being abused is a baseline, that sometimes having to choose safety for ourselves and our families really is so, so important and part of the healing in a pragmatic and very real way. Yes. You shared at the beginning of our conversation some of the history about how you started learning about trauma and dissociation. I'm so curious why you're with us, how you got connected to ISSTD.
• 47:49
  Speaker 1: I was part of the group that founded ISSTD. That that that there's a famous mama Leone's dinner where there were two groups who were wanting to found it. We sort of threw our lot in together and found an ISSTD at at that point in time. And so that's how ISSTD, at least was the beginning, was the the sort of two groups coming together, having this dinner at Mamma Leone's in Chicago and saying, let's all put her work together and I'll create ISHSDD. It's been, I don't know, what is it, twenty five years, fifty years.
• 48:32
  It's been a long time.
• 48:35
  Speaker 3: I wanted to make sure that part of the story got told as well, that dinner. Thank you for sharing it. Oh, you're welcome. Oh, my goodness. Anything else that we need to cover before we let you go?
• 48:50
  Speaker 1: No. I think we've covered a lot. Appreciate that. I'm hoping that, you know, that I'm using the book as a soapbox to talk about these problems. And and also to lobby for better resources for trauma victims, but focusing a lot on on what's available for children and how do we make this whole system better for families.
• 49:16
  Speaker 3: This work that you have done for all of these decades is not just responding to trauma, it is lifesaving for those who have been traumatized. And I am so grateful and just wanna thank you.
• 49:29
  Speaker 1: Thank you. I you know, I for me, it's the right thing to do.
• 49:34
  Speaker 3: Thank you so much for being with us today. I really appreciate it.
• 49:39
  Speaker 1: Well, thank you for having me. I really appreciate it.
• 49:42
  Speaker 3: Thank you. Bye.
• 49:44
  Speaker 1: Bye bye.
• 50:08
  Speaker 2: Thank you so much for listening to us and for all of your support for the podcast, our books, and them being donated to survivors and the community. It means so much to us as we try to create something that's never been done before, not like this. Connection brings healing.