Latest / System Speak: Complex Trauma and Dissociation / Guest: Eli Somer

Transcript

Guest: Eli Somer · System Speak: Complex Trauma and Dissociation

• 0:00
  Speaker 1: Welcome to the System Speak podcast. If you would like to support our efforts at sharing our story, fighting stigma about dissociative identity disorder, and educating the community and the world about trauma, please go to our website at www.systemspeak.org, and there is a button for donations where you can offer a one time donation to support the podcast or become an ongoing subscriber. We so appreciate the support, the positive feedback, and you sharing our podcast with others. We are all learning together. Thank you.
• 1:14
  Speaker 2: Ellie Somer, PhD, is a full clinical professor emeritus of psychology at the University of HIFIS School of Social Work in Israel. He is a licensed clinical psychologist and hypnotist and an Israel Ministry of Health certified supervisor of psychopathology and psychodiagnostics Training. Professor Sommer has been treating survivors of trauma since the mid-1980s, himself a son of Holocaust survivors and a combat veteran of two major Middle East Wars. Somer has also served as a reservist mental health officer captain and a commander of a frontline combat stress treatment unit of the Medical Corps of the Israel Defense Forces. As an academic, Somer has written over 150 scientific publications in the field.
• 2:06
  He has identified a phenomenon he termed maladaptive daydreaming, and his current research focuses on the successive and distressful form of fantasizing. Eli Somer was founder and scientific advisor of Trauma and Dissociation Israel He is co founder and past president of the European Society for Trauma and Dissociation and past president of the International Society for the Study of Trauma and Dissociation Ellie is currently involved in the establishment of the International Society for Maladaptive Daydreaming. Sommer is the ISSTD recipient of the Cornelia Wilbur Award from the year February for his outstanding clinical contributions to the treatment of dissociative disorders and the recipient of ISSTD's Fellow Status (two thousand and one) for his excellent contributions to the field of dissociative disorders. Ellie Sommer also received the President's Award for Outstanding Leadership twice, from ISSTD in 02/2006 and from ESTD in 2012. As well as in 2014, the ISSTD awarded him the Lifetime Achievement Award.
• 3:26
  He has been listed twice as one of the 10 best clinical psychologists in Israel. Welcome, Eli Sommer.
• 3:34
  Speaker 3: I'm Eli Sommer. I'm a clinical psychologist, out of Israel. I'm a professor emeritus, at the University of Haifa here, and my main field of interest is, trauma and dissociation. But in, so I'm a both, I'm a scientist practitioner, meaning that I, I see patients, but I also conduct research. And in recent years, I have been involved extensively in research of a, I would say, in a pathological, excessive form of daydreaming that we, we call maladaptive daydreaming.
• 4:24
  It's a form of an associative absorption inwardly.
• 4:28
  Speaker 1: So we actually have kind of an interesting story as far as connecting, because I think we got connected online initially because we had some mutual friends. So that's actually how I first found you. And then because I was following that, I saw the articles that you were writing or the things that you were sharing, the studies that you were doing about maladaptive daydreaming.
• 4:54
  Speaker 3: And
• 4:55
  Speaker 1: that was really intriguing to me, but then you contacted me when you saw our article come out. So it's actually perfect timing because I want to talk about all of this. But before we dig into that, tell me how you got involved with trauma and dissociation in the first place.
• 5:17
  Speaker 3: Well, it's been almost, you know, a career long practice and involvement on my part. I think that it was more than thirty five or forty years ago that when I first started my clinical work that a person with DID walked into my office. I mean, was at the time where the concept of dissociative identity disorder was not really known. It was called at the time multiple personality. But at any rate, was really unsure how to proceed clinically.
• 6:03
  I sought some supervision and got very interested in this unique form of post traumatic dissociation and the psychopathological aftermath of of of such adversities. So so this is how it started. Ever since then, I've been involved in treatment, research and education of maladaptive daydreaming. Oh, I'm sorry, of dissociative disorders. And it is in this context that I discovered maladaptive daydreaming because my practice, even until now, is comprised of people with post traumatic dissociative disorders.
• 7:02
  And it was in this context that I discovered this phenomenon, what I mean by discovered, just people, I by chance had a cohort of patients, of six patients who talked to me about or sort of insinuated some talk more openly about their fantasy life. And it caught my attention and I described it, but because I saw these patients within a, you know, my practice, I assumed that it's trauma related. And this is how I described it in the seminal paper that I published, on this phenomenon.
• 7:48
  Speaker 1: So how are you describing maladaptive daydreaming? What do you mean when you say that? And how is it different from other dissociation, or is it any different, or what is going on with that?
• 8:01
  Speaker 3: Well, it is different in several ways, but let's first, try to characterize what it is. Well, everybody daydreams, and this term daydreaming is sort of murky because different people and scholars mean different things when they when they talk about daydreaming. For example, one synonym used in the literature is mind wandering. But mind wandering is mostly sort of the mind being off task, of floating freely from one association to the other, thinking about conversations one had or plans to have or planning what to do on vacation or what to cook for dinner. That's, that is in contrast to the very vivid visual and fanciful form of daydreaming that we see in maladaptive daydreaming.
• 9:09
  So we're talking about a form of daydreaming that essentially requires a trait that enables the individual to be fully immersed, absorbed in fantasy. And capacity is utilized by people who have this ability, which we call immersive daydreaming. It's a unique form of daydreaming, very vivid. So people who are immersed in their vivid daydreams often spin scenarios and create fanciful, rich stories inside. They could be about unrealistic developments in their real life, for example, having an affair with an office worker that is not interested in you, that will be something involving real life.
• 10:06
  But other scenarios could be living in or with a fictional family performing, you know, on stage or being a world class athlete, unless you are a world class athlete. But if you're not, that's offensive fantasy. So on and so forth. I mean, some of the fantasies can be fantastical, completely fantastical in nature, like science fiction type or Harry Potter environments and so on. So that's something else.
• 10:43
  I mean, that is really having a virtual reality hardware between your ears and turning it on, sort of switching the software or the world inside at will, that that's to me pretty cool. I mean, I'm saying it's to me pretty cool because I don't have this trait. I I can't do it. So that's that is, in essence, what we're talking about. Now what is it is a question that we're still debating among people who are interested in this.
• 11:18
  What is it in essence? Is it an obsessive compulsive disorder where people feel compelled to do something in their mind? Is it behavioral addiction because people sort of can't help themselves but, you know, repeating this mental activity and wanting to go back to it. You know, variables are valid, but we believe that what it is in essence is based on our research, that it is an intense form of dissociative absorption. Dissociative absorption was always part of the basic measure of dissociation, the social experience and scale, but was recently argued not to be part of the domain of pathological dissociation that we commonly study, because it was argued that it's just a normal mental activity, you know, everybody gets absorbed in a book, in a movie, or even in thoughts while driving, and that's normal.
• 12:32
  What we are demonstrating is that there is a pathological form of this normal variant of dissociative absorption, and it's immersive daydreaming taken to the extreme. Immersive daydreaming, as I said, is ostensibly a pleasant, rewarding mental activity. It's disconnect to disconnect from the boring, mundane reality and creating perhaps a more exciting or exhilarating or emotionally intense alternative experience in your mind. However, what we know in basic psychology that anything that is rewarding tends to increase in frequency. I mean, if you're getting rewarded for a particular behavior, that's increases the likelihood for you to repeat it.
• 13:29
  So in in in moderation, immersive daydreaming is is just, you know, a talent that some people have and some people don't. Talent involving the ability to get a sense of presence in your inner world that you can create and be creative about. But when this rewarding activity is employed excessively, I would compare it perhaps to the savoring of wine. You know, good people can enjoy a complex, glass of wine, enjoy its its color and its bouquet and its complexity of taste and so on. But downing a bottle or two every evening would not be a refined behavior anymore, constitute perhaps an addiction.
• 14:30
  I think this is a fair analogy. We have something that is potentially, that is complex and rewarding and enjoyable, but it can be overused because it is accessible and it is legal, you know? And it can, for some people, be a vehicle for the regulation of difficult feelings. So it can come, so this is, now I'm closing the circle and I'm going back to where I started. So this is how some of my client patients that I described originally, who had adverse childhood experiences.
• 15:16
  So they apparently had this trait of immersive dating, and they utilized it to regulate their feelings of distress under duress, and later on to deal with their memories and the aftermath of their abuse. But I will conclude this long answer to your short question by saying that you don't need to have a trauma history in order to develop maladaptive daydreaming because the trait is unrelated to adversities. It could it is innate. That's that's our belief because most people, they they have been doing it since they remember themselves. So it is an innate trait, and that can become addictive because of its rewarding nature regardless of any adversities one one had experienced in life.
• 16:19
  Speaker 1: Thank you for sharing that. I know that some of the intersectionality between what you've been studying and my article came because of that piece with the online community. And that article that we just pub that I just published in the European Journal of Trauma and Dissociation was the history of how the plurality happened online and just getting that language into the literature so we could study it more. But that intersects so much with what you've already been working on. And I talked about in the article that it almost has become two separate groups.
• 17:00
  So they have termed themselves or ourselves, the group, the community online, with the overall umbrella term of plurals. And that is including the two groups of the traditional traumagenic DID, partial DID, OSDD, those kinds of dissociative disorders, where it is trauma based, people are distressed by their symptoms, phobic of parts or alters, and the avoidance behaviors,
• 17:37
  Speaker 3: all
• 17:37
  Speaker 1: of those traditional traumagenic kind of trauma responses. And then the other group of people who are identifying as plural culturally, but not distressed or bothered by their symptoms, some of them, most, many of them. And it's a very delicate thing because politically, we're not trying to offend anyone or we're not trying to dismiss anyone from any kind of treatment that they want for even other reasons that don't have anything to do with And so at the same time, it's spreading in such a phenomenon. Like it's really important for clinicians to understand what's going on so that they know how to help and they know how to treat the people who do come for treatment.
• 18:33
  Speaker 3: Right.
• 18:34
  Speaker 1: And so the years that it takes, or the months that it takes or weeks that it takes, however it all unfolds to actually get an article published, in that time, we've also now had the rise of TikTok, which brings up a whole new thing because even other mental health issues are documenting this phenomenon of sociogenic mental health issues that are people who watch symptoms happening so much, whether authentic or otherwise, that it's then replicating in them. And that's been extensively researched, especially with Tourette's. And so that brings up a whole new thing because this is another area where it's almost like, so that's like almost a third group now under that overall umbrella of this sociogenic phenomena that doesn't have anything to do with trauma, but really is a valid experience they're experiencing because of their interaction on TikTok or YouTube. And so that's another area where it really starts to intersect with what you're describing of these repeated exposures, I guess, if you will, and correct me if I'm using wrong terms, but just trying to break it down a little bit. These repeated exposures to what that is like and the reinforcement of experiencing that over and over again.
• 20:14
  So that with the non traumagenic plurals, we get almost the opposite where instead of that traditional phobia or avoidance of a system, we have this, I know all of my alters. I have these very rich, detailed inner worlds. And I'm just trying to express what I have seen and heard talked about. This is not my experience. So I don't mean at all in any way disrespect.
• 20:43
  Just they have this capacity to know this extensive, deeply detailed, rich inner world and all the relationships with the people. And it's so fascinating to me, not in a way that I want to be gawking at them intrusive to their experience at all, but my experience in therapy is, I don't want to know. Been in therapy for this long and I've made this much progress, but I still don't want to know. And it's such a different thing that in trying to just connect well with and just be supportive or present or ask clinicians knowing how to treat them. It's a very different presentation than traditional traumagenic DID.
• 21:33
  Speaker 3: Well, you're raising a few interesting points. First of all, the term sociogenic DID has been used by detractors of DID and its validity and its trauma history. And it was used particularly in courts mainly by the defense attorneys of people accused of hurting their young family members. And the claim was that it was something learned, There's no evidence that trauma can produce DID, and this is something people somehow get influenced by others through popular media and develop this as a fashionable or desirable way to be. So, but I'm sure you're not, you don't mean to go to that direction.
• 22:33
  Speaker 1: That is actually one of the big concerns of the community of people who do have traumagenic DID, is that we've worked so hard for research we have like the fMRI studies coming out now with Simone Rendeers, and that it is a traumagenic disorder, that it is distinct from other disorders. And now we have this phenomenon coming out and clinicians who already are not familiar with dissociative disorders, it's like another excuse to just write off all the progress that we've made. I think that's one reason there's a little bit of tension in the online community that it almost feels like even though, oh, it's so tricky because like I want to be inclusive and supportive and yes, everyone should have access to treatment in the ways that are meaningful to them. But then also at the same time, it's like, this is putting me in danger, or this is putting us in danger. This is what it feels like, the the affective experience.
• 23:36
  Yeah. And so it's hard to not like, how do you wrestle that tension and untangle what is what?
• 23:42
  Speaker 3: Right, well, you are now taking the discussion to that of DAT, sociogenic versus traumatogenic DAT. The issue I've been focusing on, again, definitely is not conditional upon a trauma history. Although people with a trauma history are highly and disproportionately represented among people with maladaptive daydreaming, most, like seventy percent at least, of people with maladaptive daydreaming report no trauma history. We have discovered, and that's in a paper that my the most recent paper that I've led and was published in October. It has to do with another emerging online culture, and that is of reality shifting.
• 24:41
  This phenomenon has been brought to my attention by a person who knows me through my writing and thought that I might be interested in it, and I, much to my astonishment, I found a flourishing online culture of people who are trying to teach each other how to create an an alternative world. And some of them, by the way, believe that they actually create parallel in existence, a parallel environment that exists out there. Like in quantum physics, they could they could they believe that they could be in both here and now and and over there at the same time or within a few seconds to move to a totally different, environment. But, regardless of those particular claims, the youngsters are, are really interested in this as a way to free themselves from the constraints or the limitations of their immediate external reality. What I found very interesting in reading the posts and the interactions online is the fact that some are very successful in doing this and are teaching sort of all sorts of techniques that basically involve what we concluded are self hypnotic techniques, like focusing attention and giving oneself affirmations and sort of planning very carefully and self suggestions of what to see and what to experience.
• 26:33
  But some, apparently, are very successful in doing that and others express the frustration of being unable to do it. So what I believe is happening is that people simply differ in their ability to dissociate willingly or to engage in immersive fantasy. I, for example, have no such capacity at all. So no matter, I'm very difficult to be hypnotized, I don't have a rich fantasy life that is vivid. And so people like myself would express frustration with being unable and wanting very much to do it.
• 27:08
  But at any rate, what's interesting is, again, that people are seeking consciousness altering experiences and to what extent is it normal or pathological? Mean, that I guess is depends on their functioning ultimately and on their level of emotional well-being.
• 27:34
  Speaker 1: I think this is actually a really important piece to remember, because even though what is commonly shared is that experience of multiplicity amongst those two or three different groups of these experiences. We're talking about distinctly different things, because traumagenic DID is a response to trauma. These other experiences are using intentional dissociation, and they are not distressed by it, and it's not disordered in that context. So I think they would agree that it's not DID in that way. At the same time, they have other things like, like Peter Barish said, if they're distressed by anxiety or depression or something like that, then they still can come for treatment, of course.
• 28:29
  And so I think one thing that when people are feeling sensitive or anxious about it is just remembering that what's shared in common, the plural concept, is just about the experience of multiplicity itself. But traumagenic DID these other forms of plurality, where it's the sociogenic on TikTok or anthropological in these other intentional dissociation ways that everyone can sort of hold space for themselves and each other without it being the same thing. It's not the same thing and that that's okay. Yeah.
• 29:09
  Speaker 3: No, I agree. I agree. And, you know, the insistence of staying pleural even at the end of therapy is something I've encountered throughout my career. I mean, I know that more conservative leaders in my field insist that there's only one cure to DAT and that's complete fusion integration. But the fact of the matter is that it's up to the client to decide how they want to be and how to define themselves.
• 29:45
  And from my perspective, and that is in line with the DSM principles, one can have all the phenomenological manifestations of DID, but if there is a sense of well-being, internal communication, cooperation, and awareness and exchange of information and external functioning is intact, then, it's just a different way of being. It's not a disorder.
• 30:18
  Speaker 1: So how does a person who is not a clinician know when they have sort of, I don't know, cross the line does not seem the right word, but how do they know the difference between utilizing intentional dissociation in healthy and supportive ways that are meaningful to them, whatever that looks like, and when it becomes maladaptive and is interfering with functioning or things like that, how do they discern that difference when they know they need to go ahead and ask for help?
• 30:52
  Speaker 3: Well, you just said it. You just said it. It's when they are unable to to to meet their obligations in real life, when they're unable to advance their goals in life, when they are experiencing internal strife and conflict and and they are paralyzed and and and unable to conduct their lives effectively. So that's in the functioning domain. So that's one criteria, a very important criteria, scholastic, academic, work, family relations, functional, and all that.
• 31:32
  If it's not impaired, then there's no problem. And of course there's the other, that's the objective criteria. And the subjective criteria is distress. So if you're not bothered by multiplicity in the sense that you are not, you don't feel that you're being taken over against your will, if you're not losing time, if there's no depression and anxiety associated with this disorder, if some parts are sort of leaking distress to other parts, I mean, that subjective criteria is another important indication that one needs help. But other other in in other conditions where these two criteria are not met, a person can be completely dissociative in the in the sense that they are functioning as a system and still not meet even the DSM criteria because in the DSM, each and every diagnostic entity, there is a condition that it must impair functioning or create distress.
• 32:52
  And unless this condition is met, then there is no diagnosis.
• 32:55
  Speaker 1: And what about for clinicians? How do they discern the difference of what's going on and how they can help in untangling, which is which?
• 33:06
  Speaker 3: Well, talk to the patients, ask them. So, you know, all we know about our patients in psychotherapy is what they tell us about themselves. We don't have neuroimaging equipment that can objectively identify a psychological disorder. Although now with the recent findings with neuroimaging, we might have some markers, but we are far from that. So traditionally, assessment is based on interviewing and talking to our clients.
• 33:46
  It is up to the clinician to determine based on the client's experience if, functioning is intact and well-being is preserved.
• 33:57
  Speaker 1: I think that this is one of my favorite things about what I've seen of your work is the humanity of it. Because I think in the community, there is that tension of, but mine is trauma based. And so I don't have, like, I don't want to stay like this. I want to get better. How do I express that insulting them who want to be proud of themselves and fight stigma and all these things that are good things?
• 34:31
  And yet at the same time, when you have that focus of just listening to each other, it helps us remember that my experience can be mine and their experience can be theirs, and we can still learn from each other. They can be respectful to those of us who do have trauma, we can learn courage from those who are out and proud and fighting stigma on behalf of all of us and all that they've done in that way. And then at the same time for clinicians, when we have patients come to our office with DID, we have so much history and experience and skills and literature to know how to treat that well. And in the same way, when we have people coming with these non traumagenic DID or maladaptive daydreaming or whatever is going on with other expressions of multiplicity, it's okay that that's not DID and they are still humans who need treatment and that's okay.
• 35:38
  Speaker 3: Yeah, I agree. I agree. At any rate, for me, are exciting times personally to be involved this line of research because it's refreshing. To so many years of studying trauma related dissociation to encounter a whole new field in which, I mean, it has never been talked about. It's not, it's really groundbreaking work and apparently very relevant to countless people out there who many of them felt that as if they are the only ones in the world who have this because they never read or heard or came across any any literature about this form of fantasy.
• 36:32
  And when many of them go to seek help, those who are distressed by it and want to lead a more effective life than be present in their own minds all the time, then they, many of them get dismissed because the clinicians, again, have not been, it's not in the DSM yet, it's not taught in school, So it's being either dismissed as a normal mental behavior or misdiagnosed consequently when, of course, wrongly treated. So there's a great need out there to identify those who have multiple worlds and identities, to identify the other forms of multiplicity and dissociation out there, and to label and understand better the variants ranging from normal and adaptive to excessive and abnormal and distress producing, and develop ways to help those who need help and want help. So that's where we are at now And our work with maladaptive daydreaming, if eventually gets into the DSM, perhaps should be called daydreaming disorder or absorption disorder or something of that sort, because there are certain talks in those terms.
• 38:12
  Speaker 1: I think that's a beautiful thing to focus on validating people's experience and being present with what they are experiencing without dismissing them because it's not something else. I think that's really, really important and really, really beautiful. Thank you for that.
• 38:30
  Speaker 3: Well, it's, it's there is almost a sense of mission there. And of course we need to overcome the skepticism in the scientific world. So that's always the challenge when you have something new. So at this point, we have over 50 scientific papers published in good peer reviewed journals showing that maladaptive daydreaming is a distinct mental phenomenon that is that causes distress and impairment, and that is not better explained by any other DSM, nosology. So therefore, at least warrants mentioning in the DSM as requiring further research, if not, be accepted as a new entry into this psychiatric catalog.
• 39:31
  Speaker 1: Is there any connection or pattern at all that you've noticed or has been researched between the recent rise in these cases or our discovery of them and the stress and trauma that the world has been through in recent years, whether that's the pandemic or, political strife or those kinds of things with it being so increasingly divisive and emotionally unsafe in so many ways, or that's just a parallel process that's also happening?
• 40:04
  Speaker 3: Well, to be able to answer such a question accurately, we would have needed to have measures of maladaptive daydreaming or reality shifting going back to many years ago and sort of compare the trend, but that is impossible. So what we can do is, for example, measure Google searches. Google has a tool called Google Trends, and you could enter a term, an exact term, and then compare it to another term that is of interest and to see and and then define the span of years that you want to gauge volume of Google searches and compare. So what essentially what we know and what we found is that, for example, concerning reality shifting, that's our newest discovery, is that the term has practically been nonexistent on Google searches before the pandemic broke out. Only a few months after the pandemic was declared a world threat by the World Health Organization, a global threat, we we see a steep increase in searches for reality shifting.
• 41:50
  And and it's this peak sort of leveled off a little bit currently, but it's still much higher than comparable terms. So, yeah, they have apparently, is some kind of relationship there. We also studied maladaptive daydreaming changes before and during the first global lockdown of the first wave of the pandemic, and this without any doubt, we saw definite deterioration in all a wide range of psychiatric indices, including maladaptive daydreaming, which shows, by the way, that it's not a form of it's not a normal form of daydreaming. By the way, maladaptive dreaming is highly associated, correlated with depression, anxiety, and so on. So that's another indication that it's not normal.
• 42:53
  And it was also a proof that it's not an effective coping skill because we measured increases in metabolic engineering and distress during the first major lockdown of the epidemic. So yeah, there are correlations there. But again, these abilities to alter consciousness without substances is not something new. The ability for multiplicity is not something that was born as a result of this pandemic, but of course, if people have these abilities and can utilize them to regulate their distress, they would use it more intensely under duress.
• 43:46
  Speaker 1: It's so fascinating what the world has been through and what can tear us apart further and what can bring us together and the difference that listening and supporting and validating each other really makes in healing for all of us.
• 44:03
  Speaker 3: Right.
• 44:04
  Speaker 1: Was there anything else that you wanted to share before I let you go?
• 44:08
  Speaker 3: No, I think I know you took this discussion to the directions that were of interest to you. And it was of course, since it was more of a discussion than an interview, it was also very interesting for me. So thank you for having me and giving me this opportunity. And it's a pleasure to meet you online.
• 44:29
  Speaker 1: I am so grateful. Thank you. I really am.
• 44:33
  Speaker 3: My pleasure. My pleasure. So hi there. Tell me, you are in Kansas. Are you okay?
• 44:42
  I mean, I heard there was some terrible tornadoes in the state.
• 44:47
  Speaker 1: Oh, the tornadoes were about 30 miles east of us, so we are okay, but we had some wind damage. But in Oklahoma, we have tornadoes frequently. And so in this part of the country, not that that makes it okay, we're pretty well prepared as much as you can be. But east of us, they don't always have them there. And so the damage is pretty extensive and it all happened fast.
• 45:15
  And it was such a long stretch of where it was effective, which was very unusual.
• 45:21
  Speaker 3: Yeah. Yeah. All right. Well, thank you for giving me this opportunity, as I said. And
• 45:27
  Speaker 1: Thank you so much.
• 45:29
  Speaker 3: You're welcome. Bye bye. Bye.
• 45:48
  Speaker 2: 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 for free 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.
• 46:12
  We look forward to connecting with you.