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McLean at Harvard · System Speak: Complex Trauma and Dissociation

• 0:11
  Speaker 1: Welcome to the System Speak podcast, a podcast about dissociative identity disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to 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
• 0:46
  Speaker 2: to the podcast. Thank you. We attended the conference that McLean did at Harvard, and there were pre conferences. And then two days, like Friday and Saturday, like, the weekend of conferences. So I just wanna talk about some of those things, not in-depth because it's so much, but to just recap some of what happened.
• 1:23
  First of all, Bethany Brand was there talking about finding solid ground, which is really very I talked to Cloughton about this at the annual conference last year. It's really very phase one stuff, but it's researched and collaborative. I know many people have been in the research study with their therapist as part of the top DD studies, and so I've kind of worked the program for the research. But but they did a two day intensive training about it. And, basically, what it wants to accomplish is to help clients quiet the alarm systems, like, neurologically, internally, talking about being able to identify too much or too little, like the window of tolerance stuff, and then also recognizing signs that the risk of doing unhealthy or unsafe things is going up.
• 2:27
  So that's part of what finding solid ground is about, and that program and the workbooks for being really phase one stuff, safety and stabilization, which is such an important part of the therapeutic process and the phase based approach and something we are always returning to. Right? It's not like we finish one phase and then go to the next phase and finish that and go to the next phase and then we're done. As things come up, like, really, that's what's integrated. It's not about just making parts go away or disappearing or everybody becoming one like we went through a big mixer.
• 3:05
  It's as I am able to tolerate my emotions, as I'm able to tolerate my memories, as I'm able to integrate the different experiences of me, whether that is, including all parts of myself in my life in ways they want and need, whether that is being aware of and having access to my parts and whether that is, like, what was my memory? What is the sensory information? What is all that? Like, that's what gets integrated, or having access to all of everything. And as we do that, every time we sort of work through something, we're able to do that a little more, we go back to safety and stabilization again, always repeating that process.
• 3:55
  Like in our workbook, we talk about it as that spiral staircase where we're always making progress up, but we also have sort of these platforms from time to time. So, yes, we're going in circles and we're repeating some things and coming back to safety and stabilization. And, also, we're at a higher platform than we were before. Like, we are still making progress. So they talk about things like collecting experiences, noticing when times and things are safer, calmer, not threatening, or okay.
• 4:27
  Writing these down, like, literally as safer experiences, like, we sit talk about safe enough, and now time is safe because like, I still, like, you guys, I know we have been through NTIS, now time is safe, and we moved to set, safe enough time. We still use NTIS. I just now know that I'm the variable as an adult that can make things safe enough for my peoples, for the rest of us, for like, we as a system work together. It is my responsibility to offer care and protection and safety and love to all parts of me. Does that make sense?
• 5:12
  So being grounded in that and recognizing and even literally documenting safe enough experiences or safer experiences that Bethany Brand calls them so that our brain can even start to remember good things too, not in an instead of way, not in a toxic positivity way, just acknowledging so we can learn what that looks like. Because when we learn what safe enough feels like and looks like, we can also recognize when things do not feel safe enough. Does that make sense? And then the other thing is basically what I shared all through 2020 is about learning to tolerate our emotions and widen that window of tolerance, practicing self compassion for ourselves, learning how to walk through things, and to be present with ourselves. The part of that, if you remember, like, the mother hunger episode, from, like, the original interview with that author and then the Dan Siegel one about what's happening neurologically and how my brain just put that together and the whole thing about, oh, these are my hands.
• 6:25
  Not just hands in front of me, but literally they are my hands. Like, that's an example of recognizing physical sensations in a good and safe way. So, also, what are physical sensations when I start to be sad or when I start to be upset or when I start to be anxious? Like, how do I know? So not just tolerating that it's out there, but noticing what it feels, learning to interpret what that means, and then practicing those skills until I can also apply them to other feelings that for some of us are more challenging, like anger or guilt or shame or self compassion.
• 7:05
  Like, some people think self compassion is a good thing, but those of us with relational trauma, that may be really hard. So that's an important thing to be learning. Also, I think part of that is trusting our body and knowing that our body is what's going to tell us the truth. We've talked about that before when someone told us that, like, our body is the only part of us that has been here the whole time. So trusting our body, it's going to tell us the truth.
• 7:37
  And then at the same time, making lace with what feels outside those bounds, what feels off the blanket. In Bethany Brand's program, we talk about exploring relationships with feelings and sensations. What emotions or body sensations feel not allowed or not okay, and what do we do with those feelings that don't feel okay? So so what we call making lace, they talk about in this program about accepting feelings and parts. So recognizing that we can sense them, recognizing that we can feel them even if we don't like having them or even if we're not comfortable with them being there.
• 8:24
  So just sort of tolerating awareness even with discomfort. So maybe I'm also tolerating the discomfort rather than just blocking that out. Like, I'm uncomfortable, so I'm just going to dissociate. Instead, staying present in discomfort and just okay. So I'm uncomfortable.
• 8:48
  And, also, I'm noticing and I'm feeling, and they are there. My feelings are there. My body's talking to me. Other parts are talking to me. All the things.
• 9:00
  So learning to balance that and also being aware how that sort of impacts our experience of reality, that sometimes we tell ourselves stories without having all the information because we aren't listening to ourselves. So if we aren't listening to our body, if we aren't listening to other parts, if we aren't receiving the information that emotions hold, we are not having all of the variables to have an accurate understanding of our own lives or the reality in which we live. One thing that I really liked from the Bethany Brand training is how they covered toxic shame and that this is very connected to depression, which maybe seems obvious or makes sense, but it was a connection I had never made. And they said part of it is because it's maintained by harsh criticism and trauma based thoughts and beliefs. But they also talked about how this this puts ourselves at risk of making more mistakes.
• 10:08
  And I think that's one of the things that I learned after the retreat last year, like, a year ago, was how if I'm pushing myself too hard or, again, like, not listening to myself or not meeting my needs, then I don't realize how high risk things are and then get myself into situations that are hard to get out of, whether that's relationally or financially or academically or professionally. So, again, having compassion to pace things, to trust myself, to trust my body, to trust my system, and also accurately receive information, which I think is part of what we meant by un daydreaming as well, that it is great to see the good, and dissociation has protected us in the past. And also, I have to see life accurately to understand what I'm going through and what my needs are. Another thing I appreciated from this part of the training was how they talked about how feeling good can be difficult for us because they said, quote, trauma can lead people to believing that feeling good is not okay, undeserved, or too risky. It can also trigger severe feelings and body sensations of shame.
• 11:34
  And I really appreciated that that was included. I can't even I think that's really, really important to understand. And they said that you can notice signs of that somatically as well, like, in your body, that dissociation or disconnection, so attachment as well. Disconnection is basically a disruption in connection. Right?
• 12:00
  And so they talked about how avoidance of eye contact or slumped body posture, shallow or frozen breath, or covering the face and hiding, things like that can be signs of shame starting to come up or surface. Another great thing they talked about is how all dissociative self states, so they called these DSS, dissociative self states, that everyone is attempting to help and cope with reality as they understand it, which is another reason it's so important to increase communication and awareness of each other, not to make everyone go away, but so that we can accurately understand reality, because not everyone is aware of the passage of time or of our current circumstances, and so we really need to, like, constantly in an ongoing way, work on grounding and orienting to the present. Then finally, just covering the sort of overview of the framework of finding solid ground. This talked about the stages of treatment. Again, we've talked about the phase based approach.
• 13:22
  We've talked about that a lot on the podcast that that's really from Judith Herman onward in the research. That is what is what we have found to be safest and most therapeutic without retraumatizing people. So the way they call those stages are symptom management and stabilization, and then processing, and then consolidation and reconnection. I appreciate that reconnection is included. It's what I have said should be stage four.
• 13:54
  Ever since we've talked about phase based approach to treatment for dissociative disorders, we they have had the three stages. Right? Safety and stabilization, memory processing, and then rehabilitation or integration or consolidation, like, whatever words you use depending on what part of history you learned them, I have said there has to be a stage four that is about reconnection both internally and externally before treatment is complete so that people aren't just let loose into the wild without any support. Like, some people maybe are already doing that enough or more extroverted that maybe they have the skills for that. Everybody is different, but, like, someone who's introverted or who has been fairly deprived socially or religious trauma, things like this where people are more isolated and disenfranchised anyway, they're going to need some more support for all of this to be integrated externally.
• 14:55
  They also talked about being able to do finding solid ground in a group format now as well. And so they talked about their goals being how to to learn how to give self the care that is needed, helping people understand the impact of trauma so that we can reduce shame and increase self compassion, and then learning to shift from trauma based thoughts and feelings to stabilize and increase our window of tolerance, and then learning the reasons for difficulty moving away from unhealthy coping as part of helping ourselves learn how to get healthy needs met safely. This was really helpful for me personally as well in that I can see where in some things I've made some progress from when I started ten years ago, which is helpful to know. But, also, of course, it was just interesting to see how the program has lined out, as the research progressed. There was also a lot of theory covered in that preconference.
• 16:05
  So we talked about attachment relationships and that that really is the prerequisite for our window of tolerance and emotional arousal. I have never thought about the intersection of that, that where we learn our window of tolerance is from our attachment relationships. Like, it makes sense if we're not allowed to like, it makes me think of the movie Elemental, where one family, the fire family, is really great with passion and really great with anger, but they don't know how to be sad. They don't know how to be compassionate or soft. And then the water family is super fluid, great with things like sadness and joy, but they don't know how to have boundaries and also can't feel anger.
• 16:57
  And so that makes sense, like window of tolerance. If part of our social contract as children is not knowing how to feel the things because no one reflects that with us or tends to that with us, if there's no attunement, or if we're literally not allowed as part of the social contract. Like, if we're punished for being sad or mad or if we are neglected when we are sad or mad, then there's not gonna be a lot of window of tolerance for that because our brain is gonna know it's unsafe to feel the things. So healing that through healing attachments makes a lot of sense. So they said that when we get hyper aroused, we're unable to think and react rationally, and dissociation looks like being unable to stand back and reflect.
• 17:51
  So this is when, like, it's just rage and anger instead of advocacy or when it's just big feelings and weaponizing anger as opposed to anger informing us. I'm just using the anger as the example. Hypoarousal, when there's not enough, there's poor social engagement, not connected enough, then we're not able to feel. And I actually appreciated this a lot because it means that to reflect, we have to be connected to our frontal cortex and think, which means we need some of that grounding and stability to be able to do the reflecting and left brain work. But to get to our frontal cortex, we also need to be connected to others in some way.
• 18:49
  We cannot be so isolated and so disenfranchised or so on our own that we are not connected because then we will not be safe enough to actually feel things. And that also explains how when we get super connected with people, even if it's something temporarily like the retreat or the symposium or community meetings or meetups, things like that healing together, why there is such big feelings that also surface. Those things we've actually been feeling all along, we just didn't even know it. So they also explained how too much emotion is actually an active defense, but too little emotion is a passive defense. And I thought that was interesting because I had not considered it in that way.
• 19:47
  There was also a handout about doctor Lowenstein presenting about pharmacology. I did not see this presentation, but he had interesting concepts about doctor and patient and the contract between them and how there's a historical and contextual but unspoken understanding that the doctor is treating the patient, which he said goes back to the visit and only the doctor signing the prescription pad. So the patient doesn't understand that it's a contract because they didn't actually sign it. So like they're saying here's some advice, you could try this at we're supposed to take the medicine as prescribed or report back on symptoms or say what works or doesn't work. And that how that does not always happen as intended.
• 20:39
  And then Rich Lowenstein also talked about how trauma impacts this contract and the doctor patient relationship, including things like past history with alcohol or substances that may not be disclosed, or a family history of abuse of authority, family history of substance abuse or medical traumas, and then other traumas like caregivers withholding needed medications or even stealing them, or the use of medications and other drugs and things like controlling dynamics, ritual abuse, or trafficking. And then he also pointed out that medications used to treat DID are simply shock absorbers for the symptoms to make functioning easier, that there's not an actual cure for DID itself or to make parts go away. He talked about comorbidity comorbidity and different rates of that. I shared that on the community. And then he also talked about the traits of people who have dissociative disorders, that they process information in a complex fashion, they tend to back away from emotional stimulation, they have a hyper developed capacity to reflect on the self in a non emotional way like insight, and they have an internal understanding or assumption that the external world and relationships will not meet their needs.
• 22:04
  And so they look to their inner world, even if unconsciously, to meet their own needs. And then also explicitly stated, which I appreciate, that there is a resiliency factor that preserves the developmental process for survival and attachment in circumstances of trauma and deprivation. One thing that he also talked about that I appreciate is unconscious flashbacks that I really thought made a lot of sense and explained a lot. And I feel like relational flashbacks may be in this category. But he said unconscious flashbacks are when the individual has a sudden or discrete experience that leads to an action that recreates or repeats a traumatic event, but the subject does not have any awareness at the time or later of the connection between this action and the past trauma.
• 23:05
  He said we can act and respond to memory time things without even realizing it, which is different than being triggered or activated and being aware that we are distressed by the influence of those experiences and feelings. So this was a huge piece to me, and I'm really glad I looked at the slides because he did not present. And so I was really glad that even though the schedule for the conference got changed, and I think it was doctor Gomez who went early for him and then some other people spoke unscheduled later. But I was glad the slides were still there because that piece was really important to me. He said the subject, meaning the person, carries out complex integrated actions based on past experiences that are not consciously remembered, with no awareness that he is repeating anything, as in a post hypnotic suggestion.
• 23:58
  The subject invents rationalizations for his or her behavior. So things that are literally post hypnotic or even hypnotic suggestions that we don't realize, kind of like we talked about the return and report thing of, like, go do the thing, come back and said you do the thing. Like that's conditioning and programming can be hypnotic. So kind of like to simplify, a passive influence, except the influence is coming from memory time experiences rather than other parts or alters. Does that make sense?
• 24:34
  It also talked about shame traps in relationships and how we don't trust anything that's good to be real or to stay. And I would have liked to have seen him present about that a little more. So, I was sorry that we did not get to hear him speak. There was also a presentation about transgender care that was super helpful. They talked about moving beyond gatekeeping of gender affirming care, uncoupling gender diversity from stigma and diagnostic classification, and how you can use non diagnosis codes to still allow for reimbursement or seeking reimbursement for services without a diagnosis or an assumption of distress, that is huge because was huge period.
• 25:33
  And also, that's one of the things the lived experience community about DID has said forever is that not all of us have distress about being multiple or plural and yet we're still plural or multiple. So that should not be a qualifying piece of diagnosis. That has been a hard piece for me that I've wrestled with because I am distressed still, But maybe it's hard for me to let go of that piece and to let go of that distress because I still don't know what's on the other side of those walls because mine is Traumagenic. So, I don't wanna get off track too much, but this was huge and it caught my attention that they said this in the presentation, about not assuming distress or psychopathology. They also had discussion, Doctor.
• 26:28
  Robinson, Doctor. Matt Robinson, and Doctor. Melissa Kaufman were there obviously as part of this conference. And the follow-up discussion was really good about the difference between transgender and opposite gender parts in DID. And one thing I wanted to highlight was how Doctor.
• 26:45
  Robinson talked about clarifying the conflict. And Doctor. Robinson, who will also be on the podcast soon, I did just talk to him and Melissa Kaufman, but Doctor. Robinson did an excellent job clarifying about the conflict itself. So with transgender, the conflict is the body on the outside, not matching the identity on the inside.
• 27:10
  And that being the conflict about how to express themselves or find congruence or resolution through a variety of ways. Everything from pronouns to presentation to hormones to surgery, with different examples of all of that. But with dissociative parts, parts being a phrase clarified earlier in the conference, as I've said, so just for context, the conflict is between each other and the presence of others and not being in the only one in the body that is shared. So there are some presentation or other variations of identity expression that is navigated in the context that is also adding the conflict of not being the only one in the body. Even though also, obviously, some DID systems may be in a transgender body as well.
• 28:05
  But they handled it very thoroughly, very sensitively, very intentionally. I thought it was really good. That being said, I do not identify as transgender. So I would defer to people who do identify as transgender for what they thought or how they received it. But it was still better than any presentation I've heard about this thus far.
• 28:29
  So I very much appreciated it. It was excellent material. They went through everything talking about sex development, as in as in gender development and, just there was so much about this. I can't even say it. It was so good about female or male bodies and intersex variations.
• 28:53
  And then sex development and gender identity terminology from understanding cisgender or cis to transgender, trans, or gender diverse, and what the terminology means. And the diverse identities even within that and non binary and gender queer and gender fluid, all of these things, the whole continuum, understanding gender affirmation, psychologically, socially, legally, medically, surgically. It was a very broad presentation that was really, really good and also came down to questions about suicidality. And that gender affirming care is medically necessary even as part of suicide prevention. And also, I appreciated that the speaker explicitly said, you cannot exclude trans people from gender affirming care or surgeries just because they have DID.
• 29:53
  Yes, people with DID have different alters, so as a whole, they look inconsistent. You guys, how many times have any of us, even if we're not trans, any of us with DID or OSDD been told could you be more consistent or you're not consider like, you can't be what other people expect because it's not always you who's there. And people forget that. Even when they know about DID, they forget that. And then they're like upset because something is wrong or something is off or something is not consistent, except you can't predict me because I have DID.
• 30:28
  So if you want me to be predictable, that will be fawning and that will be a limited number of parts. I don't know what to tell you. Right? But as part of an overall treatment care team, we learn those alters just like we learn all of our patients, right? And each alter is themselves consistent with who they are.
• 30:47
  John Mark is always John Mark. Doctor. E is always Doctor. E. Right?
• 30:53
  So, even though there's inconsistency in presentation as a whole, each alter is consistently themselves and that is enough to answer the question about someone having DID and also having medical decision making capacity. They also talked about sex assigned at birth, gender identity, gender expression, and gender perception. I had not heard that piece before, but obviously how the world externally sees you or views you, I just didn't have the word for it. So I appreciated learning that. And then also about gender minority stress, and external stigma related stressors, and then that interplaying and intersecting with psychological processes and internal stigma, and that resulting in behavioral health problems and physical health problems.
• 31:49
  It was so good and I love that this was included and I think it was super, super important. And then again, in another set of Doctor Lowenstein's slides, he talked about transference and reminded people that transference can come from the whole person, Also from like the id or the body or the part of the mind that all parts have access to or a specific part or alter. And he gave different examples of different kinds of transference. So classical transference is positive, negative, erotic, dependent, but also traumatic transference, flashback transference, and then specific things in mind control. So he defined traumatic transference specifically as meaning that we assume our therapist or partner will treat us the same as everyone else has, which is different from which is when we get ourselves into situations and that actually happens.
• 32:59
  So this is when we're not really being treated that way, but we feel like we are or expect that it will happen at any moment. And then he defined flashback transference as when we experience our therapist or partner as literally being someone who is someone else from the past. Like thinking our therapist or partner is our actual mother or father, not just reminding us of our mother or father or whoever our abuser was. And he said this is sometimes the brain trying to heal and letting hard things surface. And other times, it could be coming from a part, doing it to another part, like as a warning or something.
• 33:40
  And then he also described mind control transference as the patient's belief that the therapist's overt helpfulness and concern is really in the interest of gaining access to the patient's mind in order to malevolently invade, control, or enslave the patient psychologically because of organized abuse or other related things in the past. So these were hard, hard things. It was a super intense weekend. There were schedule changes, so there are slides and things I don't have because as a Deaf person, I have to be able to see and cannot see and listen at the same time. And so, like, just attending this by myself, Jules was not here attending this by myself.
• 34:30
  I could not take notes and watch and listen and learn at the same time. But there was lots of lived experience. There was the talk about transgender gender affirming care. There was the OEA talk. There was the explanation of DID, what it is, how to care for it.
• 34:50
  It was an incredible conference. The brain studies, I hands down, I actually loved it. I don't have any idea what is happening on social media. I hope we are moving beyond that collectively, not to speak over or away from or not acknowledge trauma or the hurts of the past. I know we've had guests on, we talked about it at the time, our responses to all of those things.
• 35:18
  And also for these presentations to be given at Harvard, for that audience to receive this information is so so important. So I don't mean to override or dismiss or minimize past traumas in any way or those ruptures. They are not mine to repair and I do not mean to speak over them or silence them. And also, moving forward and having object relations of looking at what is good and what is not and what we learn and how we grow. There's evidence of this in the presentations in the conference itself.
• 36:03
  There was healing, even doctor Lowenstein, no Looney Tunes slides. Good job, buddy. Like, high five. And, oh my goodness, there was so much packed in and it was sensitive and it was accurate and it was up to date. And there's still lots to discuss, I'm sure.
• 36:23
  But the research was outstanding, and I just I really, really loved it and enjoyed it. And I'm grateful that despite other things and I was not involved in those things, I cannot speak to them. But I also, again, I'm just holding space that it's still a thing. Right? Like making lace, it's still true.
• 36:47
  So, there we go. And I have already and I have already interviewed doctor Matt Robinson and doctor Melissa Kaufman. So they will be on the podcast soon just talking about what they're doing. We do not address previous issues because of, legal restrictions and things that don't have anything to do with me. So there's only so much I can do on that.
• 37:12
  But the conversations are good. They are showing up. There is learning. There is growth. It is powerful stuff.
• 37:19
  And the fact that these things were presented in a setting like Harvard is huge. It's huge. And so I know it doesn't change the world overnight and also it's exponential. And there's tons of resources, tons of information. I know it was packed, but there you go.
• 37:41
  Have at it. So so it is a good example of us learning and healing together. Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemspeak.com.
• 38:17
  We'll see you there.