Transcript: Episode 325
325. Guest: Eli Sommer
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Eli Somer, PhD, is a full Clinical Professor Emeritus of Psychology at the University of Haifa 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 Somer 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. He has identified a phenomenon he termed maladaptive daydreaming, and his current research focuses on this excessive and distressful form of fantasizing. Eli Somer was founder and Scientific Adviser of Trauma and Dissociation Israel TDIL. He is cofounder and past-president of the European Society for Trauma and Dissociation (ESTD) and past-president of the International Society for the Study of trauma and Dissociation (ISSTD). Eli is currently involved in the establishment of the International Society for Maladaptive Daydreaming. Somer is the ISSTD recipient of the Cornelia Wilber award from the year 2000 for his outstanding clinical contributions to the treatment of dissociative disorders, and the recipient of ISSTD’s Fellow status, 2001, for his excellent contributions to the field of dissociative disorders. Eli Somer also received the President's Award for Outstanding Leadership, twice, from ISSTD in 2006, and from ESTD in 2012, as well as in 2014 the ISSTD awarded him the Lifetime Achievement Award. He has been listed twice as one of the 10 best clinical psychologist in Israel. Welcome Eli Somer.
*Interview begins*
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I'm Eli Somer, a clinical psychologist out of Israel. I'm Professor Emeritus at the University of Haifa here, and my main field of interest is trauma and dissociation, but in science. So I'm in both. I'm a scientist practitioner, meaning that I see patients but also conduct research. And in recent years I have been involved extensively in research on pathological, excessive form of daydreaming that we call maladaptive daydreaming, which is a form of dissociative absorption inwardly.
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. And that was really intriguing to me. But then you contacted me when you saw our article come out. Correct. So it's actually perfect timing because I want to talk about all of this. But before we, before we dig into that, tell me how you got involved with trauma and dissociation in the first place?
Well, it's been almost, you know, a career long practice and involvement on my part. I think that it was more than 35 or 40 years ago that when I first started my clinical work that a person with DID walked into my office. I mean, this was at a time where the concept of dissociative identity disorder was not, not really known. It was called at the time multiple personality. But anyway, I was really unsure how to how to proceed clinically. I sought some supervision and got very interested in this unique form of post-traumatic dissociation and the psychopathological aftermath 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, or I'm sorry, 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. And it was in this context that I discovered this phenomenon. What I mean by discovered by 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.
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?
Well, it is different in several ways. But let's first try to characterize what it is. For everybody daydreams. And this term daydreaming is sort of murky because different people and scholars mean different things 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 tasks, sort 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 is in contrast to the very vivid visual and fanciful form of daydreaming that we see in maladaptive daydreaming.
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 that is that capacity is utilized by those 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 great fanciful, rich stories inside. They could be about unrealistic developments in the real life. For example, you know, having an affair with an office worker and then he's not interested in you. That will be something involving real life. But others scenarios could be living in or with a fictional family, performing, you know, on stage of being a world class athlete. Unless you are a world class athlete. But if you're not, that's a fanciful fantasy. And so on and so forth. I mean, some of the fantasies can be fantastical, completely fantastical in nature and like science fiction type or Harry Potter environments, and so on. So that's something else. I mean, that is really having a virtual reality hardware between your ears and turning it on so it’s reaching the software, or the worlds inside, at will. That's to me, pretty cool. I mean, I'm saying it's to me pretty cool because I don't have this trait. Like, 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 are interested in this. What is it in essence? Is it an obsessive compulsive disorder where people feel compelled to do something in their mind? Is it a behavioral addiction because people sort of can't help themselves, but you know, repeating this mental activity and wanting to go back to it? And all these 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, Dissociative Experience 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. Everybody gets absorbed in a book, in the movie or even thoughts while driving, and that's normal. 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 disconnected from the boring, mundane reality and then creating perhaps a more exciting or exhilarating or intense, emotional, intense, alternative experience in your mind. However, what do we know in basic psychology that anything that is rewarding tends to increase in frequency. If you're getting rewarded for a particular behavior, that increases the likelihood for you to repeat it. So in moderation, immersive daydreaming is a signal of talent that some people have and some people don't. A 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 why. You know, good people can enjoy a complex, rich glass of wine, enjoy its color and its bouquet, its complexity of tastes, and so on. But downing a bottle or two every evening would not be refined behavior anymore, would constitute perhaps an addiction. So 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. [Laugh] And it can, for some people, be a vehicle for the regulation of difficult feelings. So it can come-.
So this is now enclosing the circle and then going back to where I started. So this is how some of my client patients they describe originally, who had adverse childhood experiences. So they apparently had this trait of immersive daydreaming and they utilized it to regulate their feelings of distress under duress later on to deal with the memories and the aftermath of their abuse.
But I will conclude this long answer to a 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 the adversities. It is innate. That's, that's our belief because most people 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 had experienced in life.
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. So they have termed themselves, or ourselves, the group the community online with it, overall umbrella term of Plural. 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 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 multiplicity. 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. Right.
And so the years that it takes, or the months that it takes, the weeks that it takes, however long it take as that all unfolds to actually get an article published. In that time we've also now had the rise of Tik Tok, 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 Tik Tok 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.
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. 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 or intrusive to their experience at all. But my experience in therapy is, I don't want to know. I’ve 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.
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 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, by then, I’m sure you don't mean to go to that direction.
That is actually one of the big concerns of the community of people who do have traumagenic. Is that we worked so hard for research. And we have like the fMRI studies coming out now with Simone Reinders 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. And 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 and 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. Is what it feels like, the affect of experience. And so it’s hard to not, how do you wrestle that tension and untangle what is what? Right.
Well, you are now taking the discussion to that of DID, sociogenic versus traumagenic DID. The issue I've been having focusing on, again, definitely is not conditional upon trauma history. Although people with a trauma history are highly and disproportionately represented among people with maladaptive daydreaming. Most, like 70% at least of people with maladaptive daydreaming report no trauma history.
We have discovered-. And that's a paper, that's my most recent paper that I've led and was published in October, has to do with another emerging online culture and that is of reality shifting. 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 much to my astonishment, I found a flourishing online culture of people who are trying to teach each other how to create an alternative world. And some of them, by the way, believe that they actually create a parallel existence, parallel environment that exists out there, like in quantum physics. They believe that they could be in both here and now and over there at the same time, or within a few seconds to move to a totally different environment.
But now, regardless of those particular claims, the youngsters 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 to reading the posts and the interactions online, is the fact that some are very successful in doing this and are teaching 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. But some apparently are very successfully doing that. And others express the frustration of being unable to do it. So I 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 I'm very difficult to be hypnotized. And 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. 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? I mean, that I guess that depends on their functioning, ultimately, and their level of well-being, emotional well being.
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. Right. But at the same time, if they have other things like-. Peter Barach said if they're distressed by anxiety or depression or something like that, then they still can come for treatment, of course. 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 and these other forms of plurality where it's the sociogenic on Tik Tok, 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, I agree. I agree. And you know, the insistence of staying Plural even as at the end of therapy is something I've encountered throughout my career. I mean, I know that more conservative leaders in my field insists that there's only one cure to DID and that's complete fusion and integration. But the fact of the matter is that it's up to the client to decide how they want to be and how they define themselves. And from my perspective, and that is in line with the DSM principles, one can have all the phenomenological manifestations of the DID but if there’s a sense of well-being, internal communication and 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.
So how does a person who is not a clinician know when they have sort of, I don't know, “crossed 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? How-.
You just said it. You just said it. That it's when they are unable to meet their obligations in real life and are unable to advance their goals in life, when they are experiencing internal strife and conflict and are paralyzed 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, functioning and all that, if it's not impaired, then there's no problem. And of course there's the other-. That's the objective criteria. And then 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 in other situations where these two criteria are not met, a person can be completely dissociative in the sense that they are functioning as a system and still not meet even the DSM criteria. Because in the DSM, for almost each and every diagnostic entity there is a condition that it must impair functioning or create distress. And unless this condition is met, then there is no diagnosis.
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?
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 newer imaging we might have some markers, but that we're far from that. So traditionally, assessment is based on interviewing and talking to our clients. It is up to the clinician to determine based on the client's experience if functioning is intact and the well-being is preserved.
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 that… mine is trauma based. And so I don't have, like-. I don't want to stay like this. I want to get better. And how do I express that without insulting them who want to be proud of themselves and fight stigma, and all these things that are good things. 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. And we can learn courage from those who are out and proud and, 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 this same way, when we have people coming with these nontraumagenic 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.
I agree. I agree. Anyway, for me these are exciting times personally to be involved in this line of research because it's refreshing after so many years of studying trauma-related dissociation, to encounter a whole new field in which-. I mean, it's never been talked about. It's really groundbreaking work and apparently very relevant to countless people out there who many of them felt as if they're the only ones in the world to have this because they never read or heard or came across any literature about this form of fantasy. 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 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 variance 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're at now. And our work with maladaptive daydreaming when it eventually gets into the DSM perhaps should be called daydreaming disorder or absorption disorder or something of that sort, because it just talks in those terms.
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.
Well, 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 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.
Is there any connection or pattern at all that you've noticed or has been research between the recent rise in these cases or our discovery of them and this 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?
To be able to answer such a question accurately we would have needed to have measures of maladaptive daydreaming or energy shifting going back to many years ago to 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 then define the span of yours that you want to gauge the 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 non-existent on Google searches before the pandemic broke out. And only a few months after the pandemic was the declared a world threat by the World Health Organization, global threat, we see a steep increase in searches for a reality shifting. And this peak sort of leveled off a little bit currently, but it's still much higher than comparable terms. So yeah, apparently there 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 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 daydreaming is highly associated, correlated, with depression, anxiety, and so on. So that's another indication that it's not normal. And it's also a proof that it's not an effective coping skill. Because we measured increases in maladaptive daydreaming 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, can utilize them to regulate their distress, they would use it more intensely, under duress.
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. Right.
Was there anything else that you wanted to share before I let you go?
No, I think, you know, you took this discussion to the directions that they 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.
I'm so grateful. Thank you. I really am.
My pleasure. My pleasure. So, hi there. Tell me, you are in Kansas. Are you okay? I mean, I heard the some terrible tornadoes in the state.
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. But 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. And it was such a long stretch of where it was effective, which was very unusual.
Yeah, yeah. All right. Well, thank you for giving me this opportunity, as I said.
Thank you so much.
You're welcome.
Bye.
Bye bye.
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