Transcript: Episode 32
32. Healing Together (Part 1)
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[Short piano piece is played, lasting about 20 seconds]
Hello. I wanted to share what we’ve learned at conference so far. Today was the first day - Saturday’s sessions after registration last night. I did have to work this morning before we could attend the conference and so I missed the opening remarks and the keynote session while I was finishing my work.
But, I made it upstairs in time to attend the first round of break out sessions. I chose the workshop entitled ‘Neuroscience Applications to Treating DID’ by Lynne Harris.
She spent a lot of time describing dissociation in new ways I haven’t thought of before. Some things I know and other things I know our therapist has said, but it was in a different perspective from the brain and how the brain works and it helped me to understand it a little differently.
First of all, she pointed out that all dissociation is functional and that all people employ it at times. What makes it maladaptive is overusing dissociation as a strategy instead of a function. And then she gave four functions of dissociation. And for those functions, she gave four examples of dissociation. Number one, to divide attention into two or more streams of consciousness - such as highway hypnosis. Number two, to compartmentalize affect and information - such as a grief response, when you’re having to listen to the information about someone who has passed away while also feeling feelings at the same time. And number three, to create distance from trauma - such as this feels like it’s happening to someone else, not to me. And number four, to maintain attachment, especially for children, who for their own survival are required to remain attached to their caregivers even if their caregiver’s an abuser or someone not rescuing them from an abuser or comforting them after abuse.
That piece goes back to what I’ve been studying about shame and those attachment theories and Patricia DeYoung’s work. So, it was interesting to hear it from a neuroscience perspective about how that process works in the brain.
Next, she gave the continuum of dissociation from the daydreaming that everyone does to that in the zone feeling you have when you’re really focused on preparation or speaking or presenting material or studying something to the actual trauma response when it’s happening and then along the continuum into PTSD and then C-PTSD and then other dissociative disorders and then DID.
What she pointed out was that as dissociation increases, information processing decreases. So, the inside parts or the inside personalities or the others inside, whatever language you use, that’s where the information is. So, this was really interesting because someone from the audience even directly asked her about the old, original theory that there is a core where others are split off from them or the newer structural dissociation theory where everyone starts out dissociated so to speak and through development integrate those personalities into one and that trauma stops the integration from happening.
I thought at first she was going to skirt around the politics of it and I was interested to see how she was responding, but what she did was say that basically, that wherever your theory is and whichever one is right or if there’s another thing that we don’t even understand yet, because research is still happening, that it really doesn’t matter. Because what’s important is that in the brain the more we dissociate or the more the trauma has gone on or the more that dissociation has become a response or a strategy instead of a function, then the less information gets processed and that that’s where the disintegration really is. So, it may be that different parts hold different pieces of information, but the point is that those walls are there and you don’t have access to it laterally across the system.
She came back around to that and we’ll talk about it again in a minute. But, what she points out is that dissociation helps children, because they can’t fight back. Which I know everyone knows, but she really explained why. Because if you think about your brain and the fight or flight response, children can’t really fight - they’re not big enough, even if they try. And so their only option is flight, but children also can’t really physically get away, even if they’re not exactly confined.
The other thing that she pointed out as far as development is that the cortex, the frontal cortex, isn’t even developed until the mid-twenties. So, children aren’t physically able, even chemically able or brain-functionally able to integrate these parts, meaning the information that they hold from the different aspects of the experience. So, in this perspective, it wasn’t just that there are different parts, meaning alters having different perspectives on something traumatic that’s happened. It’s that the emotional response of what happened, the sensory response of what happened, the intellectual understanding of what’s happening, the physical experience of what’s happening, all of these are stored in different places in the brain and processed in the brain in different ways.
And so, whether it’s one alter who has all these pieces and another alter that does not is irrelevant ultimately from the brain-perspective. The point is that these pieces of the memory are held in different parts of the brain. So, again there’s a push to redefine how we understand what is integrated and what is not integrated at really a neuroscience perspective, it doesn't really matter if there are different alters that hold different pieces. The experience itself is disintegrated. It’s not that the personality is disintegrated or that the person or their parts are disintegrated and that integrating it altogether is about having access to the information, not about making certain parts disappear or be gone or go away.
She also said that dissociation protects against instability from the overwhelming sensory input that can’t be processed. Because it’s disintegrated information, the brain can’t process it and doesn’t know how to store it all in one place. So, what happens is that a memory that’s traumatic gets stored in a brain as feeling or as sensory information or as both in a different part of the brain, where then other memories are stored such as information or narratives.
So, the memory itself is literally broken up, it’s not just that the personality development happens the wrong way or is prevented from happening a certain way or that different alters hold different pieces, it’s literally the memory itself is broken up and stored in different parts of the brain. As opposed to a non-traumatic memory with someone who does not dissociate, where that part of the brain has a narrative about that story that includes the integrated pieces of the sensory input and the emotional response and all the different layers of that memory. It’s all connected in one place.
But with dissociation and with ongoing trauma, the memory itself is literally split up into those separate layers and then stored in the brain in different places. So, they’re literally connected. So, it’s not just about bringing alters together, but bringing together memories that are including the different layers of what that memory is. So, what happened is part of the memory, but also the emotional response is part of the memory and the physical response or experience is also part of the memory, the sensor input is part of the memory. And that’s why when you only have one piece of it, DID can feel so crazy, because it really is a different kind of memory and it really does feel like that has nothing to do with me or if another alters...or why different alters can have such different experiences of the world around them, because the memories are chemically and literally stored and processed in different ways completely and entirely.
So, what she said was that dissociation is a way the brain uses a strategy to maintain function. And this becomes a problem, because as the child develops, dissociation itself becomes the function.
So, all people dissociate. Everyone always gives the example of the highway hypnosis and initially that is a defence mechanism that is a strategy to protect the system as a whole to maintain function, either for safety, or to get through the experience or to wait for help, or whatever the child’s needs are. Dissociation is a strategy to maintain function. But what happens over time, when there’s ongoing trauma and dissociation is relied on because of the ongoing trauma, then the brain rewires itself and dissociation becomes how the child functions - rather than a strategy to maintain function.
And this actually changes the entire limbic system in the brain. Your hippocampus is what does memory and context from memories. Your frontal cortex handles executive functioning and logic. But trauma causes a smaller hippocampus, especially with ongoing trauma. And then when dissociation is used as a function, meaning how the brain processes memory instead of a strategy to maintain function, then what happens is the adrenaline system, the central nervous system with the chemicals like adrenaline and cortisol, actually train the brain to skip the frontal cortex altogether for a faster response.
So, trying to increase safety by skipping the defense system so that the brain doesn’t have to think, oh, is this a dangerous moment or not? And what should I do about it? It skips the frontal cortex altogether, because the brain thinks, oh, we are already in danger. There’s no more need to decide whether we’re in danger or not. We just are in danger and we don’t even need to decide how to respond to it, because we already, the brain, know that we respond to drama, we respond to trauma, by dissociating. That’s just how we function.
So, because it becomes how you function, it skips the part of the brain that would choose it as a strategy. So then dissociation is no longer even a choice in response to trauma, but is actually the way the brain works. And so executive functioning and logic get either separated or even underdeveloped, because what they’re going through does not make sense and because the ongoing trauma leaves them in a state of danger. So there’s no need to decide about whether it’s danger or not and so it’s just not used as much.
This puts all the trauma memories into the amygdala and that is why past time feels like now time. But then normally, in healthy families, emotional regulation and tolerance to distress and knowing how to respond to difficult things is learned through attachment to caregivers. That’s the attunement part of shame, right? That we’ve been talking about and so with attunement, that’s mirrored back and you would be in agreement and you would be in agreement with a supportive person that yes, this is a problem and it’s distressing and here’s what we’re going to do about it. That’s attunement.
And when you don’t have that, there’s shame - either no, this isn’t a problem or no, there’s nothing we can do about it or no, I’m not going to help you. That’s misattunement and it leaves you stuck with the problems that they have said are not problems, like trauma or denying that abuse is going on. Which means it feels like, tells your brain that, you are the problem instead of the abuse is the problem. And that prevents the amygdala from linking to the frontal cortex to filter all of this through that executive functioning, to decide what is the problem and what to do about it. Because if it’s decided that there isn’t a problem, then there’s nothing to think about and there’s nothing to do.
And so, when there are not caregivers supporting you through this process, then past time stays present time. Because the problems and the abuse and the experiences and the memories don’t go away. But the brain has to store them a different way and that’s what causes the trauma loops and gets littles or other alters stuck in some of the trauma that they’ve been through.
It also increases the danger in the stress chemicals, like adrenaline and cortisol, that a person feels in their body on an ongoing basis. So, what you get in the present time, is a person who feels like they’re crazy, who feels like they’re failing, who feels like they’re messing up, who feels like they’re wrong and all of these shame responses, because those are the chemicals being put through from the brain, because that’s how the brain has learned to work.
And she also talked about how the buildup of these chemicals causes auto-immune diseases and pain responses and that there are times even that caregivers or doctors or physicians trying to get to the medical care providers, trying to get at the root of what’s going on may even say that it is made up or blame the victim for what’s happening. But, it’s not made up. The body is not meant to be flooded with those chemicals long term and these are responses to these chemicals. There’s inflammation and other responses to the chemicals, because the body does not forget. The body remembers.
So, she talked about the window of tolerance for the nervous system that becomes chronically dysregulated. So, when there’s feeling too much, the information cannot process, because there’s dissociating. And so the information itself is divided up in the brain so that it can get stored somewhere, because it’s too much to be stored in one place. And then the person responds by underreacting, not realizing when they’re stressed, not being aware of when there’s danger, not being aware of the impact of the trauma, not aware of boundaries, all these things that cause more stress that other healthy people who haven’t been through trauma, would be like this is too much or this is a problem or I need help or this is not okay. People who have been through ongoing trauma don’t get those signals, because there’s already a tolerance so high built up for the trauma response in the central nervous system.
On the other hand, it can also be too narrow and not feel enough. Too much trying to process rather than too little and that’s what the overreaction’s look like - being too sensitive, irritability, responses out of proportion to now time. Because you're responding because of the chemicals in the brain and in the body in response to things that happened a long time ago, but the responses are just now happening in the present time. So, it feels out of balance to what’s happening now, but it’s literally chemicals from years and years and years ago.
The goal then is to widen that window of tolerance while maintaining regulation. And that’s why we need therapy, to literally retrain our brains how to handle all of this and how to physically heal our bodies from what has happened to us, chemically and at a neurobiological level in response to trauma.
So, she gives three stages to healing. Number one, safety and overcoming dysregulation - like body safety, stopping reenactments of trauma, reducing retraumatizing situations. And she gave the example how a lot of survivors also end up in domestic violent situations when they’re older. Stage two, coming to terms with trauma memories - that includes an increased awareness, increased orientation to time and place and safety, also remembering which she said is different than reliving, like in nightmares or flashbacks. And then third, integration - and for her, she was not talking about all of the personalities merging into one, she was talking about the affect and the information being merged together so that it can be stored as normal memories, even if they were not good memories, being stored all in one place instead of the affect and the information being split into different storage places in the brain.
She referenced Jung saying that we are all a system of complexes, short from internal family systems, referring to us as a system of parts, Lawrence who referenced ego-states.
Once you find a good therapist who knows how to treat trauma or how to help with DID, what is most important is knowing that all of you are welcome, all have a role or a function, and all are important. And the goal, she said from shorts, is to restore a leadership of self. So again, integration that’s not about anyone disconnecting or going away or being shut down, but about smoothing things out between affected information and that this is done through increasing communication, cooperation, and consciousness.
So, increasing your presence - being more oriented to now time, increasing awareness, being more aware of the different parts of information that others hold, working together better, a smoother shifting between you, and less loss of consciousness when someone else is out.
I found this session really helpful and I thought that it gave me a clinical understanding that answered for me emotional questions. So, for me it was very much an integrating experience, as far as feeling a lot of shame about my own diagnosis and a lot of confusion about not understanding why it works or at a deeper level, of both shame and confusion, why I can’t just make it stop, or why I can’t just make it go away or turn off. I understand much better about how it works in the brain and how it developed and how it gets continued and what’s happening when I hear from some of the others or read in the notebook about my experience is this, and this is going on, make it stop. And I feel nothing like that experience or I’m very calm about the same experience.
So, it helped me understand how it’s different and what’s going on. It also felt a little bit overwhelming, because it means we still have a lot of work to do. And it felt very challenging in that I think there are a lot of pieces that are really difficult and even though we feel like we’ve done a lot of work in the last year, I could also see how we’re very much just at the beginning. And so that was a little bit frustrating, but at the same time understanding, at least for me, understanding better how it happens and what’s going on from a neurological standpoint.
It helped me to have a little more compassion with myself and some of the others. As far as why things are they way they are and that it’s not just behavioral, I can’t just coerce them into behaving a certain way or cooperating in a certain way, according to what I think should be done on my own timetable. So, it really helped clarify a lot of things and so I was really glad that that was my first session, because it grounded me a little bit and just that experience of in a small tiny way, being able to put that affect and information together. So, it was interesting because as she talked about it, I was also experiencing it. Which somehow is helpful and therapeutic in a way that I had not anticipated.
That said, the biggest challenge for the conference so far for us has definitely been the social aspect. There are people that we really would like to connect with while we’re here and literally may have no other time to ever connect with them in person and so that’s pretty special and a big deal, but at the same time, our anxiety about it is so high that that has not been able to happen. And so trying to focus on safety and self-care and having compassion with just acknowledging where we’re at and that it’s not our season to do that has been difficult, but also empowering as we have come to terms with it a bit.
Last night we didn’t speak to anyone at registration, we just signed in and got our things and left. This morning we were able to look around and got a few trinkets, like an art kit for art therapy with some prompts, because we have several who like to draw, one specifically, but several who also draw and paint and are artistic. So, I wanted to reach out to them and make sure that they knew that they were being included in this conference. So, I did go ahead and permit the purchase of that and left a note about it in the notebook.
But then, we did take a break and come back to our room for some down time before the afternoon sessions. We just needed a break and to rest a bit and refocus and do some grounding. It has been a little bit of a challenge. There is a creative corner for people to have a little bit of an artistic processing space if they need that at the conference. But, it’s right in the same area as where all the vendor tables are. So, for us, that is way too stimulating and exposed to be able to sit there and focus or to be able to participate in that at all.
And then I have heard from others online that the littles room or the grounding room both are off to the side of that and there is an arrow on a sign that points to it, but the door is closed and there’s no sign on the door and you have to walk past the art people to get to it. And so for us, that’s just too many steps. We can’t do that. It’s not accessible to us. So, that is one frustrating thing about the conference so far.
And then they have also had some difficulties with accessibility. We have some friends who are blind and have struggled with issues regarding their dogs who are their legal-seeing eye dogs. And then we also have a friend, who is completely deaf and requested interpreters, and that was denied due to cost, which is illegal actually. And so that’s one area that the conference is certainly going to have to grow and improve.
But otherwise, I really appreciated my first session this morning and after a small break, I felt prepared to return for afternoon sessions.
After lunch I went to see The Crisses’ presentation, because I appreciated them letting us join their group a few weeks ago and we really learned a lot from it. So, I wanted to be supportive, even though we were too shy to be directly supportive. We were there and really proud of their work.
We were also really proud of our other friends who opened up in that session - sharing things that answered questions from the audience and were really helpful to other people. I’m just really proud of the support that everyone has been to each other in this conference, even for us when we were not able to connect directly.
In their session, The Crisses also talked about making the outside world safer can make the inside world safer. And making the outside world healthier can make the inside world healthier.
They also talked about how being dissociative often means you’re very suggestible and so to consider carefully what is in your outside world that you’re suggesting. So that psychoeducation for your system needs to include accurate information and the things that you do on the outside need to reflect goals that you’re trying to accomplish on the inside. So things about safety and health and cooperation and communication and compassion, that there should be a congruence between what’s happening outside and what’s happening inside.
For the final session of today, I attended ‘Therapist Guided Practical Skills and the Treatment of Complex Dissociation with Steven Gold. He opened by talking about the false-memory group in the 90’s. Much like Dr. Ross said when I interviewed him for the podcast and I remembered that Dr. Ross also said they were since deceased. So now, things like the #MeToo Movement are opportunities for survivors to reclaim their voice from that second layer of societal oppression that fought against DID and created so much stigma surrounding it.
But even besides that, he said that no one, whether it’s someone who’s on the outside or just a person who’s fronting or anyone inside, that no one's able to talk about trauma before they’re ready.
Further, research shows now that the experience of growing up in that kind of ongoing trauma environment is as traumatic as the trauma incidence themselves. So, survivors need more than just the stabilization of the 80s and 90s. They need those developmental connections and attachments that they missed growing up and that whole healing doesn’t come without it.
So his treatment model is called CTT - Contextual Trauma Treatment. And it heals not just trauma, but the experience of being in the context of that trauma. He talked about there being three components to this model - relationship, context, and skills.
The purpose of these are to decrease distress in the survivor and to modulate dissociation. And he emphasized that this is not about making survivors stop dissociating or taking away the skill of dissociation, because everyone dissociates at some level, but instead it’s a deliberate collaboration between the therapist and the client to increase coping skills, build relationships, regulate affect, and integrate identity - again, meaning the experience, an awareness of what’s happened in the past.
He then presented a model that explains how this happens in the context of ACEs or Adverse Childhood Experiences. When there’s a deficient family environment, it leads to the person developing insecure attachment and deficient or defective social learning. That results in gaps in emotional expression, development and regulation, and interpersonal skills. In turn, that leads to insecurity, restricted competence, and isolation.
Together, all of this leads to an increase of vulnerability to victimization, which leads to abuse. And as these things are not resolved or the cycle repeats itself over and over with ongoing trauma, then even into adulthood, that leads to further gaps as the survivor grows up, which can lead to further victimization, such as domestic violence in adulthood, like we were talking about earlier.
He also said, it only takes five of those adverse childhood experiences to live twenty years or less than a person without trauma. That just blew me away. He sees ACE’s as having an impact in two ways. One, with trauma, but also with developmental deprivation - like not being rescued from the trauma, the trauma not being intervened, the trauma not being stopped, not being comforted after the trauma, as well as all of the experiences that you would receive through a positive attachment, healthy interactions with the caregiver.
That trauma leads to PTSD. The developmental deprivation leads to disturbance of self-organization. And together, those two things lead to complex trauma. This shows up in two ways he said. One is psychological symptoms. And this is where we have the conversation that Sarah Clark and I have talked about before, about how you could technically, according to the DSM-5, be plural or live at a level of functional multiplicity, if your dissociation is not interfering with function and you are not distressed by it.
The second way is functional impairment. And these are issues from the developmental deprivation and things you can’t do or skills you struggle with or anxiety and depression relating from not being able to keep a job, or not being able to maintain friendships, because you never got to learn those skills or had opportunity to do so.
So he proposes three phases of treatment. Number one, a remediation of developmental gaps - such as safety, attachment, trust, meeting your needs, self-soothing, emotional regulation, being able to regulate attention, like being present without dissociating, and an increase in judgment and reasoning without switching. Number two, a narrative trauma processing - this would include remembering things, but staying present with them, increase in presence, meaning your orientation to time and place and parts telling their stories while maintain regulation and safety and without regression in connection with attachment to the therapist or others as that develops later. And three, functional and gratifying life structure - not returning to the way things were before therapy, but creating a new baseline of what your life can be as you pursue your own healing.
He said you often have to repeat phase one to increase resiliency as you go through the therapeutic process, because it’s so difficult. And you also often have to repeat phase two for things such as flashbacks and nightmares.
So really, the three components that he presented were interpersonal, conceptual, and practical. The interpersonal was about interactions with an attachment to the therapist, as well as internal communication and cooperation. The conceptual component was about the client providing the content, such as what’s happened to them and the therapist providing the process. Such as when our therapist rescued the girl inside. And the third, practical, are things like problem resolution, life skills, psychological development, interventions transmitted from therapist to client. And those are skills we just got from the therapist.
So, this session was pretty helpful in learning new ways and specifically he himself is proposing his own treatment model and he does have a book that is getting ready to go onto publication. So really this session was about that, was about his theory, his program at NOVA, and what his book is going to be out to generate interest for that.
So, it was really helpful for one perspective and for one kind of approach to treating DID and complex trauma.
I also really appreciated the way he normalized dissociation besides just giving it a function.
So, at the end of the day, I feel like things were pretty intense. There was lots of opportunities for triggers and to stay present and focus for that long, for such a long day, so right now, physically just checking in. I feel a bit dizzy and I feel very, very tired and I feel physically worn out and even sore from being still. And so I certainly think that it is time to balance that out with some play time and some relaxation, whatever that means to them and that I am finished for the day.
So, that was our experience with our first day at the conference and going to sessions to learn more about DID. I took notes in the notebook that will get to the therapist and I will continue to think about and see what we can do to help and improve our functioning. And it will be interesting to see what we learn tomorrow.
[Break]
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