I appreciate your response. IFS looks at DID in a similar way – that it’s simply a more extreme manifestation of how we all are naturally. In DID, the trauma has been so severe that the parts are often cut off from each other, as well as the Self. As you mentioned, the parts are often much more harsh – roles that they had to take on during the trauma to survive – and they can feel foreign to the person due to being cut off from the rest of the system.
That being said, UBs are very different (even though they may initially present the same). Whenever a possible UB is encountered in IFS, great pains are undertaken to 100% ensure that it isn’t a part before it is expelled. (Expelling a part would much things much worse.) I didn’t delve into this in the article due to lack of space, but assessing UB vs. part is the top priority before anything else is done.
It’s amazing what you and your wife were able to achieve. Have you by chance written about this in more detail anywhere?
The lack of an apparent positive intention is one of several ways to differentiate parts from UBs, and you’re right that it’s not sufficient in of itself. It’s often the first indicator though.
A wonderful article and study. What I’d offer is that until we acknowledge the root cause of mental health conditions – which is clearly trauma in my view – we’re not going to have much luck escaping psychiatry’s marriage to the biomedical model. It’s more than clear by now how psychiatry got off-course and why it continues to stay there.
This study’s results are about as surprising as saying that people don’t think singing will help heal their broken arm. The only difference is that the consensus etiology of the broken arm is actually correct.
When we don’t understand the true causes of mental health conditions, we can expect the treatment of such conditions to be entirely misguided. Hence our epidemic of Pharma here in the west. Then we blame and shame people for not getting better.
“The pathologizing will continue until morale improves.”
This is where Internal Family Systems really takes things to the next level in my view. It’s wonderful to view depression as some kind of signal rather than being due to a mysterious gene, but the obvious question then becomes “What is it signaling?”. Odds are most people will go right back to cognitive-level talk therapies or simple behavioral changes in an attempt to hunt down the apparent cause.
With IFS however, we work things from the bottom-up by unraveling what’s going on in the unconscious that is bringing on symptoms like depression. The proximate cause is almost always going to be stuff from the past (trauma) rather than anything happening in the present. (Although things in the present can of course exacerbate it.)
I’d argue that all of these things (“psychosis”, anxiety, social problems) are symptoms – of trauma. But certainly, one aspect of good therapy work is addressing what a client wants to work on rather than imposing your own agenda.
Using cognitive/behavioral therapy for trauma-based symptoms is surface-level treatment at best, but that’s a separate issue. 🙂
I think Jay’s article here is a great look at what goes wrong with labels and diagnoses in general. We treat them as if they explain something, when in fact all they do is describe symptoms. This fundamental error is in my view what drives a lot of subsequent misunderstanding, shame, and judgement.
Hard to draw many conclusions from this study alone, but it aligns with a few things that are known already:
– Parental emotional support lessens the degree to which childhood traumatic events lead to trauma
– What’s important in any interaction is not what the parent intends, but what the child interprets – and the meaning which the child takes from it. Hence the difference between parent-reported and child-reported positive parenting.
I agree with all of this, but I’d note that a wider lens could be used to make similar arguments about any “disorder” listed in the DSM:
– They are all pathologizing
– The very notion infers that disorders are “things” (nouns) that people “have”, when in fact the evidence is clear (to me anyway) that they are dynamic processes (verbs) that come online as the result of trauma
Though I don’t think circumcision is a particularly good example, I wholeheartedly agree with the notion that essentially everyone in modern society is traumatized. The basic reason for this is that modern culture is traumatizing, and trauma begets trauma.
Part of the issue is that the way people define ‘trauma’ has typically been with a fairly narrow lens – overt things like wars, sexual abuse, car accidents, and…circumcisions. Widening this lens to include more covert/chronic situations – such as a lack of attunement with one’s primary caregivers – is very eye-opening. When our fundamental developmental needs as children aren’t met, the result is trauma.
Trauma in my view is a spectrum, and we’re all on it somewhere.
With the overwhelming majority of therapy these days being cognitive (top-down) and symptom-focused, these results are hardly surprising. No doubt I’m biased here, but I believe that differentiating based on modality would show substantial variations in effect, and bottom-up approaches such as IFS and EMDR would be shown to be far superior.
Sad to hear. The approach of the therapist is everything. If cognitive-level (top-down) techniques such as CBT/DBT are being used, it’s not surprising at all that the effects are marginal. In my view, true healing requires bottom-up modalities such as Internal Family Systems which work with the unconscious.
“Until you make the unconscious conscious, it will direct your life.” – Carl Jung
I think it’s helpful to ask “Why?” until a root cause is found. Regardless of how many people are on drugs for conditions like depression and anxiety, the question is Why have the incidence rates of virtually every mental health condition been steadily increasing for decades and decades? One could perhaps attempt to argue that it all started with over-diagnosis, at which point we over-prescribed and exacerbated the problem even more. But this doesn’t do it for me. The totality of the evidence, from my perspective, points squarely at developmental trauma – both overt and covert.
(At the risk of blatant self-promotion, my article on MIA from a few months ago goes into more depth on this.)
This is a great post. Trauma responses/adaptations/conditioning/etc are driven by the unconscious – there is no “choice” involved in any individual case.
What we can choose to do, however, is get to know these patterns: be aware of them, understand them, get in relationship with them. This is the beginning of true healing. (Note how this fundamentally differs from what we usually do: attempting to control, resist, or distract.)
We all have response-ability – the ability to respond to what isn’t working for us. But this has nothing to do with the type of blaming/shaming that comes along with the illusion that people have conscious control over their trauma responses.
This strikes me as largely being correlation rather than causation, though there’s no doubt in my mind that autonomy in general (beyond just “independent activities”) is a fundamental need of children, one which is often lacking in modern cultures. There are others though, including a child being able to feel their full range of emotions without their caregivers reacting negatively. Thee parent/child attachment relationship is everything.
Fair question. I don’t skip over events later in life to get to the earlier ones. I address things in whatever order they arise, because I trust the client’s inner wisdom – things will come to them in a given order for a reason. So we address things as they come rather than trying to trace back to some kind of “root trauma”. (I’m not aware of any theory which states that healing earlier trauma also heals later trauma, but it’s possible some people think so.)
That being said, I do think that traumatic events later in life such as bullying or abuse – when they are on-going/chronic rather than acute – are often indicators of earlier developmental trauma. Understanding how this works can be helpful for those who tend to self-blame.
Wonderful, thank you!
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Hey Sam,
I appreciate your response. IFS looks at DID in a similar way – that it’s simply a more extreme manifestation of how we all are naturally. In DID, the trauma has been so severe that the parts are often cut off from each other, as well as the Self. As you mentioned, the parts are often much more harsh – roles that they had to take on during the trauma to survive – and they can feel foreign to the person due to being cut off from the rest of the system.
That being said, UBs are very different (even though they may initially present the same). Whenever a possible UB is encountered in IFS, great pains are undertaken to 100% ensure that it isn’t a part before it is expelled. (Expelling a part would much things much worse.) I didn’t delve into this in the article due to lack of space, but assessing UB vs. part is the top priority before anything else is done.
It’s amazing what you and your wife were able to achieve. Have you by chance written about this in more detail anywhere?
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Robert Falconer’s book on this is wonderful if you’re up for diving in more.
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Thanks Ron!
The lack of an apparent positive intention is one of several ways to differentiate parts from UBs, and you’re right that it’s not sufficient in of itself. It’s often the first indicator though.
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Thank you Birdsong! Appreciate your feedback as always.
“The pathologizing will continue until morale improves.”
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A wonderful article and study. What I’d offer is that until we acknowledge the root cause of mental health conditions – which is clearly trauma in my view – we’re not going to have much luck escaping psychiatry’s marriage to the biomedical model. It’s more than clear by now how psychiatry got off-course and why it continues to stay there.
Report comment
This study’s results are about as surprising as saying that people don’t think singing will help heal their broken arm. The only difference is that the consensus etiology of the broken arm is actually correct.
When we don’t understand the true causes of mental health conditions, we can expect the treatment of such conditions to be entirely misguided. Hence our epidemic of Pharma here in the west. Then we blame and shame people for not getting better.
“The pathologizing will continue until morale improves.”
Report comment
This is where Internal Family Systems really takes things to the next level in my view. It’s wonderful to view depression as some kind of signal rather than being due to a mysterious gene, but the obvious question then becomes “What is it signaling?”. Odds are most people will go right back to cognitive-level talk therapies or simple behavioral changes in an attempt to hunt down the apparent cause.
With IFS however, we work things from the bottom-up by unraveling what’s going on in the unconscious that is bringing on symptoms like depression. The proximate cause is almost always going to be stuff from the past (trauma) rather than anything happening in the present. (Although things in the present can of course exacerbate it.)
Report comment
I’d argue that all of these things (“psychosis”, anxiety, social problems) are symptoms – of trauma. But certainly, one aspect of good therapy work is addressing what a client wants to work on rather than imposing your own agenda.
Using cognitive/behavioral therapy for trauma-based symptoms is surface-level treatment at best, but that’s a separate issue. 🙂
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Great point Kate, totally agree! When traumatic environments continue into adulthood, so must the coping strategies.
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Thanks so much Birdsong! Glad it resonated with you, and I appreciate the kind words as always.
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“Some disagree with the term ‘disorder’ to describe the aftermath of trauma, viewing it as the medicalization of understandable trauma effects”
I couldn’t agree more, and coincidentally just had this published today: https://cptsdfoundation.org/2023/06/22/examining-the-d-in-cptsd/
I think Jay’s article here is a great look at what goes wrong with labels and diagnoses in general. We treat them as if they explain something, when in fact all they do is describe symptoms. This fundamental error is in my view what drives a lot of subsequent misunderstanding, shame, and judgement.
Report comment
Hard to draw many conclusions from this study alone, but it aligns with a few things that are known already:
– Parental emotional support lessens the degree to which childhood traumatic events lead to trauma
– What’s important in any interaction is not what the parent intends, but what the child interprets – and the meaning which the child takes from it. Hence the difference between parent-reported and child-reported positive parenting.
Report comment
I agree with all of this, but I’d note that a wider lens could be used to make similar arguments about any “disorder” listed in the DSM:
– They are all pathologizing
– The very notion infers that disorders are “things” (nouns) that people “have”, when in fact the evidence is clear (to me anyway) that they are dynamic processes (verbs) that come online as the result of trauma
Report comment
Though I don’t think circumcision is a particularly good example, I wholeheartedly agree with the notion that essentially everyone in modern society is traumatized. The basic reason for this is that modern culture is traumatizing, and trauma begets trauma.
Part of the issue is that the way people define ‘trauma’ has typically been with a fairly narrow lens – overt things like wars, sexual abuse, car accidents, and…circumcisions. Widening this lens to include more covert/chronic situations – such as a lack of attunement with one’s primary caregivers – is very eye-opening. When our fundamental developmental needs as children aren’t met, the result is trauma.
Trauma in my view is a spectrum, and we’re all on it somewhere.
Report comment
With the overwhelming majority of therapy these days being cognitive (top-down) and symptom-focused, these results are hardly surprising. No doubt I’m biased here, but I believe that differentiating based on modality would show substantial variations in effect, and bottom-up approaches such as IFS and EMDR would be shown to be far superior.
Report comment
Sad to hear. The approach of the therapist is everything. If cognitive-level (top-down) techniques such as CBT/DBT are being used, it’s not surprising at all that the effects are marginal. In my view, true healing requires bottom-up modalities such as Internal Family Systems which work with the unconscious.
“Until you make the unconscious conscious, it will direct your life.” – Carl Jung
-Terry
healingtheself.net
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I think it’s helpful to ask “Why?” until a root cause is found. Regardless of how many people are on drugs for conditions like depression and anxiety, the question is Why have the incidence rates of virtually every mental health condition been steadily increasing for decades and decades? One could perhaps attempt to argue that it all started with over-diagnosis, at which point we over-prescribed and exacerbated the problem even more. But this doesn’t do it for me. The totality of the evidence, from my perspective, points squarely at developmental trauma – both overt and covert.
(At the risk of blatant self-promotion, my article on MIA from a few months ago goes into more depth on this.)
Report comment
Agreed! Forcing someone makes no sense – almost by definition, they’ll be resisting while being forced, resulting in the worst possible outcome.
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This is a great post. Trauma responses/adaptations/conditioning/etc are driven by the unconscious – there is no “choice” involved in any individual case.
What we can choose to do, however, is get to know these patterns: be aware of them, understand them, get in relationship with them. This is the beginning of true healing. (Note how this fundamentally differs from what we usually do: attempting to control, resist, or distract.)
We all have response-ability – the ability to respond to what isn’t working for us. But this has nothing to do with the type of blaming/shaming that comes along with the illusion that people have conscious control over their trauma responses.
Report comment
This strikes me as largely being correlation rather than causation, though there’s no doubt in my mind that autonomy in general (beyond just “independent activities”) is a fundamental need of children, one which is often lacking in modern cultures. There are others though, including a child being able to feel their full range of emotions without their caregivers reacting negatively. Thee parent/child attachment relationship is everything.
Report comment
Fair question. I don’t skip over events later in life to get to the earlier ones. I address things in whatever order they arise, because I trust the client’s inner wisdom – things will come to them in a given order for a reason. So we address things as they come rather than trying to trace back to some kind of “root trauma”. (I’m not aware of any theory which states that healing earlier trauma also heals later trauma, but it’s possible some people think so.)
That being said, I do think that traumatic events later in life such as bullying or abuse – when they are on-going/chronic rather than acute – are often indicators of earlier developmental trauma. Understanding how this works can be helpful for those who tend to self-blame.
Report comment
Thanks so much everyone for the kind words. Lovely to see this stuff resonating with you.
Birdsong: I appreciate the website feedback very much!
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