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Emma shares about complex trauma, deprivation, and dissociation (CPTSD, OSDD, DID). Educational, supportive, and inspiring, System Speak documents the best and worst of life through insights, conversations, and collaborations. An archive curated for dignity for all.
Welcome to System Speak, a podcast about Complex Trauma and Dissociation. It's our story, our learning, and the ideas we've been working with as they've unfolded over time. Earlier episodes give context for where we are now, and current episodes may engage more advanced material, harder content, or reference earlier conversations. A few things to remember as you listen. The podcast is education, reflection, and storytelling.
Speaker 1:It's not therapy, and listening doesn't create a relationship. Although I am a therapist, I am not in that role here, and nothing that I share is individualized clinical advice. Every system, every internal world,
Speaker 2:all of your own stories are all different and you take
Speaker 1:up your own shape. What we share about ours won't translate directly to yours. It isn't meant to. We're all different, and all of our stories matter. As always, take care of yourself during and after listening, and we are so glad you're here.
Speaker 2:Okay. Can you see and hear me okay? Our favorite topics, Infanticidal Attachment and Chronic Suicidality. Obviously, these are some of the hardest ones. You're already joking about it in the chat.
Speaker 2:But, seriously, please care for yourself during and after listening to this training practice. It is a practice, so I may have to stop and fix things or all of that. We are also recording it for the podcast, so if you do not want to be on the podcast you can type anything and also questions as we go are okay and helpful. Alright. Okay.
Speaker 2:You know I like history, so we're gonna do some history because I think it's really important that we understand the context, that clinicians understand the context of where we're coming from. In case you haven't heard us talk about it before, unfortunately, one of the things that is happening in schools and educational settings and even in clinician trainings of that is that people are teaching students techniques, which is great. There's no shame in having good technique. We want therapists to have good techniques. And also it is so pulled away from theory, And if people aren't understanding history or where some of these things come from or how to actually do therapy, then the techniques can, not just backfire, but leave both the clinician and the client kind of stranded when we get into territory that technique does not address or when it's something else going on.
Speaker 2:Like, for example, relational trauma, which is different than incident trauma. Right? So complex trauma from childhood, complex trauma from domestic violence or interpersonal violence is different than a car accident that is specific over in the past. We process that differently than something that is chronic, relational, and ongoing. So if we go all the way back to Charcot, where hysteria, which is what it was called at the time, was moved from suspicion of just, we don't know what's happening with women when they have feelings into the category of observable clinical disorder.
Speaker 2:That was what was helpful is that we identified, oh, this is a medical thing. This is a real invalid thing. This is actually happening. And then it turned out after studying, once we invented the railroad and trains and there were workplace accidents, we found out that, oh, men can also have trauma. And it is not just because of women and their wandering uteruses.
Speaker 2:We need to keep those under control, ladies. It's not about that. Right? So literally that we had to go through this timeline of learning that. In his clinic, I'm using the word clinic because it's how we would say it today.
Speaker 2:It was a whole different thing. He taught Freud and Genet and Bene like, all of these timelines that we talk about these different schools of thought in regards to dissociation went through Charcot's clinic. And also part of how they did clinics back then were the demonstrations where someone would come out. You all have seen my presentations before about the history of DID specifically, where, it has all the men sitting around with the woman in the front and the painting on the wall, that illustration of this spectacle where women patients were photographed and demonstrated before audiences. And when theater was discredited, the phenomena went down with it.
Speaker 2:So the thing that was good is how much Charcot did to validate trauma responses as an actual medical issue. And what was hard is that patients were really exploited through those demonstrations and how much was sort of written off when the theater of it was discredited and no longer what it used to be. We have Freud, and I know about the great recanting and all of that, that's a different side quest. But what Freud proposed initially about childhood sexual trauma causing hysteria and traumatic memories returning through symptoms mattered because he was putting together not only are the experiences and what they are presenting and reporting valid and real, and also the cause that has led them to be experiencing these systems symptoms is also real. It was Janae, though, who really described dissociation as multiplicity of consciousnesses.
Speaker 2:So it was not a divisibility. It was, very much the fixed ideas that trauma really becomes intrusive, what we now call intrusive symptoms. He talked about alternating states. We have journals from several different women even before this time where they described different parts of themselves and different personalities and how they were so different than each other. He also talked about structural organization, but all the things that Genet gave us was really overshadowed by Freud's dominance through culture.
Speaker 2:Even though we have the great recanting of Freud and also Genet's framework then falling out of citation, even though his observations kept resurfacing under other names. So there are some schools of thought that we still follow that were because, we can trace all the way back to Genet. We have, I'm skipping way into time over, mid century, But when we get to Henry Stack Sullivan, the reason I'm mentioning him specifically is because that is who gave us the good me, bad me, and not me. Those other mes, that language comes from Henry Stack Sullivan. Henry Stack Sullivan was an amazing guy.
Speaker 2:He worked with lots of gay men who were diagnosed with schizophrenia because they were gay. Not that they actually had schizophrenia. I suspect some of them had complex trauma that was being described as schizophrenia, but he was able to cure these people in the way that other schizophrenics were not able to be cured through relational treatment. And he talked about trauma responses as interpersonal and, really had this language that we even reference now the same concepts in attachment theory. So we didn't have attachment language yet, but this is what he's talking about.
Speaker 2:So the good me is the part of me that experienced tenderness with my caregiver, even if it was not the parent or the mother or the father. The bad me is the part of me that experienced disapproval from my caregivers. And the not me is the part of me that experienced the anxiety, like that double bind of we can't be held at all. Some of us were not literally. And also if I can't figure out what that contract is socially, we're not able to do the things to gain the approval or the tenderness or the care.
Speaker 2:And also we are experiencing harm from our caregivers. So we can't even experience a self because there's no self being related to. So we keep that not me out of awareness and that dissociation got described in relational terms before we ever had language for it. Later, we had the DSM changes. I'm not gonna go through all that right now.
Speaker 2:It's a whole different side quest. But part of what's important is that when we're talking about suicidality now, we have for the first time with the DSM-five TR from 2022, that suicidality for the first time can be documented in diagnosing or as a diagnostic category apart from any other diagnosis. So before suicidality was considered maybe a side effect of depression or a side effect of the overwhelm from anxiety or a result of psychosis, like it always was connected to another diagnosis. But we now for the first time have specific codes for the first time someone presents with suicidal behavior, the next time someone presents with suicidal behavior, and then after that, a third time they have history of suicidal behavior. We also have the differentiation for the first time between suicidality and non suicidal self injury, or what we call NSSI, that does not also does not have to be connected to any diagnosis.
Speaker 2:So they can have current non suicidal self injury, or they can have a history of non suicidal self injury, but it can just stand on its own. This is really important because of what we know about complex trauma. It's really important for what we know about getting CPTSD into the DSM eventually. We've got it with the ICD-eleven. And also this is a way at least we can document it as part of the chart or as part of the history, as part of the record.
Speaker 2:If this is what someone is experiencing, we no longer have to justify it through something else. So when we get to the nineties, one of the things that the other really big relational piece that I wanna come back to when we're describing dissociation is Philip Bromberg. And I know we're jumping around in the timeline a little bit, but the reason Philip Bromberg is so important is he's the one who described the self as originating, not all integrated, that multiplicity was a normal developmental organization. And so trauma disrupted that normal integration that happens developmentally. And it's really important that this comes through because whether you're a fan of structural dissociation or not, and y'all know I have a whole separate side quest soapbox about all of that, but those pieces that are really good in structural dissociation are Philip Bromberg's.
Speaker 2:And I think it's really important for wisdom credit that we're naming that explicitly and teaching that explicitly and not just saying, here's the good piece of structural dissociation. Because the good piece of that came from Philip Bromberg. And it's okay to just say, here's what we got from Philip Bromberg because that's where they got it too. So the other piece of that is part of what we do to heal relationally is stand in the spaces between parts of self, between states, where even the therapeutic relationship becomes a space where self states can coexist without annihilation. And that annihilation piece is really important, so we're gonna come back to that.
Speaker 2:This is where we get the importance of those codes for suicidality standing on their own. And it's also important because these are symptom codes rather than disorders. So the clinical impact of that or consequence of that is that chronic suicidality can now be named in the record without being attributed to a mood disorder that does not fit. That was really important in 2022 because we were realizing that there were causes of suicidality that were not organic. At the time, we were still understanding depression or anxiety or mood disorders as these chemical imbalances.
Speaker 2:And so thinking that caused chronic suicidality. So to be able to have other causes of chronic suicidality was really important, even though also we're now understanding depression and anxiety differently, and that those can also be a symptom or result of even with organic changes being because of trauma and these other experiences. So when suicidality functions as an attachment strategy, which is what we're gonna talk about today, before we had to code it as depression and it might not even show up in history, that doesn't help the client, and it doesn't help with reimbursement when clients need that from insurance, especially in The States. So with the ICD-eleven, when we're getting CPTSD, what is important is that it was proposed by Herman in her book Trauma and Recovery, and it did get into ICD 11 in 2019, but it did get narrowed down. So she wanted it broader than it was, but we did at least get it in there.
Speaker 2:So if you think of CPTSD as PTSD plus the three things of affect dysregulation, negative self-concept, and disturbances in relationship, The other two things that Herman wanted, somatization and dissociation, are still in the text as features, but they're not a criterion. So someone could have CPTSD according to ICD 11 without physical symptoms or dissociation. But what's really important is how we consider, the language that we're using, what we're talking about. So today, when we're talking about trauma, we're referencing the harder bad things that happened. And then we've got deprivation, which we learned from Steve Gold, the good that was missing.
Speaker 2:So protection, nurture, eye contact, attentiveness, all of those pieces. So PTSD being post single incident specific trauma that's happened, it's finished, and now we're having symptoms because of it. So like a car accident having symptoms after the car accident has happened, we're no longer in the car accident, and also maybe having visual flashbacks or aural flashbacks or something like that. But with CPTSD, what is the complexity in the CPTSD is that it is chronic, it is relational, and it is ongoing. So if we circle all the way back to Freud, the other piece that happened or that we we really learned from Freud's work, especially with Charcot's work, learned it was not just women that could have trauma.
Speaker 2:And then with Freud developing the deaf drive concept, we learned that he was noticing that war neurotics, was what they was called at the time, any symptomology was neurotic, they were dreaming their way back into their worst nightmare over and over. So they were having these nightmares. And the pleasure principle that Freud had talked about could not account for a mind that returned to what injures it. So if there were only the pleasure principle, if we were only measure if we were only motivated or driven by what feels good and right to us, then we wouldn't, instead of having nightmares, we would be having dreams about the things that we want. We would be focused on the things that would help us or heal us or progress us in life.
Speaker 2:Even in our dream states, we would be thinking about good things. It would be all this, what we now call bypassing or toxic positivity. Right? So it's not that we can't do those things, but what happens is that our brains and our motivations go back to protection. We know what's bad.
Speaker 2:We've learned by experience what's bad. We don't wanna repeat the bad. And so we get hyper focused on the bad so that we can predict it before it happens. So he really positions the, death drive as opposite of eros, which is like the binding force. So what combines and connects and holds a life together, the death drive is what unbinds it.
Speaker 2:He got that from Plato's symposium actually, and it carries this sense of the force that draws things toward union. So like self preservation, attachment to objects, healthy sexuality, including libido, those kinds of developments that help us towards living an ongoing life as opposed to this death drive that's why are we wanting to go back to war. Now here's what happened and why this piece of history is important. Mostly with the great recanting and other things, this was rejected by Freud's circle. But Klein built on it, and it has continued to circulate.
Speaker 2:So what happens is it looks like trauma repetition, different than reenactment, but it leaves the cause inside the person. Like, I keep getting in these bad situations because I keep choosing badly or doing bad, and really that's what led us to DVT. So I'm gonna show you that. Ferenzi, though, did the opposite. He diverged from this and kind of flipped the script.
Speaker 2:He said the reason we're doing it is not because the cause is inside us. The reason we're doing that is because it is a response to our environment. And in fact, he talked about that the children even have to be actively induced by love and care to even accept having been born. So when we are deprived of love and care, when we are unwanted children, when we are neglected children, when we are deprived children, there's a part of us that is struggling even to accept having been born. And so we are attuned instead of to life like the eros.
Speaker 2:We're more attuned to not existing, not even death necessarily, but not existing, like the void, the abyss. And that's why some of us have those feelings inside of us. And so the destructive tendencies of the death drive sort of fall into that to protect us by noticing it. But what that leaves us is sort of in the depths of it and how painful and dark and deep that can be. So rather than trauma damaging the child, Frenzy proposed that the caregiver's welcome is what makes life tolerable.
Speaker 2:And when we are unwelcomed children, that absence itself is the injury, which is what Gold is talking about for deprivation. And this is what Ada Sacks came back and talked about with infanticidal attachment. So we're going to get there. But what happened with Klein is that she focused on the death drive, kept talking about the destructiveness and then that even the envy in the infant. And so what happened clinically with abuse survivors is that we got focused as bad, what ultimately became bad behavior or, the badness within us.
Speaker 2:Forensi's approach that school kind of got lost because he died while this was still sort of in debate clinically, amongst the professionals, the pioneers in the field, but Klein stayed alive and developed a school. And so because there was an institution that continued to teach this, we sort of lost some of the good that frenzy was offering. And what happened with Klein is that it went on to describe the splitting of the object. So dissociation divides the personality. That is not the same as the splitting dividing the object.
Speaker 2:So the borderline construct inherited that splitting from Klein, and the inheritance is still visible. So DSM five criterion nine names transient stress related dissociative symptoms, and the manual's already conceding some overlap. We have that vague reference to frenzy that no one even knows is there unless they know frenzy's work. But that overlap is larger than what is explicit with the DSM because dissociation is present in more than two thirds of borderline presentations, and the dissociative disorder comorbidity is substantial. So if we look at this again, Freud put the destructiveness inside the infant.
Speaker 2:Klein kept it there and built a school that taught that. And then the borderline construct, so literally this reenactment over generations, now the child of the school, the borderline, the people with the borderlines, collectively, the borderline carries that inheritance forward, that intergenerational trauma forward so that a survivor suicidality becomes an attachment strategy that gets read as a person who is difficult, as someone with bad behavior, as someone with bad relationships. And so we need to be assessing for dissociation before we're doing character reading of our clients. Now we're gonna circle back to that in a minute, but for now, looking the other thing that was happening simultaneously through the mid century, which is why we skipped it a minute ago, is that the behaviorism was growing. So we got the law of effect in 1898 and we got Watson's behaviorist manifesto and then Pavlov in 1927.
Speaker 2:And then in the thirties and fifth like, thirties through the fifties, sixties, into the sixties, Skinner's work with all the behavior. This happens and they do this. This happens, do this. We can train them to experience this and do this. We can make it happen so that this happens without this happening because it happened that way in the past.
Speaker 2:This whole cognitive revolution displaced the interpersonal aspects that were happening. So when we think of patterns then as behavior, behaviorism ruled that interstates outside of the boundary of science from roughly, like, 1913 to the sixties that outlived its metaphysics. So that is how we got into DBT from Klein's school and behaviorism. I know it came from Linehan, but this is the, like, the the ancestry, the genealogy of it, if you will, which now becomes dominant treatment frame for chronic suicidality, even though it's frequently misapplied. So I know we've talked about this a lot on the podcast, the difficulty of DBT, but most often what I have seen, I can own that that is my own soapbox and bias, But my struggle with it is not DBT itself.
Speaker 2:My struggle is the misapplication of DBT, which is not actually DBT. And so DBT with relational treatment can be very good and helpful. That is a beautiful thing. Skills with relationship, that's development. That is what childhood was supposed to give us in the first place.
Speaker 2:But putting worksheets onto a person and expecting them to have skills without relationship, that's ableism. And that is not the way Linehan designed DVT with groups and all of the things. We need the relationship structure to be able to learn the skills so that we can develop. It's not just about memorizing what's on the page or doing the things. It's about relationship with others and relationship with self.
Speaker 2:So in this way, behavior gets explained without reference to what happened to the person. And so we have these three different traditions that each have their own vocabularies, but all land in the place where the cause for the bad behavior or the bad relationships is inside the patient. And that is ableism, and it's not okay. So linking all of this together in this oversimplified recap, Freud's drives toward eros of death described an internal experience that was being observed by Charcot. Forensies linking that internal experience in response to external environment, so caregivers, made it a relational thing even though we didn't have that language yet.
Speaker 2:And then Sullivan's interpersonal patterns before we had language for attachment, basically, we could translate into thinking, am tolerated by others, so I am good. I am not tolerated by others, so I am bad. This is intolerable, so I am not me. Right? So then the patterns of behavior as survival we notice are trying to avoid harm, trauma, or to receive care so that we're not deprived.
Speaker 2:And that's just basic mammal stuff. All mammals to survive need care and need to avoid harm. So Ana Gomez, when I saw her present at ISSTD in 2024, really brought this full circle back to, we can notice the patterns without limiting it to only behavior as if the badness is in the person. It is actually the goodness in the person to use the patterns insightfully to apply strategies of behavior to try to survive by avoiding harm and receiving care. And that's how we get to attachment theory.
Speaker 2:So with BOLB back in '69, attachment is a behavioral system built by evolution to keep a small human near a larger one. Proximity is not about preference. It is how we survive. So the child will maintain that attachment at any cost, including sacrificing oneself or part of oneself. Right?
Speaker 2:So putting that in the context of mammals and primates and humans of what will we sacrifice of ourselves to survive by maintaining that attachment. So then Ainsworth did the famous strange situation experiments and came up out of that, came up with the three patterns of secure attachment, avoidant attachment, and what we call then ambivalent patterns. And each of them as an organized strategy for what was available from that particular caregiver. So what's really important about this that I think has gotten lost over time is that we say that or we think or imply that some of those are better than others or that it's a label we're stuck with on our forehead forever. This is not actually the case, and I would really challenge that.
Speaker 2:Because the strategy we use is in response to the care and harm we are receiving that we're experiencing. And all of the strategies work in that context. So when we change the context, we also change the strategies. When I am in a safe and secure relationship where I'm receiving care, I don't have to have anxious attachment because I am secure in that relationship. If I am in a safe and secure relationship, even friendships, like any ships, right?
Speaker 2:If I am in a safe and secure ship and I am not being harmed, there's nothing that needs me to, like, get away from it. I don't need to avoid anything because I'm not being harmed. Now I also just for full transparency, I also don't mean that that's easy. When we have grown up using particular strategies with particular caregivers, we are going to more quickly default to some of those styles because it's what we have the most practice using. So I'm not saying it's a light switch we can turn on and off and just like, oh, well, we don't have to use that anymore.
Speaker 2:We can go like, I know that it takes practice and I know that it's hard. I'm just saying that it is possible. Later in the nineties, Maine and Solomon talked about a fourth pattern in which the strategy itself collapses. So they notice infants freeze, they approach, let me back up. They notice that infants could be held but freeze.
Speaker 2:They noticed infants, like toddlers, preschoolers could approach but look away instead of making eye contact. They can move toward the caregiver and then kind of veer off, or they could start towards the caregiver and just kind of stop. And so ultimately what happened is they classified these kids as disorganized because there was no option available. If I approach my caregiver who is hurting me, I will be harmed. So this is the other thing where translation over time has gotten misapplied and been really harmful.
Speaker 2:Disorganized attachment does not mean you are bad. Disorganized attachment does not mean you have failed. Disorganized attachment means your care was disorganized, and you were trying to use all of the strategies. You were trying to approach to receive care, and you were trying to avoid being harmed. That's what disorganized attachment is.
Speaker 2:So this happens when the caregiver is both the solution and the threat. So looking at this, looking at this at the time when my friend Peter Barrish, who has been on the podcast, was literally studying with these people. He noticed that when a child is in this position of the care being disorganized where they could approach the caregiver, but the caregiver was gonna be the one who harmed them. He recognized that what Bowlby had been talking about as detachment and what dissociation literature was calling dissociation was the same thing. And when you add active abuse on top of that, then dissociation itself becomes the attachment adaption.
Speaker 2:So then Jennifer Fry took this further and said detecting that it is our caregivers who are harming us, even though they're supposed to be caring for us, requires us to withdraw from the person to stay alive and also we must depend on them for survival. And so knowing what we know is what has to go. Because we cannot fully sacrifice ourselves and remain alive, we sacrifice our awareness of ourselves. So the amnesia that happens with dissociation is not about reducing suffering. This is what for years before Jennifer Freid, for decades, for a hundred years, this is what we thought, that someone's trauma was so bad and so significant, like the incident of this kind of abuse or that kind of abuse was so bad that it led to the dissociation.
Speaker 2:And Jennifer Freid said, no. The amnesia is so that it is possible to maintain attachment. So they described what was impossible, not just a double bind, but the impossible bind. Peter Barrish said the personality has to dissociate from itself in response to that. And Jennifer Freid said it's the memory that goes because the alternative is losing the caregiver and dying anyway.
Speaker 2:So this is an important piece in history because Peter Barish linking attachment dissociation happened before we had the language of disorganized attachment and noting that disordered attachment was a cause. So Peter Barrish was trying to say this even before we got to CPTSD or what complex trauma is. He was following Bovie, emphasizing the psychodynamic of what was going on. But then we start to like, from this work, we have actual attachment theory. Lions Ruth added to this later that, yes, frightening behavior is one route.
Speaker 2:So if your caregiver is literally threatening you, of course, you're gonna dissociate because you rely on them to stay alive even though they're harming you. But she said it's not just the literal threat or the literal harm that can cause it. It was Lyons Ruth who said disrupted effective communication does it too. So withdrawing care, role confusion about who is the parent or the child getting to be the child and also grow up into an adolescent and grow up into an adult, contradictory signaling and failure to repair. The caregiver who is unreachable is as implicated as the caregiver who is alarming.
Speaker 2:So emotional hostility, emotional absence, physical absence, and actual harm to the child's brain are all the same. And then we got this in '20 in 2004, we got the disorganized child build several incompatible working models of self instead of one. The persecutor, the rescuer, and the victim held simultaneously and unintegrated. That multiplicity of models is the developmental precursor of dissociative structure. So trauma dissociation and disorganized attachment are like three strands of one braid.
Speaker 2:So when we talk about we don't wanna do the drama triangle in our ships that we can only rescue our own babies, Healing also means we have to recognize we are the baby and that how we have treated them or not treated them is the harm to the baby, that we've learned that from our caregivers. So, yes, the reenactment happens when we act the drama triangle out in our ships this way laterally, but it only can happen there when it's happening in here this way. So we are given the drama triangle by our caregivers harming or not caring, And then it is inside us and healing that inside us is what prevents it from being enacted externally in reenactment ways. Letting it surface in therapy where the therapist can help us tend to it safely, that's an okay enactment. In therapy, we want things to surface.
Speaker 2:But reenactment happens when we don't tend to it and it comes out sideways. So when we're talking about folks with borderline or complex trauma or OSDD or DID, they are not dramatic because of trauma drama carried around with them. It looks dramatic because the drama triangle is running inside. The good me is the goodness that was victimized. The bad me is the trauma makes me bad, and deprivation makes me not worthy of care.
Speaker 2:And the not me is I could not stop the badness. I could not earn the care. I am still waiting for something outside myself rescue me. So when we have Sullivan's good me, bad me, and not me, it's about ways to organizing ourselves based on how and how much of what we experienced from what we were getting from our caregiver. It says caregiver's anxiety because that references a whole thing more than what we talk about anxiety today, but that whole dynamic we're getting from our caregivers.
Speaker 2:And then Cartman's triangle, the drama triangle, becomes an interpersonal model externally, but now we see that it happens internally as well. And then with lion's root, the child internalizes both sides of the relationship. The hostile position and the helpless position are both taken in and both carried forward. So if we had a parent who only screamed at us all the time, it's not just that we internalize how helpless we felt in those moments. We also internalize the screaming.
Speaker 2:And so we have parts of us that are so helpless, but we also have parts of us that are screaming at those parts still. And that is part of what needs help, part of who needs help in therapy. If we had a caregiver that would not see us, then yes, we have parts of us that feel invisible or don't wanna take up space or don't wanna have needs because they can't be seen anyway. But we also have parts of us that won't look to see them. And that's why we need help in therapy, an other to tend to those pieces, to those parts of ourselves, pieces of our experience and those parts of ourselves.
Speaker 2:So we experience attachment through dissociation as me, I'm the good one, or me, I'm the bad one, or not me, whatever bad is intolerable for the good ones, or not me, whatever is good, intolerable for the bad ones, or we, all the good and all the bad and the intolerable that we tolerate. That is what healing looks like. That is what our whole brain looks like. So often when we talk about healing with dissociation, we talk about, all the integrations or we talk about, oh, I'm feeling better and I'm not depressed anymore. I'm all that.
Speaker 2:But healing is feeling all the things and having access to it all the time and how intolerable that is and also being able to tolerate it differently because it's not all actually happening right now. And that is a lot to be learning in awareness and access to ourselves with our whole brain. And that takes time and it takes gentleness that was missing. Part of the deprivation was gentleness. We were deprived of gentleness.
Speaker 2:So clinically, that looks like structure that includes parts that attack and parts that submit. It looks like chronic suicidality playing an internal transaction role rather than a response to anything happening now. So with other folks who don't necessarily have complex trauma, their suicidality might show up because something terrible has happened. We see what's that movie at Christmas time. Like something has happened with the guy's money or job or something.
Speaker 2:And so then he's thinking about ending his life and then you have the whole movie. Right? Like something happened, it's causing it because I'm so desperate because of this thing. But with chronic suicidality and complex trauma, you don't need a thing to happen. It's the expected baseline we were conditioned in.
Speaker 2:So asking what triggered it can be really meaningless and actually make things worse because we don't need a reason. It's already the state of being. It's already the occasion. It's already the expect expected baseline. We'll come back to this.
Speaker 2:So what's really important is that we talk about attachment as strategies, not style. What kind of attachment I have isn't the same as fixing my hair or picking out what clothes I wanna wear. Attachment reflects relational strategies shaped by the kind of care or lack of that was present. Patterns emerge from what was required to remain connected and avoid harm. Those strategies carry intelligence that are shaped by context, not who we were.
Speaker 2:Yes. The movie is called It's Wonderful Life. Thank you so much. So anxious attachment is an approach strategy. So there's heightened proximity seeking in context of inconsistent care.
Speaker 2:There is increased signaling, supporting connection and protection. There's activation of attachment system reflecting hope for responsiveness. With avoidant attachment, you're trying to avoid harm. So there's deactivation to make distancing possible and distancing supporting protection from rejection, intrusion, or emotional pain. Early learning that proximity increases the danger of it because the autonomy functioning as survival adaption adjusts to that baseline so that safety is only felt from so far away.
Speaker 2:So if anxious attachment is an approach to approach strategy to receive care and avoidant attachment is a strategy to avoid harm, disorganized attachment is trying to do both. It was the care that was disorganized, not the person. There's a fright without solution arising from caregiving conditions and the caregiver's experience is both needed and dangerous. I need you to stay alive, but you're not gonna feed me anyway. I need you to stay alive, but you're not going to see me anyway.
Speaker 2:I rely on you to stay alive, but you are completely unreliable. The disorganization reflects that deprivation, fear, and misattunement in the relational process rather than it being a character trait about who the person is. So again, when we are safe and receiving care and not being harmed, We are capable of practicing secure attachment, and I think that's really important to remember. So when we talk about activation with approach strategy or deactivation with avoidance strategy, this shows up in suicidality in two ways. With the approach strategy or attach cry with hyperactivation, it is a don't leave me.
Speaker 2:This protest behavior is a bid for repair, for connection, and often gets mislabeled as manipulation, which is really one of the most violating things that can happen because that is so often a good me feeling victimized now being accused of being bad. That's really, really traumatic for those particular parts. For the avoidant or attachment collapse or deactivation, which is happening in dorsal vagal, that looks like numbness, shutdown, dissociation, and it appears low risk distance, so sometimes more hurtful to those who are an anxious attachment place, but it is more dangerous to self because the compliance becomes congruent with not existing. So we'll talk about that in just a minute. So suicidality with clients with complex trauma is often not a crisis.
Speaker 2:A crisis has an onset, a peak, and a resolution. But with dissociative folks, suicidality often persists. It reoccurs without occasion or cause and remains when circumstances improve. That's what makes this suicidality chronic. So it can be part specific where the suicidality belongs to a part rather than to the whole person.
Speaker 2:One self state may hold it, others may not even know it's there or may hold the opposite. It can happen with emotional flashbacks. So a flashback with no picture attached, the affect of the original experience returns without image or narrative or context. If we see a flashback like the car accident example, a car coming towards us or something, we know, oh, there's the context of what I'm seeing. I know I'm remembering.
Speaker 2:But with emotional and relational flashbacks, we don't have the context, so we don't know what's happening. And the despair, terror, or worthlessness arrives as current fact rather than history, which is why the person cannot point to a trigger or why reassurance about present circumstances does not reach it. Now as part of that, neurologically, it can also happen with implicit memory. So explicit memory is when you know you know you're remembering. So, like, if you remember what you had for breakfast this morning or for lunch today, you know that you're remembering, that's explicit memory.
Speaker 2:Implicit memory is what you don't know that you don't know you're remembering. So, like how to walk. If you are able-bodied and able to walk, if you know how to read and you don't unlearn how to read, you just know how to read. And so once you learn how, you don't know that you're remembering how to read. You just read.
Speaker 2:Right? That's implicit memory. So what can happen with chronic suicidality is that it is implicit memory. I don't know that I'm remembering how to align with my caregiver's rejection of me. I only know I'm trying to be invisible.
Speaker 2:I may not even realize that, right, with dissociation. I am trying to not have needs. I'm trying to not have wants. I'm trying to not exist. I'm trying to not take up space.
Speaker 2:I'm trying to not give evidence of my existence because my caregiver didn't want me, didn't honor my aliveness, didn't let me grow, which is part of being alive. Any living organism, if they're not allowed to grow, cannot survive. Right? So, I mean, that is that is the opposite of being alive. That is death.
Speaker 2:And so whether it's literal or metaphorical, that can be implicit memory where it's like, wasn't trying to kill myself today. And also the implicit memory is, I'm supposed to be very small. I'm supposed to be very invisible. I'm supposed to not take up space. I'm all the supposed tos, that's conditioning.
Speaker 2:So what is stored implicitly is a caregiver's wish that the child doesn't exist. That is infant infanticidal attachment. So when we define infanticidal attachment with sex, the attachment is organized around a caregiver whose stance is towards the child's death or nonexistence. The child builds an attachment strategy because the child has no alternative, and that strategy is built around a caregiver who wants them gone. In every other attachment pattern, including disorganized, the child's behavior still reaches towards safety, whether that is closer to the caregiver or away from the caregiver, that is where we're reaching for safety.
Speaker 2:But with infanticidal attachment, we are oriented towards death, towards invisibility, towards not existing. So now Sacks is actually arguing that it should stand as an attachment disorder in its own right rather than being a subcategory of disorganized attachment, but the field has not yet formally adopted that. So childhood infanticidal attachment means that in adulthood, suicidality, literally or metaphorically, is the attachment. The suicidality is not a symptom on top of the attachment or because of the attachment. It is the attachment.
Speaker 2:So staying alive can register as a betrayal of the caregiver. Every safety plan we write assumes the client wants to live and needs help managing an obstacle. But for a client with infanticidal attachment, living is what violates the relationship with the caregiver. Living is what breaks the rules. Infanticidal attachment happens in two forms.
Speaker 2:The symbolic, where the caregiver conveys without acting that the child should not exist, treated as if they're already dead, not letting them be as alive as a previous sibling who died, treating them as a mistake or as someone who was never supposed to be here or a mistaken decision to allow them to be there. It can also be concrete where the caregiver acts via attempts to literally and actually kill or torture that carries the actual risk of death. Concrete forms can show up as echoes later through direct expressions such as nonsuicidal self injury or ideation intent, plans, and attempts. Symbolic forms show up more passively and can be easy to miss because nothing appears to be happening. These folks are easy to work with, don't cause problems, and leave your office with you feeling like an excellent therapist.
Speaker 2:But that's not success on your part, that's them being compliant with the unspoken agreement not to exist or take up space. So examples of that symbolic being enacted, taking not taking up space, occupying as little room as possible physically and socially, apologizing for existing chronic invisibility that gets read as shyness or low self esteem, not having needs because the need is not suppressed after being felt, it just doesn't show up. Asked what they want, they're not withholding the answer, there is no answer. We're not allowed to have needs because needs are evidence of existence. And not even knowing what a need is.
Speaker 2:So hunger, rest, comfort, company, and help, those don't arrive as signals because the signals are for people who are allowed to want. Knowing what you want or meeting your needs are for people, for those who can exist. And with infanticidal attachment, we're not allowed to exist. And then also chronic self erasure that looks like humility, low maintenance, or being easy to have around, frequently crazed, sometimes for decades. In fact, our culture really, reinforces this, and I think it's a problem.
Speaker 2:So the organizing rule is that having a need asserts you exist. If existing against the rules, then wanting is a violation of those rules. Needing something is a rule already broken. We don't deserve it. It's not allowed.
Speaker 2:We shouldn't ask. And so the suicidality runs underneath it quietly, but with nothing visible going on the surface. So the clinical trap becomes asking, what do you need? As standard practice, even when well intended, but it can land as a demand they have no way to meet, so ableism. And also the non answer then gets charted as poor insight, low motivation, or resistance when actually it's survival.
Speaker 2:That reframe matters because there's a difference between coping and compliance. Coping implies a person is managing something, but compliance means they're following a rule that was installed and that they're following it correctly. So then the quiet client stops reading as the stable one and progress and healing looks like learning to say no, healthy disagreement, navigating conflict, expressing preferences, and need meeting. So chronic suicidality may actually be compliance with early caregivers. Dissociation increases suicide risk, but is often overlooked in assessment.
Speaker 2:Fragmented parts may hold contradictory intentions where one wants to live, another wants to die, but suicidal impulses can originate from dissociated states, amnesia, or trauma time. Some clients report an SSI or suicide attempts with no memory of the act. Trauma changes the landscape of suicidality. Exposure to complex trauma alters our stress response systems and relational templates. Suicidality can emerge from unprocessed grief, betrayal trauma, or coercive control.
Speaker 2:For some, suicidality is not a desire to die, but a strategy for escape, control, or connection. For others, suicidality may be a source of belonging, literally fulfilling their family role from childhood by existing as little as possible. Misunderstanding this will be misattunement, which leads to rupture, leads which to increased isolation, which leads to increased suicidality. So we need to identify what is being relived, what nervous system state is activated because that help us know what is happening, and then suicidality may reflect that implicit memory. So reorienting to present co regulation in parts differentiation.
Speaker 2:When suicidality is coming from memory time, it's not desire for death in the present. Those parts may be young or stuck in moments of terror or abandonment. I want to die may actually mean I want this to stop, which in now time means I want to escape from a memory that still feels real. So rather than asking, are you suicidal? We can ask how old is the part who feels that way.
Speaker 2:With the betrayal and dissociation, when caregivers cause harm, the child has to dissociate to stay attached. So that creates a loop where threat leads to dissociation, which increases isolation, which adds to shame, which increases suicidality. Betrayal trauma teaches the child, my pain must stay invisible. If I protest, I lose the caregiver. So then ultimately, I must be invisible.
Speaker 2:When it's a betrayal echo, suicide becomes a reenactment of
Speaker 1:the
Speaker 2:original rupture. A protest, a withdraw, a desperate attempt to preserve connection. I will prove to you how much I deserve care by not being here at all. When the parent has not done their own therapy and reenacts it and acts on it with children, that unremembered past shows up with the parenting. Or when there is a mother who is not alive either because of her own stuff or physically or psychically or emotionally absent after her own loss, then what the child attaches to is not actually the mother, but or caregiver.
Speaker 2:This is says mother because it's from the seventies. But rather than the child attaching to the caregiver, it's like the child attaches to a shadow of the caregiver because a shadow is all they're getting. So then the infanticidal attachment style or shape is actually relational vacancy. That relational vacancy shows up two ways in reenactments. Externally, it shows up outward, ending up with partners who do not let them exist.
Speaker 2:The arrangement gets rebuilt with someone new over and over with each relationship, even though each relationship may not allow them to exist in different ways. So this looks like relational instability, but the reenactment is having partners who don't let you exist. It can also show up inward or internally when not allowing themselves to exist inside those relationships, including those where they would be permitted to. No partner even has to enforce it. We just don't take up space.
Speaker 2:We don't express preferences. We don't identify needs. We don't speak up for ourselves. The inward version produces a client with a good partner, a stable life, and no complaint, but who does not actually exist in the relationship. When the child has a caregiver who could not metabolize their own stuff, when they pass on to the child unprocessed grief, unrealized desire, death wishes, or their own chronic despair.
Speaker 2:It shows up later in adulthood for that child with chronic suicidality that can feel like finishing the parent's story or completing an emotional contract, keeping faith with a suffering that no one has even said and was never actually even theirs. So one of the things we need to do in therapy is separate our own stuff from our inherited stuff. When we have persecutors or abusers that we identify with because we cannot get away, and that is our only option for attachment. So without someone who's present with us, we attach to the shadow. But when someone is present but dangerous to us, we attach to the danger.
Speaker 2:This creates internalized persecutory voices often mistaken for, like, self hate or negative self talk. That self destruction may imitate the caregivers. There may be contempt or rage or death wishes directed toward the child and discerning the client's authentic voice versus the caregiver's voice that got lodged inside. What is me and what is an echo becomes really, really important. So suicidality can communicate, please see me or help me escape or don't leave me.
Speaker 2:These are protesting silence, betrayal, and abandonment. And so it's important to validate what the message is even while we're trying to support and answer the questions in healthy ways. So why does the amnesia increase suicide risk? Because suicidal planning can occur outside conscious awareness. One part may know nothing of another part's intent or the presenting part in session may be non suicidal, giving a false sense of safety.
Speaker 2:We can notice when it may be indicated that this is happening because there may be time loss around dangerous objects. There may be unexplained injuries. I just woke up in a different place. Here it was. Or statements like, I wouldn't do that, but I worry someone else might.
Speaker 2:When we look at the ethics of this, mainstream ethics often emerge from white Western individualistic frameworks. And what feels risky in one culture may feel like ancestral grief in another. So with liberation ethics, we need to be asking who defines harm, who decides what safety means, and who benefits from institutional responses to suicidality. So what if the suicidality isn't just pathology but protest? What are they protesting?
Speaker 2:Against betrayal, erasure, abandonment, colonization of the self? And who are the people that most often get labeled as high risk? Usually, those who have been the least safe in our institutions. BIPOC clients, queer youth, survivors of state and family violence, and people with complex dissociative identities. There may be suicidality as ancestral grief.
Speaker 2:There could be disconnection from land, language, or lineage. There could be generational trauma like genocide or enslavement or colonization. Suicidality may reflect cultural rupture, not just individual pathology. So a liberation centered lens asks, what meaning does this suffer carry? What meaning does this suffering carry?
Speaker 2:Whose voice is speaking through this suicidal impulse? What does this part need to survive, not just to stop? Again, looking deeper than just the behavior. Shame arises when ruptures are not repaired. The child internalizes, I am the problem.
Speaker 2:My needs are wrong. So suicide becomes an attempt to eliminate what is bad, which is me. We can validate that shame is relational, not personal. We can practice repairing ruptures explicitly with our ships and our clients. We can help clients experience being held in mind without performance or perfection.
Speaker 2:We do not need to interact or promise care in ways to our clients that are inauthentic, but authenticity goes a really long way. For many of our clients, suicidality has been their primary emotional landscape. Therapy needs to help build new identity that isn't centered around pain, suffering, or attachment to death. And also, we can't just take away those things. If all they have is a shadow, it's too bright to turn the lights on, right?
Speaker 2:It goes back to that sunburn of care, but we can explore what future there is beyond just suffering. We can use guided imagery to help visualize a self that exists outside or beyond the trauma narrative or with a rewritten narrative. We can introduce meaning making practices like symbolic survival, identifying values beyond attachment wounds. Healing is not detachment. It's claiming the right to attach with consent, boundaries, and safety.
Speaker 2:So liberation means forming relationships where we don't have to perform safety to be safe, where we can protest and still belong, and where we can disagree and not be abandoned. Clients with infanticidal attachment patterns often experience doxical connection between love and destruction. Therapy must redefine relational safety while addressing the unconscious belief that self destruction is a form of attachment completion. We can, instead of saying, are you suicidal? We can ask, what part of you is struggling the most right now?
Speaker 2:What would it be like to feel less alone? What would safety look like for you, for others in the system, whose roles can be transformed right now and how we understand them or later in functioning? Even when there's no clear path forward, we can sit together in the dark. So when we're talking about safety plans, why don't we do safety contracts anymore? It's really not recommended to do safety contracts anymore.
Speaker 2:Formally introduced in '73 as a no suicide decision, It was an assessment tool rather than a contract, but this sort of got watered down like the other things we were talking about earlier. Over time, it got watered down and the name of it drifted. And so what became a gauge to risk, like to measure or assess risk, became something you had to sign. But there's no theoretical or conceptual model that supports that. It's also not actually consent or an agreement because it's conditional.
Speaker 2:You only receive care if you do it this way, or if you do it that way, I won't care for you anymore. So it actually becomes part of the reenactment. There was a in 2,001, there was a study where patients with a no suicide contract actually showed higher rates of self harm. And in 2000, forty one percent of clinicians using no suicide contracts had patients who died by suicide or made very serious attempts while under contract. And also in 2000, there was a study with no empirical evidence supporting no harm contracts in preventing suicide.
Speaker 2:So there's a lack of standard definition. There's a failure to provide clear theoretical or conceptual model to explain if it's actually even a therapeutic intervention. And the word contract implies legal authority and may limit open and honest communication. In 2017, we found in a systematic review of suicide assessments that most do not have adequate studies to even evaluate their accuracy, and those that did did not fulfill their requirements for sufficient diagnostic accuracy. However, in 2024, some argued that these criticisms were dated.
Speaker 2:Newer models are doing better, are stronger, and the purpose of a model is risk stratification that informs a clinical decision rather than predicting what the individual will do. So even with the strongest defense of predictive positions, it is an aid to clinical judgment rather than a replacement. Within one year of hospital discharge, three percent of high risk patients died by suicide, but sixty percent of suicide completers would be classified as low risk. So they're needing to research to do that better. So rather than it being something that we approach with sign here or go to the ER, we need to talk about what does safety mean for you?
Speaker 2:How can we support that safety? Who wants to live? What does living mean? Who does it feel dangerous to? How does it feel dangerous?
Speaker 2:How does it make us feel trapped? What is your plan for staying connected to yourself when it's hard? We need it to be collaborative, culturally responsive, and identity affirming. Traditionally, I won't kill myself if you promise not to leave. But with liberation, the framework becomes when it feels like no one is coming, how can we stay with that part together so that we shift from compliance to co regulation and move from control to connection?
Speaker 2:That's what makes the difference with suicidality. In conclusion, the relational field allows shame to be held, the bad me, and fear to be witnessed, what is intolerable, and aggression to be survived, the actual danger and its deprivation, While dissociated states enter awareness without collapse, the healthy all of me. Safety becomes co experienced survivability. Bromberg reframed safety. For him, the problem is not that dissociation becomes rigid because self states cannot coexist safely.
Speaker 2:Integration is not elimination of multiplicity. It is capacity to stand in the spaces between states without annihilation. What allows that? Relationship. When I'm experiencing infanticidal attachment and there is nothing between me and the abyss that I cannot survive.
Speaker 2:It is relationship that gives me presence that pushes the abyss further away. Safety is the client experiencing you as nonexploitative. The client can disagree without being punished. A protector part can attack and you remain steady and safe. A child part can emerge and not be shamed.
Speaker 2:Power is acknowledged rather than denied. When connection is consistent, structure softens. When connection is absent, structure hardens. When relational wounds are the organizing principle of dissociation, you cannot dismantle that architecture by removing danger alone. We dismantle it by introducing a new relational experience, connection that does not annihilate, authority that does not dominate, witnessing that does not exploit, boundaries that do not abandon.
Speaker 2:Safety is someone is with me and not harming me. Safety is come here, don't hurt me. Chuck Finenkasa said, safety is not the absence of danger. It is the presence of connection and community. Thank you so much.
Speaker 1:Thank you so much for listening to us and for all of your support for the podcast, our books, and them being donated to survivors and the community. It means so much to us as we try to create something that's never been done before, not like this. Connection brings healing, and healing brings hope.