Thomas Hübl: Welcome back to the Collective Healing Conference. My name is Thomas Hübl and I’m the convener of the summit, and I’m honored to be sitting here with Dr. Judith Lewis Herman. Dr. Herman, warm welcome to you. I’m very happy to be speaking to you.
Judith Lewis Herman: Thank you for having me.
Thomas: Yes. And I want to start with first of all, acknowledging your work. I think for a long time you really look deeply into the effects of trauma, the effects on trauma on individuals, but also our as society and how we live in a field of trauma. And I am very passionate about it. I feel very inspired by your work, and I would love to acknowledge how much of your life force went into opening a path in society. So first of all, very much thank you to you and to your work. You wrote a sentence that very much caught my attention and I would love, it’s about one of your books, I think it was Trauma and Recovery, and you wrote, I expect a book to be controversial first because it is written from a feminist perspective. Second, because it challenges established diagnostic concepts, but third, and perhaps most importantly, because it speaks about horrible things that no one really wants to hear about. And I found that amazing. And so I would love you to speak a little bit to the controversial part of your book and how it affected society, but also what you mean with these three parts, especially how it changed diagnostic concepts that I’m very interested in. And then maybe also about the things that nobody really wants to hear about. And so maybe we start a conversation here.
Judith: Okay. Well, I think in some ways the diagnostic concepts part is the simplest to talk about because what I proposed in trauma and recovery was that trauma really needs to be understood on a spectrum of disorders rather than a unitary disorder. Because the impact of single trauma, and particularly a trauma that is not of human design or accidental and is very different from the impact of prolonged trauma, especially if it begins in childhood, but even if it begins in adulthood. Because if you have a single impact trauma that means whatever or the terror of the moment afterwards, the person is able to escape to safety. An auto accident would be an obvious example.
And by contrast, if a trauma is prolonged and repeated, it means that there is no escape, which means that a relationship of coercive control has been established. It means that there’s a relationship of dominance and subordination, then it’s enforced periodically by violence. And when that happens, it affects one’s entire sense of self and relationship to others. It means that one has seen up close the cruelty and malice and desire for complete control. One has seen tyranny up close. And that’s true whether you’re talking about prisoners of war and political prisoners and torture survivors, or whether you’re talking about survivors of incest and domestic violence and child abuse or survivors of sex trafficking, human trafficking, you’ve seen human criminality up close and that affects your sense of who you are and your sense of trust. And whether there’s, it doesn’t just produce nightmares and flashbacks and freeze response. It affects one one’s whole sense of oneself in the world.
And so I propose the concept of complex PTSD, which has now finally 30 years later, been recognized by most of the world. Well, by the World Health Organization, the ICD 11, the of the United States lags behind the rest of the world. We still don’t have that in our diagnostic manual, but I really thought of that as one point along the way from an acute stress response that self-limited and doesn’t proceed to post traumatic stress disorder to the standard PTSD to complex PTSD and at the extreme and the dissociative disorders. I think at least that concept of a trauma spectrum has been generally accepted now.
Thomas: Yeah, that’s interesting because that’s how I quoted you in my book. So that’s why I love when you speak about this, especially the complex PTSD. Maybe you can speak a little bit about, you said it changes your sense of self and how the self experiences itself in relationship to the world. Maybe you can speak a little bit how that sense of self changes and maybe also what did you find in the treatment that really works to reverse that because we are also interested, okay, there are states of complex PTSD, what is actually what brings relief or what brings transformation, healing integration. Maybe you can speak about these two things a little bit, how this sense of self changes and what really heals
Judith: Well, as we understand the formation of a sense of self, it is formed developmentally in a relationship of safe attachment. Safe attachment means a relationship of mutuality. It means a relationship where, I mean, if it’s a parent and child, there’s the power imbalances of extreme of course. There’s no power equality, but there can still be a sense of mutual respect of negotiation, of fairness, of mutual caring of. And it’s in that kind of relationship that we form both our sense of trust and our sense of trust in ourselves. And so when is one is subjected to a relationship of coercive control where none of the, where there is no trust, there is no mutuality, there is no fairness, there’s only command and obedience.
And very often as will in the course of control relationship, it’s not enough for the tyrant to break the victim’s will, to have a submissive victim. But often the tyrant demands war. The tyrant demands a willing victim. The tyrant demands that any responsibility for the harm be taken in by the victim. If you had only behaved better, if you had only obeyed better, if you were only a better person, then this wouldn’t have happened to you. And in fact, one of the most devastating methods of course, of control, well, there are the methods that induce fear and terror, but definitely are the methods that induce shame, control of bodily functions, forcing people to do things that are disgusting and degrading. And then finally forcing people to do things that violate their own attachments and moral principles in the purpose of torture is to get the political prisoner to portray their comrades in the sex trade prostituted, women are made to recruit others and to participate in the seasoning of others and domestic violence and child abuse, oftentimes the abused woman will say, “Do anything to me, but just don’t touch the kids.”
And then, but by the time he is abusing the kids, she’s too terrorized to intervene. And so she witnesses passively the abuse of her kids. And when once you’ve betrayed your own moral principles and your own closest attachments, oftentimes people feel that they not only are ashamed and guilty, but that they don’t deserve to live.
How do you repair that in a relationship with mutuality? And you can’t assume that a trusting therapeutic alliance is going to exist on day one. It’s not. It has to be built over time. It’s one reason. There’s no quick fix. You’re not going to do six sessions of CBT or EMDR for complex PTSD might work fine for an auto accident, but not for complex PTSD. You have to establish a relationship. And only after trust has been established can you do the trauma focused work of creating a trauma narrative that integrates a trauma into a life story so that the person is not utterly defined by the trauma, but trauma is inescapable part of the person’s life and then grieving everything that has been lost. And that’s a process of psychotherapy that takes some time.
Thomas: That’s a beautiful point because I think you said something very important that lives a bit in contradiction with our fast paced, fast, what I call sometimes the fast food world, that we want everything very fast. We want a quick fix and we want it as fast as possible. And how can we be very clear about it that especially complex PTSD really needs its time. And often I believe that sometimes the urge for a quick fix is already a symptom of the trauma. And how can we also create a cultural environment that understands that the depth that’s needed is really important. And maybe how did you create this in your work?
Judith: Well, the cultural environment that we’re in, first of all, it’s a capitalist environment where nobody wants to pay for mental health care and certainly not for long-term treatment. I mean, I worked at a public sector safety net hospital where we were able normally because we served the poor and the marginalized, and for a while we had a financial base that supported that. And we were able to offer a high standard of care to our patients, including long-term psychotherapy. You’ll hear a lot of PR now about evidence-based and data-driven treatment of trauma. And there are short term models that again work pretty well for prolonged exposure and so on that work pretty well for signal impact trauma, although they have very high dropout rates.
But for complex trauma, our patients are the ones that are screened out of those clinical trials because they don’t just have simple PTSD, they have comorbid other substance abuse, other comorbid borderline personality disorder or dissociative disorders. They have chronic suicidality, so they’re not even in evidence-based trials, there is a good evidence base now for longer term psychotherapy, basically in the literature on treatment or borderline personality disorder and dissociative disorders, because as I and my colleagues Chris Perry and Bessel VanDerKolk showed many years ago, now over 80% of people with the borderline diagnosis have a childhood abuse history.
And there’s been a multi-site randomized clinical trial conducted in Germany by Bar Bo who said his colleagues comparing DBT staged DBT with a PTSD component treatment lasting 15 months compared with cognitive processing therapy. And the staged DBT/ PTSD treatment was superior on multiple measures. And then in the uk, Bateman and Fonagy have an eight year follow up of 18 month individual and group mentalization treatment for people with borderline personality disorder that has incredibly positive results. So there is a good evidence base for more prolonged intensive form of treatment for complex PTSD and then the dissociative disorders. That’s been a prospective longitudinal study going on for several years now, looking at a sort of staged model of treatment for DID over time, long-term psychotherapy and with very nice progression being shown. That study doesn’t have a control to my knowledge, but it is a prospective study that shows that the effectiveness of long-term treatment.
Thomas: And so how do you see treatment, the different options like one-on-one treatment and processes that happen in groups, and how important do you see group environments in the healing of trauma or complex trauma or maybe one or the other or where do collective spaces have their place and where is one-on-one have their space or are they mixed?
Judith: I think it’s both. And we love groups that are victims of violence program. We’ve had many, many short term trauma focused groups that we had. Two of them, we have practice guides now for our sort of trauma 1 0 1, stage one model, which is the Psychoeducational 10 session group called the Trauma Information Group. And then we have our stage two group, the Trauma and recovery Group, which is a much more trauma focused past, that’s usually a 16 week group, but groups are amazing as an antidote to shame and isolation.
Thomas: Yeah, wonderful. So you spoke about tyranny and you spoke about tyranny, let’s say in the micro level on the family system. When we look or what’s your experience with tyranny on the macro level like dictatorships or forms of tyranny that actually affect the self of a whole either cultural group or a society? How does that affect the self, the sense of self of a society? Maybe you can speak a little bit about this, and of course there are individuals in that society, how it affects them, but maybe also a little bit how it affects the ecosystem, if you have any thoughts you want to share about the collective impact of tyranny.
Judith: Well, I think the person who has written really very well about this since Masha Gsen, and she talks about how the dictator cannot rule alone without collaborators and without the passivity of bystanders. And so a lot of the behavior of tyrants is aimed at the bystanders. And as a bystander, you can either align with the oppressed, in which case you yourself will be subject to punishment. You can ally with the perpetrator and be part of a corrupt system and get the benefits of corruption. Or you can withdraw and just see no evil, hear no evil, speak no evil, and become passive.
And a lot of the effort of the bystander of the tyrant is to get the bystanders to just think about their own private lives, to forego any sense of community or just to kind of withdraw and submit and do whatever the dictator says. Basically turn out for rallies and cheer to show that you’re, to have the portrait of the dictator in your home and to inform on the neighbors, talk about betraying your own law, to inform on your neighbors, to participate in the corrupt system, how you get things done. And so that it destroys any sense of community solidarity.
And it leaves people and it appeals to people’s most selfish motives and to people’s cynicism. Well, that’s just the way the world is. So you really, it degrades civil society. You can’t have a flourishing civil society and dictatorship. That’s why there’s always a brain drain. And so it leaves, if dictatorship is overthrown and you try to replace it with a democracy, you start with people who have absolutely no habits of cooperation or mutuality and who are often deeply ashamed of their behavior and eager not to talk about it, think about it, certainly not to face any kind of accountability.
Thomas: That makes a lot of sense. We have done a lot of work in Germany, and what you just said, this period of silence, it was very powerful. And also in the retrospective work was very powerful how it appeared that nobody wanted to talk about things, and the next generation was growing up in that kind of creepy silence like the disaster happened, but nobody spoke about it. And it reminded me also of the work that we did on the east West in Germany, the east west separation and what you said, reporting on the neighbor. And I’m wondering, when you look at now the intergenerational transmission of trauma, like when we say, okay, when we grow up in a culture where that happened, so what do you see are the after effects of that very thing that you just described of growing up in a post dictatorship culture? And how does this affect our psyche? How does it affect our living together? And maybe also how this intergenerational trauma transmission can be approached. Like what’s the healing when the trauma also happened in the lives of my parents grandparents?
Judith: Well, I is similar in some ways to the individual. We recovering want to start by rebuilding trust. We got to talk about it while, I mean, talking about it by itself isn’t a cure, but it’s a necessary first step. I’m reminded of, but a talk or an Israeli psychologist named Dan Baron, who used to do groups for children of Holocaust survivors and children of the Nazi SS to come together. And by the way, the children, the Holocaust survivors, their parents haven’t talked about it either, but the children of the SS kept saying, oh, we just had a very normal family.
And of course, they had never talked with their parents about what happened during the war. And he described the case of one man whose father had been driven the trains that transported the Jews to the ovens, but he said he’d never witnessed, he’d never himself participated in or witnessed any violence. And then after they explored for a while, he actually did talk to his father. And this time his father said, well, one time he did witness that they uploaded a whole freight car full of people onto the platform and they shot them all. And Barron said, how terrible, and that must’ve been, the affect was very flat. No, that’s just what happens in the war. And then a year later, he reinterviewed this guy and he had forgotten completely what his father told him. He didn’t remember that he had told about the shooting. So dissociation, repression, these are defenses on a group scale as well as the individual scale.
Thomas: Right, right. No, that’s very powerful. And we have also worked a lot with also descendants of Nazi families, former Nazi families, and it’s exactly, and also how to develop slowly a relationship to the past and how important that is that any kind of restoration can happen. And I’m curious, in your work, how do you see the restorative process? So let’s say that happens, that’s part of a country or groups or a person’s experience, so what are actually the ingredients that we can come to some sort of restorative process? What do also victims need so that this kind of entanglement can slowly unravel? So how do you look at the restorative process on individual and also more collective levels?
Judith: For my new book, Truth and Repair, I interviewed 30 survivors of gender violence. I chose that because it’s the most common human rights violation in the world and also because what I know best, but I think it would apply to any form of dominance and subordination built that’s deep in the society, whether that’s based on religion or race or gender, caste, class. And what they wanted was not punishment and not forgiveness, but they wanted acknowledgement. First of all, they were unanimous on that. And they wanted it not just from the offenders, they wanted it even more from the bystanders acknowledgement of the facts, acknowledgement of the harm and acknowledgement that it was wrong. They wanted the bystanders to vindicate them, to denounce the crime, to say, no one deserves that kind of treatment and you didn’t deserve it. And to lift the shame from them and put it on the shoulders of the perpetrator. And beyond that, they wanted apology and amen.
And again, more for the bystanders than necessarily from the perpetrator. We’ve overseen on an intimate level. We’ve overseen some family confrontations where that happened, where there was an acknowledgement and an apology, and they’re rare, but when they happen, they are wonderful. And actually, we had my colleague, my colleague Sha and I treated an incest family years and years ago. I treated the mom and sometimes the dad and at least the mom until she could get a restraining order, get him out of the house. And Emily treated the three daughters and many years later, and the oldest daughter was 12 when we started, but when she was in her twenties, by that time, there had been big changes in my family. Her father had almost died of a heart attack. He’d gotten sober. He was willing to try to repair the relationships in the family. He’d gotten into treatment. And so she had a family confrontation in Emily’s office where both parents had sobbed and apologized and said, how can we make it up to you? There was a real reconciliation, and I’m allowed to send her name because she outed us as her treaters when she wrote a wonderful book called Fortunate Daughter, A Memoir of Reconciliation. It’s her name is Rosie Beck Mahan.
But that’s rare. And I mean, most offenders have, first of all, they’re not going to, they’re deep into denial. And if there was evidence, the evidence is in controversial, controversial then. Well, you asked for it, and anyway, why are we still talking? Why are you still whining about this now on a national level, the model is the Truth and Reconciliation Commission in South Africa. And I have a colleague, a psychologist named Pamela Gato medic. She’s a professor now in South Africa and a well-known author, and she was on the Truth and Reconciliation Commission, and she actually tried to oversee some restorative justice. The deal was amnesty and return for confession. And so many perpetrators did confess in exchange for no prosecution. She also had prison encounters with Jean De Cook who was known as Prime Evil. He was the head of the secret police trying to have that kind of dialogue, a restorative dialogue. She ended up feeling that the Truth Commission was a big success because that centered the testimony of survivors and it was televised and also broadcast by radio throughout the country. Most people didn’t have television. They did have radio. And so that there isn’t a romantic narrative about how humane and wonderful apartheid was and how it civilized the savages and so on. I like say, in the US where we romanticized the Confederacy and many of us do and romanticize slavery, but there was no apology and there were no amends. There was no reparations. There was no restitution. And in that sense, that’s a restorative justice process. It has failed.
Thomas: Right, right. So this leads me to what we started our conversation with the last part of your sentence is, and perhaps most importantly, because it speaks about horrible things that no one really wants to hear about. Let’s come back to that. And let’s look at this dynamic of our societies or us as individuals, but also our society trying to anize a lot of what we don’t want to hear about and how that actually is the repetition, compulsion on the social level of all the atrocities that we try to heal, but we actually don’t really heal because we don’t want to hear about them. So it’s a vicious cycle. And so maybe you can speak a little bit about that and also what do you see models can be how we implement a different approach. Is that possible at all? I mean, since that denial also serves a function and how can we make a step as a culture to exactly deal with what you just wrote in that sentence?
Judith: Well, I think that’s why you need a human rights movement. People can’t do that alone. They have to come together In the women’s celebration movement, which is kind of how I came of age, we started with consciousness raising groups. And those were based actually on a model that the civil rights, the American Civil Rights Movement had developed. And they brought people together in what they called Freedom schools. And part of it was adult literacy and stuff like that and black history, but also people just came together in groups to talk about their lives. And it was an incredibly powerful organizing tool because people found their commonality.
And so Kathy Schild, who, a classmate of mine who was very active in the civil rights movement brought that method into the women’s movement and called it, named it consciousness raising. And it was small groups. They were kind of like therapy groups, and they were confidential, but it was just speaking the truth about our lives. And she described them not only as a method of political organizing, but as a method of scientific research because she said, nobody really knows the truth about women’s lives because nobody dares to talk about it. So we talked about our lives. And then from the next step from the consciousness raising groups, what’s the speak outs? The first speak out on rape was organized by a radical feminist in New York in 1970, I think. And from there, I mean, then we have the next iteration of that in two moment. But it’s basically people have to come together and say, we’re not alone. This is happening all the time. And support one and have them just say, this has got to change. And so it really begins with organizing. And that’s true whether you’re dealing with a political dictatorship or whether you’re dealing with deeply entrenched racism, misogyny, male supremacy, white supremacy, and so on.
Thomas: What I hear you say is also if we want to move towards nations working more consciously on the residue that they inherited from the former generations. So we actually need to begin to organize smaller groups where people can start to talk about it so that the legacies are being more out in the open and shared. And because they become actually a space of mutuality or commonality, and that’s the beginning, a stepping stone towards maybe an architecture of collective healing in different nations. Would you add anything? Is there anything else we should or need to think about? Take in consideration, let’s say we get this first step done, and so there’s more of a movement in different countries with the different legacies so that it becomes like there’s a healthcare system that wasn’t there all the time, and somehow it came into existence. And then there were the civil rights movement or other movements as you described. And now if we want to have a cultural healing architecture, so what else do we need to take into account, let’s say the first part we get, right? So is there anything else we should take into consideration?
Judith: Well, I think once you have people coming together, they’re going to figure out the next steps based on the particularities of their situation. I mean, I think public education, legal reforms, I mean, there are so many different places where you entry points developing services more widely. I mean, from the consciousness raising and the speak outs, the women’s movement went to legal reforms. They went to, we invented things like the rape crisis centers, the Nevada women’s shelters. They didn’t exist before. We invented things like getting a restraining order, a civil restraining order that could have a court order to have an abuser leave the home, things like that. And then bit by bit, those things became more institutionalized, but then they came from the ground up. And so I think once you have a ground up movement, it will figure out multiple next steps.
Thomas: That sounds very right and true to me that then we trust the emergence of that movement to fold its own intelligence. That’s really lovely. So Dr. Hammond, this was really lovely. I enjoyed this conversation. I see an hour flew by very quickly, and I really enjoyed the conversation and I’m very happy and honored to learn from you with them. I think you’re one of the pioneers deepened the understanding of trauma and paved the way for many other movements and modalities to happen. And again, I want to honor your work and honor you for staying steady and energize to do this work for a long time. I think that’s a great example.
Judith: Well, conversations like this are energizing for me too and keep me going. So thank you.
Thomas: Yeah, thank you very much.
Judith: They could care.
