Okay! Modeling, interlude, over. We can move on to betrayal trauma. The basic assumption of betrayal trauma is that trauma is independent of the reaction to trauma. Betrayal trauma was coined and described by Jennifer Fride, F-R-E-Y-D. I hope I'm pronouncing her name correctly, Jennifer Frade maybe. She introduced the terms betrayal trauma and betrayal trauma theory long ago in 1991. She made a presentation at the Langley Porter Psychiatric Institute. It is absolutely to the discredit of the profession that betrayal trauma theory is not much more dominant than possibly the dominant theory of trauma. It definitely guides me in my studies. So Frade made this presentation. It was titled memory repression dissociative states and other cognitive control processes involved in adult sequelae of childhood trauma. And it was August 1991 and I want to quote from this talk that she gave. She said, I proposed that the core issue is betrayal, a betrayal of trust that produces conflict between external reality and a necessary system of social dependence. Of course, a particular event may be simultaneously a betrayal trauma and life-threatening.  Perhaps most childhood traumas are such events. Betrayal trauma theory, she says, involved the psychic pain involved in detecting betrayal as in detecting a cheater is it's an evolved adaptive motivator for changing social alliances.  However, if the person who has betrayed us is someone we need to continue interacting with, despite the betrayal, then it is not to our advantage to respond to the betrayal in the normal way. What she's saying is we must distinguish two situations. If we depend on the person, if we can't go no contact, if we have to continue to be in touch with someone because we need him, then we deny the trauma. We deny the betrayal because it's not to our advantage to confront him. We may lose him.   He cannot get rid of that mother. He cannot go no contact with that mother. He cannot even think bad things about mother because he needs mother for survival. And that's a perfect example of denying the trauma, denying the betrayal trauma. And then, if you are not dependent on the person, you can just say goodbye. You can just walk away, but many people don't have this option. Okay. Instead, she says, we, if we are dependent on the person, if we can't go no contact, if we can just walk away. Instead, we essentially need to ignore the betrayal. If the betrayed person is a child, and the betrayal is apparent, it is especially essential that the child does not stop behaving in such a way that he will inspire attachment. For the child to withdraw from a caregiver he is dependent on would further threaten the child's life, both physically and mentally. Thus, the trauma of child abuse by the very nature of it requires that information about the abuse be blocked from mental mechanisms that control attachment and attachment behavior. One does not need to posit any particular avoidance of psychic pain per se here. Instead, what is of functional significance is the control of social behavior. Brilliant. Brilliant on multiple levels. First of all, she contextualized trauma within the realm of social interactions. Even Freud himself hinted, hinted to this when he said that the super ego has relational mechanisms, mechanisms related to other people. And of course, in object relations theory, this already blossomed and flourished into a full-fledged tenant and foundational concept. But what she did, she recast trauma as a social interaction. And her second major contribution is to say that we cannot not, it's not always, we can't always acknowledge the trauma, the betrayal and confront our tormentor and our abuser, because there are circumstances where what we need to do in order to survive is to deny the trauma, to block the trauma, so as to allow us to continue the attachment and the interaction with the abuser. And so there's this concept of betrayal blindness. Betrayal blindness is the unawareness, not knowing. You remember from one of my previous videos, the unthought known, unthought known bolas came up with this concept. So betrayal blindness is the unawareness, the not knowing, the forgetting exhibited by people when they're betrayed. It's in a way, one of the ways betrayal blindness comes into being is dissociation. And so again, Freud introduced the concept of betrayal blindness in 1996 and expanded on it in 1999. And then together with Birel, B-I-R-R-E-L-L in 2013, they developed betrayal trauma theory, which I'm going to discuss in a few minutes and incorporated it in there. Now, such blindness, we can, we see it, for example, in adultery. Very often, the spouse or the intimate partner, they have all the proof, all the evidence, everything they need to realize that they're being cheated on. And it's very, very traumatic. And yet they suppress, they repress, they deny, they dissociate, they forget, they ignore, they like themselves, they refrain, they confabulate, just not to confront the trauma. Same in the workplace where you can't afford to lose your job. And same in society, victims, perpetrators, witnesses, they all display betrayal blindness in order to preserve relationships or institutions or social systems because they depend on these. There was a very important and interesting essay by Eileen Zürbrigen. Why, why do they have these names? I think they ended up in psychology because they have these names. It's very traumatizing. Zürbrigen, Zürbrigen, whatever. So she wrote an essay, Betrayal Trauma in the 2004 election. And she used the theory to give a demonstration of something called institutional betrayal. Institutional betrayal is when the wrongdoing, the abuse is perpetrated by an institution. And it's perpetrated on individuals that depend on the institution. So failure to prevent a catastrophe like a pandemic, a response that supports wrongdoing, suppression of rights, abuse, infringement, encroachment, coercion, rings a bell in today's circumstances.  So these are all institutional forms of institutional betrayal. And again, institutional betrayal is a part of betrayal trauma theory. And I refer you to Platt, Barton and Frade 2009, Smith and Frade 2011, several papers, Medrano, Martin and Frade 2011. And the core book is Blind to Betrayal. Blind to Betrayal, highly recommended, Frade and Birel, 2013. I want to quote a sentence from Frade. She wrote in 2008, Betrayal trauma occurs when the people or institutions on which a person depends for survival, significantly violate that person's trust or well being, childhood, physical, emotional or sexual abuse perpetrated by a caregiver are examples of betrayal trauma. And then we come to betrayal trauma theory. And the most, the earliest paper that had dealt with this, the best of my knowledge, is a paper by cybers, Schuller and Frade, from 2002. And there they wrote that betrayal trauma theory is a theory that predicts that the degree to which a negative event represents a betrayal by a trusted needed other will influence the way in which that event is processed and remembered. Now that sounds simple, but it's absolutely one of the most revolutionary approaches to trauma and to the consequences and sequelae of trauma. I'll read it again, most slowly this time. Pay attention. Betrayal trauma theory is a theory that predicts that the degree to which a negative event represents a betrayal by a trusted needed other, that degree will influence the way in which that event is processed and remembered. The more you depend on someone, the more you're you need someone financially for survival, to raise the kids together, whatever.  And throughout the 1990s, and in a seminal article published in 1994 and in the book in 1996, freight together with others like the Prince Gleaves expounded on that. And so she gradually refined the concept of betrayal trauma. It's in she said it is trauma perpetrated by someone with whom the victim is close to and reliant upon for support and survival. And so betrayal trauma theory, the first appearance of this phrase was in 1994 by of course, Jennifer free, it's situations when people or institutions on which you rely, you're relying for protection, you trust for resources and survival, these people violate your trust, well being break your boundaries. And sometimes statistically, and egregiously betrayal is the core and precedent of many, many mental health manifestations. For example, when you use betrayal theory, you have perfect explanation for dissociation. You know, because dissociation is intended to preserve the relationship with a caregiver when you can't go no contact. And the child dependent on the caregiver for support will have a higher need to dissociate traumatic experience from conscious awareness. In other words, you can begin to regard the false self that the child creates as a form of dissociation. It's like a repository.  But I can't, I can't be conscious of it. Because if I, if I become conscious of the abuse and the trauma, if I develop negative emotions, if I get hurt, then I won't be able to attach to mommy. I won't be able to bond with mommy. And I won't be able to receive from mommy what I need in order to survive. That's a dangerous path. So exactly as Melanie Klein suggested, the child splits.  There's only bad. So the child cannot split the mother. Instead, the child splits himself. Healthy, normal children split mommy into bad mother, good mother, bad breast, good breast. That's Melanie Klein. Children, when they develop, when they grow between the ages of six months and two years, the mommy sometimes is good. Sometimes it's frustrating. Sometimes it's there. Sometimes it's absent. So the child learns to separate these aspects into a good mother and a bad mother. And, but with enough and later on, by the way, the child annexes appropriates the bad aspects so that he can idealize other. But it's always, it's always clear that there is a unitary, a unitary child, and a kind of disjointed mother. The need to split mother is critical in development. Then the child who later develops into a narcissist made a wrong term in split instead of splitting the bad and good aspects of mother. He splits his own. His personality fractures and fragments in a dissociative process. And that gives rise to the false set. He cannot split mother into good and bad, because there's no good in mother. So he splits himself. Betrayal trauma theory also integrates evolutionary processes, mental moduli, social cognitions, developmental needs. And even ethics, because there's a violation of trust, it's highly unethical. There's a question of foundations of morality. We know, and it's common and accepted and orthodox thinking, that empathy underlies morality. It's not possible to be a moral being on an ethical being without empathy. So in such situations, ethics, the development of morality is challenge. All people from a very early age react to injustice. We have two years old reacting to injustice in numerous studies. So we realize when there's a violation of the social contract, we realize when our trust is betrayed, we realize when our boundaries are breached, they are cheat detectors. And so in the context of abusive relationships, you want to escape. That's your first, your first urge, your reflex is to run away, you know, flight, fight, etc.  Second most fundamental is the fight response. Then there is the freeze response. And finally, the form response. But in abuse and trauma, initially in healthy situations, it's like, but what do you do? If, if escape is not a viable option, if your cheater detecting mechanism leads you to, to want to avoid and want to escape and want to flee from a person upon whom your, your survival depends.   So what you do, you suppress your cheater detecting mechanism for the higher goal of survival. It's psychogenic amnesia. It's designed to, to perpetuate attachment by blocking painful experiences. And we have this in, in romantic betrayal, early literature, pre, pre freed, you know, everyone was talking about betrayal of an unspoken agreement, like betrayal of trust, there was an unspoken agreement and it was breached. And this is the source of the of the pain. But betrayal trauma theory suggests that all these manifest all these behaviors like domestic violence, cheating and so on, they involve a betrayal of trust. But when the victim has no viable exit strategy or option, when the victim remains or returns to the abuser, does not report the abuse underreports the severity of the abuse, experiences shame and anxiety, which are also mechanisms, mental mechanisms intended to downplay what's happening, or to repress, to deny what's happening. All these, this is an attachment injury. And it's a component that is critical in betrayal trauma theory. It's not only in a betrayal of trust, like in the classic literature, it's a betrayal of trust in a time of need and dependence. This combination is what is what destroys erodes and corrodes the victim, that the victim had been betrayed at its most vulnerable moment at her most vulnerable moment. She dependent. She depended on her abuser. She believed her abuser. She relegated functions to her abuser, sometimes ego functions, internal functions. And then the betrayal. Betrayal alone is bad. But betrayal with trust, betrayal with need, betrayal with survival, betrayal, that's that's horrible. And in the context of intimate partner violence, vulnerability, fear, relationship, relationship expectations, shame, low self-esteem, communication issues. These are all outcomes of the exposure to betrayal trauma. And they are barriers, not only to escape, but also barriers to forming new relationships. You see, ironically, if you the if you cheat, if you cheat on an abusive partner, it's a sign of health. It's a sign of partial health. Let's be precise. Because at least you are taking care of yourself. At least you're trying to solve your wounds. You're trying to self administer some medication. It's a dysfunctional solution. There are much better solutions. No contact is the best solution. Gray rock second best solution. But cheating is a solution that indicates partial health. What is not healthy is to deny, to minimize, to underreport, to reframe, to lie to yourself about the abuse, the trauma and the torture that you're experiencing. I want to introduce here another concept. And it's a concept of a sumptive, a sumptive world. In 1992, Janof Balman, BOL MAN, she identified, he identified three assumptions. One, the world is benevolent. Two, the world is meaningful. Three, the world is worthwhile, is worthy. These three highly optimistic, I call them malignantly optimistic assumptions, put together, create what he called the assumptive world. The assumptive world is a core belief system. Individuals perceive the world as essentially good, secure, and fair. And these assumptions are shattered by distorted social behavior, anti social behavior, even a social behavior. When social behavior becomes anomic, seek pathologized, then this world view is, is at risk. It's threatened. Maybe the world is not benevolent. Maybe it's not meaningful. And maybe it's not worthwhile.  In the context of betrayal trauma theory, when caregivers or intimate partners in close relationships, when they violate you, they destroy your assumptive world and, and they impair your ability to reconstitute the assumptive world. Because if you burned once badly, it's difficult after that to be naive, pathologically naive, malignantly optimistic, it's difficult after that to trust, really, to trust again.  Watch my previous video about self stocking, the damage of life. And they contribute to avoidance, not only of the trauma experience, which, which is betraying yourself, but avoidance of future, future possibilities to remedy the damage. And this, this is a part of post traumatic stress disorder, or complex post traumatic stress disorder, an individual who may experience little or no conscious awareness of their trauma still develop PTSD or CPTSD. It shows you that consciousness, awareness are not everything. If the trauma does not have conscious knowledge, the effects of the abuse still manifest physically via somatization or psychological symptoms, such as dissociation. Watch my video presentation to the conference about signs of narcissistic abuse. Many found that dissociation can be a predictor of the development of developing PTSD after trauma. So dissociation proceeds actually trauma. It's not true that people who have PTSD or CPTSD are conscious. That's one of the reasons that I keep railing, railing against the over diagnosing and, and self attribution of CPTSD. Every victim in his dog has CPTSD. That's not true. PTSD and CPTSD are very often preceded by a denial of the abuse, denial of what had happened, repression, forgetting, dissociation. That's why the body is reacting and the mind is rebelling against this lie, this confabulation. The body is telling you, Hey, wake up. You have been traumatized. And your mind is telling you, Listen, I'm in trouble. I've been badly damaged. Stop invalidating me. Stop denying what had happened. Face up to it. Dissociative identity disorder is at the end of this spectrum. Because some trauma victims deploy a protective response such as dissociation or repression to block awareness to the trauma to the end, to, to the extreme.  And it's connected intimately with overwhelming trauma. And or with, with a very, very long exposure to complex trauma. This trauma can create identity diffusion or identity disruption or disturbance. Your very identity is challenged by the trauma and the abuse, partly because you are denying them. It's like you're internalizing energy, bad energy. Freud used this metaphor. He said that unconscious content has energy.   And this is multiple personality dissociative identity. And in borderline, borderline, borderline are on the verge of this. They're like on the edge. That's why they're called borderlines. They're on the border between neurosis and psychosis. They are so dysregulated. And they lack narcissistic defenses. For example, they, for example, they do have access to their negative and positive emotions and they have empathy. So borderlines don't have defenses. And whenever they experience hurt and humiliation and rejection or even anticipated, they fracture they're at high risk of a psychotic episode or suicide. 10% of people diagnosed with borderline personality disorder end up committing suicide and about 30 to 40% self mutilate and self harm. So distinct personalities sometimes are the only solution. Remember, this splitting that I told you before, that's multiple personality. When the child is faced with overwhelming, inexorable, uncontrollable abuse and trauma, the child fractures breaks apart, splits in the fullest sense of the world. The false self is another personality. The true self is another personality. What is this? If not multiple personality, the narcissist is dissociative identity disorder. It's a private case of DID. He has two personalities with distinct perception, cognition, sense of self, agency.  The person may experience the person with such a condition experiences gaps in the recall of everyday events or traumatic events, same with the narcissist, narcissists try to bridge these gaps by confabulating. And so they are perceived to be liars. Few narcissists lie, actually, they don't need to. Their whole life is a lie. The false self is false. It's all a fantasy. It's all a confabulation. There's not a shred of truth in any of it.  And of course, narcissists try, like everyone else, try to somehow self soothe and self medicate with alcohol, with drugs, with women, with something with work, work out is addictive behaviors. Interpersonal trauma, such as betrayal trauma, is intimately connected to addictive behaviors, especially substance abuse. So childhood physical and sexual abuse increases the risk for substance abuse and betrayal trauma, and also shifts the locus of control from internal to external.  So handing over the control to alcohol, or to drugs is a natural extension. When you talk to alcoholics, they tell you, they drink made me do it. The drug made me do it. I mean, they, they, they refer to the drink or the drug like for, like a kind of abuser. It's a way to cope with post-traumatic negative effect traits such as avoidance, tension reduction, self-medication. And when we come to personality disorder and, and disorders, and most particularly, to borderline personality disorder. Borderline personality disorder has, there are numerous studies that show that it has links to early maltreatment and attachment difficulties in early childhood. The maltreatment is emotional, physical, verbal, or very frequently sexual abuse, but by caregivers, by people in whom the child plays trust to perpetuate and maintain its, its survival. Betrayal trauma theory incorporates attachment disruptions, attachment dysfunctions, and damage from caregiver. It's part of the, of the definition. And it is the only marriage I'm aware of between attachment theory and abuse theory. It includes dissociation as a diagnostic criterion of borderline personality disorder. And some people say that betrayal trauma theory explains the dissociation that borderlines experience, because dissociation is a defense mechanism against childhood trauma. High betrayal traumas have been implicated in the development of traits indicative of borderline personality disorder. And it goes further and further. It's very deep. Betrayal trauma theory is very deep. It explains hyperreflection in the schizophrenia spectrum and other psychotic disorders. It explains hallucinations. So they, they tend to suggest that childhood abuse is intimately linked to hallucinate hallucinations. When you reduce betrayal trauma via talk therapy, hallucinations disappear. There's no need for, for medication. It's, it's, it's an amazing theory, which I really advise you to, to go more deeply into. There seem to be intergenerational effects. Individual levels of dissociation are correlated with betrayal trauma experienced by the individual, but also with the betrayal trauma experienced by the mother of the individual. So it seems that the mother is handing her betrayal trauma. If the child becomes the repository of her betrayal trauma, her pain, her hurt, she offloads it to the child. It's, it's perhaps that mothers with betrayal trauma or dissociative symptoms, maybe they have more difficulty in creating a safe environment for the children. Maybe they are predisposed to becoming dead mothers. They can become a safe, a safe base. So let's summarize this part of the video. Betrayal trauma says that there is a social utility in remaining unaware of trauma when the perpetrator is a caregiver. And it's based on the study of social contracts. It explains why and how humans are excellent at detecting betrayal and that under some circumstances detecting betrayal may be counterproductive to survival. And there are cases where the victim is dependent on the caregiver. And so survival may require that she remains unaware of the betrayal or even denies it. And so there are examples of childhood sexual abuse and childhood psychological abuse to substantiate this. The traditional assumption in trauma research has been that fear is the core of the response to trauma. Freed changed that. And it is not, not to the merit of the credit of my profession that the revolution that she had introduced did not go further. Freed, as early as 20 years ago in 2001, noted that traumatic events differ in degree of fear of betrayal depending on the context and characteristics of the event. Research suggests that the distinction between fear and betrayal is very important to the post-traumatic outcomes. The prince in the same year, 2001, found that self-reported betrayal predicted PTSD and dissociative symptoms much more than self-reported fear. So it seems that the critical element is not a fear. It's that the violation of trust is a betrayal. And there are numerous other studies that have confirmed this, that betrayal is the psychologically toxic substance that creates dissociation that leads to post-traumatic conditions, including PTSD. I refer you to Kelly, to Weathers, to Mason, to Pounot as late as 2012. And I also encourage you to go online and have a look at Freed's two dimensional model for traumatic events. It places everything neatly everywhere. Now a few frequently asked questions. One, is it necessary for the victim to be conscious of the betrayal in order to call it betrayal trauma? The answer is no. I will quote from The Prince and Freed, it's an article they published in 2002. The role of betrayal in betrayal trauma theory was initially considered an implicit but central aspect of some situations. If a child is being mistreated by a caregiver, he or she is dependent upon, this is by definition betrayal, whether the child recognizes the betrayal explicitly or not. Indeed, the memory impairment and gaps in awareness that betrayal trauma theory predicted were assumed to serve in part to ward off conscious awareness of mistreatment in order to promote the dependent child's survival goals. While conscious appraisals of betrayal may be inhibited at the time of trauma, and for as long as the trauma victim is dependent upon the perpetrator, eventually the trauma survivor may become conscious of strong feelings of betrayal. Of course, we still have to study in depth the emotional perception of betrayal, how betrayal is experienced, the distress, the subjective experience of distress, and what's the connection to recovery? How does it prognosticate recovery? And Brown and Frey started to do this work in 2008, but it's far from complete. Next question, is gender a factor? Do men or women experience trauma betrayal? Betrayal trauma more often? It seems that men experience non-betrayal traumas more than women. Women experience betrayal traumas more than men. This goes well with other discoveries that women attach more deeply and differently, more empathic and so on. I am not sure how valid this is nowadays. The number of narcissistic women today equals the number of narcissistic men. And many women have begun to develop psychopathic features, psychopathic behaviors and traits. Many women, especially and also post traumatized women, women who had come through CPGSD, are indistinguishable from borderlines. And so I don't know how this, how valid this is, this is here. But Goldberg and Frey, in a series of articles in 2004-2006, said that men experience betrayal trauma less. And the impacts of betrayal trauma on men and women, according to the Prince, are also different. Men have, impact is less significant with men. These gender differences probably have to do with socialization. Some factors of socialization, even a culture, because gender roles, as you recall from my previous videos, gender roles are learned. They're not real. They're not embedded in biology. 99% of gender roles is learned. It's mediated and communicated via socialization agents like mother and later father. So we learn these roles. And we can, by the way, unlearn these roles. Or the learning process can be disrupted and then we end up being gender undifferentiated. Very confused about how to be a man, how to be a woman, how to be a be, middle ground. So it seems that socialization factors also affect how one experiences betrayal and trauma. And so now there's a question about how is betrayal trauma related to the Stockholm syndrome? And I want to quote from a website dedicated to Frade's work. Stockholm syndrome named for a 1973 bank hostage situation in Sweden, refers to what seems at first a paradoxical reaction to being held hostage. This reaction involves positive feelings towards the captors, the kidnappers, the hostage takers. Stockholm syndrome is a term applied to the special case of those feelings developing after a hostage takeover, as when an individual or group is kidnapped and held for ransom. From a theoretical perspective, Stockholm syndrome reaction may possibly be understood as a special kind of betrayal trauma. The unusual aspect of Stockholm syndrome compared with most betrayal trauma situations is that the strong emotional attachment occurs after the abduction and without the pre-existing context of an enduring caretaker or trusting relationship. It is usually considered that for Stockholm syndrome to occur, the captors, the hostage takers, must show a certain amount of kindness or at least a lack of cruelty towards the hostages. From a betrayal trauma perspective, the most important elements of predicting Stockholm syndrome would not be kindness per say, but rather caretaking behavior on the part of the captors and an implicit or explicit belief on the part of the victims that survival depends upon the hostage takers. And so the victims would have to experience the captors, the hostage takers, as a source of caretaking and as necessary for survival in order to develop the emotional attachment necessary to create a betrayal trauma. Once the captors are experienced as necessary caretakers, a process much like that in infancy could occur such that the victims have a good reason for attaching to the hostage takers and thus eliciting caretaking behaviors. At that point, at that point a certain amount of reality distortion might be beneficial to the victims such that seeing the captors in a positive light might support an adaptive response to the victim's predicament. This theoretical possibility leads to an empirical prediction that remains to be tested, anecdotal support for the premise that features of dependence and survival are at the heart of the development of Stockholm syndrome can be found in an FBI online article about the Stockholm syndrome and I'm quoting from that article by the FBI. In cases where Stockholm syndrome has occurred the captive is in a situation where the captor has stripped nearly all forms of independence and gained control of the victim's life as well as basic needs for survival. Some experts say that the hostage regresses to perhaps a state of infancy. The captive must cry for food, remain silent and exist in an extreme state of dependence like a baby. In contrast, the perpetrator serves as a mother figure protecting her child from threatening outside world including law enforcement's deadly weapons. The victim then begins struggle for survival, both relying on and identifying with the captor. I also refer you to an article by Fabrik or Mano Vecchi Envan Hasselt, a 2007 article which elaborates upon it a lot. It is important to note, I'm continuing from the website, it is important to note that the Stockholm syndrome is rare whereas betrayal trauma events and reactions are unfortunately fairly common. Nonetheless, Stockholm syndrome might prove to be a useful extreme boundary condition for investigation of betrayal trauma theory while at the same time betrayal trauma theory might provide useful insight into behavior of hostages that is otherwise considered paradoxical. I would add to this that trauma bonding is a middle case. Like in the extreme, when you're really taking by kidnappers with guns, you might develop Stockholm syndrome. But when you are kept hostage because you are dependent on an abuser, an egregious abuser, even just a verbal abuser, physical abuser, psychological abuser, sexual abuser, when you are dependent, when you can't walk away, when you can't go no contact for a variety of reasons, there's a middle ground and that's trauma bonding. It also incorporates betrayal trauma because in trauma bonding you're denying the negative aspects of abuse, torment, torture, teasing, withholding, ignoring, humiliating, rejecting and degrading you. You're denying all this and you're denying all this so that you are able to continue to attach and bond with the source of everything that you need or the things that you need. So that's a middle ground situation. Next question, are demands for silence a factor in not knowing about betrayal? So there are implicit motivations for not knowing. We describe them. A person is dependent on the abuser, so he denies the abuse. But the victim may have other reasons for not knowing, for silencing, for repressing, for denying. For example, the perpetrator might demand silence, might isolate the victim from his social safety net or family or friends, might establish a rule that dirty laundry is made only in-house.  And others may collaborate and collude in that because of discomfort and embarrassment. Family, society demands for silence, and I refer you to work by Veltuis in 1999, demands for silence mainly to a complete failure to even discuss an experience, to even mention it. You know, it's uncomfortable, it's shameful, it's disgraceful, I don't want to embarrass anyone, I don't want to discomfort anyone, so I'm not going to talk about this. Experiences that have never been shared by anyone else may have a different internal structure than shared experiences. Shareability and social support are critical in healing, curing, reframing, and transforming traumatic experiences towards closure. I want to link betrayal trauma to a few other disciplines and modalities. Let's start with attachment theory. John Baulby, the father, grandfather and great grandfather of attachment theory in the Objects Relations School, John Baulby in 1969 identified a link between attachment processes and dissociative psychopathology. See, he preceded Wagner by quite a while, so he said that some attachment processes may lead to dissociation. He referred to internal representations as internal working models. I call them internal objects, actually the current usage is internal objects. So internal working models where one can discern which internal content is dominant, which internal content requires attention, and which can be segregated into unconscious awareness. It's like a mail sorting facility before the age of trauma, where the mail is sorted to be taken care of, I mean express mail, surface mail, and to the garbage mail, like mail in balance. Once the attachment system is activated, the internal working model is identified as a guide to the formation of attachment behavior and to the appraisal of attachment emotions in the self. Any others, there's a theory of mine, what makes other tick, are they attached to me? Are they showing signs of attachment? Baulby emphasizes that traumatizing experiences, especially with one's caregiver, these are likely to result in negative impacts on a child's attachment security, stress, coping strategies, and even sense of self. Securely organized internal working model, the evidence indicates the secure attachment is associated with positive appraisal of one's own attachment emotions and expectations that a child requests will be experienced as significant and legitimate by a caregiver. Compare this to an insecurely attached or insecurely organized internal working model, avoidant, resistant. This is associated with a negative appraisal of attachment emotions, with the expectation that one's requests for attention and attachment will be rebuffed, will be received as a nuisance, or an intrusion by the caregiver, emotionally unavailable mother, dead mother, and then there's a disorganized internal working model, it's very common in borderline and even in narcissism. This is linked to unresolved traumas and losses experienced by the caregiver and the effect they had on the subsequent attachment style of the offspring. Maine and Hesse in 1990, they theorized within betrayal trauma theory, disorganized attachment develops when the caregiver is both a source of the child's solution and a source of the child's fear. What do you do when the same person is supposed to provide you with safety and security and daring exploratory grandiosity and love? The same person and this and that very person is the source of your nightmares. The waking nightmare, the surrealistic dreamscape, what do you do in such case? You approach, avoid, what? And this form of retouchment is leads to altered consciousness and this altered consciousness will be called dissociation. It's a disruption of conscious memory, identity, perception of one's immediate environment. Frayed herself and her colleagues in 2007, she identified knowledge isolation, the extent to which information is hidden from awareness, boluses, unthought known, is a private case. Dissociation during time of extreme stress or trauma, we have conclusively demonstrated using functional magnetic resonance imaging that when you dissociate in extreme stress or trauma, people have been exposed, for example, the most horrifying real-life videos and photos and we saw how the brain, the neural mechanisms, the brain changes, the functioning changes and there's evidence that childhood trauma is a natural logical factor, is a cause of dissociation and has massive impacts on several areas of the brain, prefrontal cortex, hippocampus, amygdala. So the level of betrayal trauma experience, high moderate law, they influence the degree of dissociation. When you have low betrayal trauma, it's sometimes doesn't create dissociation but low betrayal trauma doesn't include strong elements of violations of trust. It seems again that the trust is the critical problem and we have empirical evidence that exposure to high betrayal trauma, where there's a massive violation of trust, is linked to increased level of dissociation, impaired memory of trauma related words as compared to low dissociation. Trauma, stress-related disorders, dissociation and personality disorders founded on dissociation, which emanate from dissociation, like borderline, like narcissism, all of them are connected to betrayal trauma. Dissociation during trauma affects individuals and causes them to compartmentalize the traumatic experience from conscious awareness. Dissociation is an adaptive process, it's aimed to maintain self-preservation, it's a protection against psychological pain and if we look at the development of psychopathology and tie it into attachment theory, this dissociation is the core feature, it's the core feature in most, most I would say psychiatric disorders. Association can occur and even to the point where there's alternative personality state or self-state, as we have in borderline personality disorder and dissociative identity disorder and so models of attachment-based dissociative disorders, trauma-related disorders, they all involve betrayal trauma and post-traumatic stress disorder, diagnostic groups, personality disorders, trauma and stress-related disorder, dissociative disorder, even schizophrenia and psychotic disorders, even substance abuse disorders, addiction, all of them are unified in the mechanism, in the transmission vector, trauma abuse, dissociation onwards to the pathology. Now the something called betrayal trauma inventory, BTI and it assesses betrayal trauma in patients, it measures all kinds of physical, emotional, sexual abuse in childhood, in other world, all kinds of traumas and it's essentially behavioural, it deals with behaviours, like did someone hold your hand, your head under water or try to drown you before you were at the age of 16, I'm not kidding you, it's one of the questions and so you see how many yeses there are, you calculate the age, the relationship, the severity of the injuries, memory of the events and it takes about 45 minutes and coupled with or founded upon the abuse and perpetration inventory API, you get a pretty clear picture of any trauma or traumatic landscape before the age of 16, the brief betrayal trauma survey is adopted from the BTI, it includes only 11 items for traumatic experiences such as sexual, physical, emotional abuse and there's a question if the person was someone close to them on an interpersonal level and it looks at events prior to the age of 18, then there is the institutional betrayal questionnaire IBQ created by Smith and Freyd in 2011, it's even shorter, it is a 10 item questionnaire, it assesses institutional betrayal in the context of sexual assault on college campus for example, similar and identifies the level of involvement of the institution in the unwanted experience and in the associated experiences, for example normalizing totally pathological conditions or creating environments which facilitate abuse and breach of rights, covering up incidents and failed policies, this is all I am sure very, very relevant during this pandemic and finally let's talk about what can be done, treatment for betrayal trauma is very new and no one is quite sure what to do, there's not enough evidence-based treatment and betrayal trauma is a very wide concept that applies to numerous pathologies which no one is quite sure how much they have in common, so there's an article by Jennifer Gomez in 2016 suggested that relational cultural therapy, relational cultural therapy may be the best treatment for betrayal trauma, it's a therapy which was established by Jean Miller, it's a feminist therapy honestly, so I don't advise men to take it, and the therapist focuses on relational disconnections that the client experiences, so there's no, the therapy doesn't deal with symptoms, it deals with disruptions in relationships, it works through decontextualizing the betrayal trauma, separating the self-decision making from the trauma and it's an interesting approach because it introduces the social and cultural aspect and it implies that what we experience as symptoms are actually merely the way we experience disruptions in meaningful relationships, again we are coming to Sapolsky's and others point of view, the self is the intersection of relationships, take away of the relationships, there's nothing left, even in pathological narcissism there's a hive mind, even there, even the false self is the intersection of the gaze of multiple others, it is this intersection that gives rise to a human being in the full sense of the world, when it's disrupted you get a narcissist, you get a psychopath, but even then they're not, they're not islands, the narcissist cannot survive without narcissistic supply which happens to come from other people, the psychopath cannot achieve goals, it's goal oriented, cannot achieve his goals, act on his impulse, be defined, if there's no one to define and no one to take from, we are social creatures, zone, political, thank you Plato, thank you Aristotelis, and if any of you succeeds to solve the riddle of why I had chosen to attribute this sentence to Eugene O'Neill and not to its originator, Jean-Paul Sartre, please let me know, I'd be delighted, one of you came close by me, don't let anyone traumatize you by betraying your trust, watch my video about who to trust and when to trust, it's a good introduction okay enough with jokes, let's get to the business of teaching you students and as is my habit or my new habit in my recent videos, I start by referring you to literature, so I suggest that you read everything you can by Dorahi, D-O-R-A-H-Y, Van Der Haart, H-A-R-T, Nijan Huys, Don't Ask, Kathy Steele, Butler, Crabtree, Brown, and go into his some historical writings by Jeanet Brown and also read everything you can by Van de Kolk, and those of you who've heard of some of these gentlemen realize that today's topic is trauma and the dissociation that trauma induces this is a topic that underlies the most modern thinking, must up-to-date bleeding-edge thinking on a variety of mental health disorders among them narcissistic personality disorder and borderline personality disorder but today what I want to do, I want to explore one approach to dissociation which is fast becoming a dominant approach in 1893 that's a bit before I was born there were two gentlemen, Breuer and Freud and of course having said gentlemen it's clear that they were Jewish so these two gentlemen came up with an article, wrote an article, published an article and they suggested that individuals with trauma memories go through numbing, detachment, amnesia and avoidance of triggers and memories and they said the very same people who try to avoid triggers the best they can in a variety of ways they are triggered the most trauma was the main topic of study I would even say the cornerstone of early psychoanalysis pre-Yung when Jung was still a disciple and a fawning and admiring student of Freud it was much later that Freud recanted and he realized that he was the victim of high society rich women with nothing better to do he was a form of entertainment they came to him and they told him stories about how they had been abused by their fathers usually and he bought it hook, line and sinker and constructed the whole theory based on their stories and false memories memories that they came up with in order to gratify and please Freud Freud went to the extent of saying that he now disbelieves most of the trauma stories that he had heard from his patients because had they been true then he himself must have been must have been sexually abused by his own father but that's a vignette aside let's continue the personality is not a monolithic slab of stone it's not the proverbial rock in other words it's not an entity exactly like the living body the living body is a colony a colony of trillions of cells and in each one of our cells they are very very ancient and primitive organisms which had survived inside ourselves these organisms have nothing nothing to do with us they don't share genetic material with us mitochondria for example so we are like a giant zoo our bodies are like giant zoos with trillions of cells organisms the gut flora for example billions of bacteria or viruses i mean we can we carry this gigantic zoo with us wherever we go the personality and the mind are the same it's a zoo it's an amalgamation of very ancient voices of constructs of defenses so different structures comprise the personality experience personality is therefore a process a process it's an experience it's not a thing and some personalities experience too little some personalities experience too much this distinction is very very important some people are prone to interface with the world and with other people much more than other people so this important although apparently trivial insight underlies the theory of structural dissociation and before we go any further structural dissociation is one of well over 50 trauma related theories and trauma related therapies which i had incorporated into cold therapy cold therapy to remind you is the treatment modality that i had invented that i had created for people diagnosed with narcissistic personality disorder or for people with major depression and i suggested to reconceive of narcissism to reconceive of narcissistic personality disorder is essentially a post-traumatic condition a post-traumatic condition and therefore requiring trauma therapies structural dissociation was an important theoretical foundation of cold therapy so together with other approaches to trauma and other approaches to re-traumatization i put these together and also with child psychology and came up with cold therapy so what is what is this theory what does it say what does it what does it teach us well dissociation is can be conceived as one of two things is either it's a deficit it's a malfunction it's a glitch in the software it's when we can't take very painful very threatening very harrowing experiences and the thoughts we had during these experiences and the emotions we had felt during these experiences we can't cope with them and we can't integrate them we can't make them a part of our self so we kind of hive them off we kind of push them out push them away these memories the cognitions that go with them the thoughts the emotions that we had felt we place them in a container and therefore there is an integrative deficit dysfunctional dysfunctional integration there's another way to look at it and that's the older way the way of Freud and others that dissociation is actually a defense it's when the child usually is faced with extreme abuse extreme trauma he has very few active defenses the defenses he has are very primitive like splitting and they work only only so far splitting for example is very threatening because if you split mother an abusive mother you split her in two there's a bad mother and a good mother the bad mother is there and she is very frightening so even the defense mechanisms the primitive defense infantile infantile defense mechanisms of the child they are not very defensive they bring the horror of the situation to the front and so the children are defenseless dissociation is one defense it's simply not remembering forgetting or not being there or thinking of the whole thing is not real derealization depersonalization amnesia in reverse order and so structural dissociation claims the theory claims that dissociation is an integrative deficit not so much a defense and that dissociation has two types of symptoms psychopharm symptoms and somatopharm symptoms when we come to it in a in a few minutes what is integration what is this integration that that the theories is analyzing and dissecting so much structural dissociation theory what is integration integration first of all is an adaptive behavior it's a behavior that helps you to survive to cope to function to propagate yourself so it is also an adaptive behavior on the level of the species not only on the level of the individual and it depends on two processes the first one is synthesis synthesis is when we associate when we put together when we combine in a reasonable coherent cohesive rational form combine all the components of experiences and all the functions into meaningful coherent metal structures and these metal structures are created on the fly as we have an experience we immediately create a mental structure to cope with this experience this mental structure contains the memories the thoughts cognitions emotions and the functions associated the behaviors associated with all this and this is the mental structure that we create with each and every experience this is called episodic mental structure and mental structures that amalgamate aggregate find common denominators across multiple experiences across time so these are the synthesis processes and then there's another process realization remember we are talking about integration integration depends on synthesis creating mental structures to cope with episodic experiences and with experiences across time that is synthesis and the second process is called realization realization is when we analyze and when we assimilate experiences but we do it in two ways personification and presentation personification is when we own the experience when we analyze the experience and then we digest it we assimilate it we own it we say it is my experience this experience to a large extent defines who is I who is me it is my self it's a little similar to the concept of constellation in Jung although there are there are important differences but constellation is a form of personification and then presentation presentation is when during the process of realization during the process of living through the experience during the process of experiencing we bring the past and the future into the present moment and we integrate all it all makes sense the moment makes sense precisely because it's a natural flowing extension of the past and it leads inexorably and seamlessly to a future which is also connected to the past in ways which are comprehensible and acceptable and reasonable and not nightmarish so presentation is the equivalent of mindfulness and it involves reflexivity it involves the ability to regard the moment as the most important it's the most important because it explicates it gives meaning to it organizes and it explains perfectly everything that led to it the past and everything that will come forth forward will come henceforth the future in other words the present is the interpretative tool and organizing principle of our lives and this presentation and personification the feeling of self they are they together combine realization and you have synthesis and synthesis and realization lead of course to integration because if you feel that your experience is yours and that is connected to your past and to your future you're integrated you are put together your parts make sense you make sense deep personalization for example when you don't feel that you are you when you feel whatever is happening is happening to someone else when you even stand outside observing yourself observing things that are happening to that that thing that entity which looks like you deep personalization being on autopilot things are happening to me but it's not really me I'm removed from the scene I'm detached mentally well deep personalization is a failure in personification because it creates semantic memory but not episodic memory it creates language memory you can describe what had happened of course you were there you were an observer you were a spectator you were documenting the events at least in your memory in your hypothesis in your long-term memory and yet you didn't experience what was happening it was not episodic this is not an episode that had happened to you it's only semantics only language and I have a whole video dedicated to this it's a lecture I prepared for my students in in one of my universities was the Southern Federal University in Wostov-on-Don in Russia and it's a video the video lecture that deals with connection between memory types of memory and identity and how disruptions in memory creates create disruptions in identity identity disturbance or identity diffusion so deep personalization is an example of personification failure trauma generally reduces our ability to integrate and this depends crucially on who we are some people are very very very sensitive to trauma they are they have pre-morbid personalities as we call them they have to start with they have low integrative capacity either because psychobiologically you know they don't have the the tools or the properly developed instrument so it has something to do with genetics of biology or because they've been exposed in early childhood to traumatic experiences or or because they are highly sensitive people there's a tiny fraction of a population which have highly overdeveloped empathy no no no not empathicism empaths are grandiose terms of what I suspect to be covert narcissists I'm talking about really really hyper empathic people people who have high who have an abnormal form of empathy so they would have they would be traumatized all the time and the trauma reduces their integrative capacity and leads to recurrent dissociation but we must distinguish dissociation from dissociative process dissociative process is anytime we fail to integrate anytime you fail to integrate and this happens a lot in normal day-to-day dissociation for example when you listen to my lectures my boring lectures your mind wanders or you fall almost asleep or you begin to zone out cut me off tune out which proves that you are very healthy it's the only way to listen to my lectures but that is a normal dissociative process so we should distinguish this from trauma-induced dissociations dissociation before I go into the theory itself and what it says and what lessons we can learn from the theory when it comes to cluster B personality disorders which I personally think are post-traumatic states post-traumatic conditions I think all the so-called dramatic or erratic personality disorders and some others like for example schizotypal paranoid etc I think many personality disorders are actually post-traumatic conditions and should be totally reconciled in terms of post trauma so this theory is very useful in an attempt to understand the wider context of what today we call in my view erroneously personality disorders these are not personality disorders these are disorders of integration these are disorders of synthesis of personification of presentation these are disorders in these are procedural disorders these are disorders of process not disorders of substance but that's another debate before we go to the theory itself and what it says about dissociation I have to because I used to be a journalist so we always bring the two sides so I have to mention what the skeptics are saying the skeptics are saying that trauma is a fantasies dissociation does exist but it produces fantasies of trauma the person is asking herself why am I forgetting things why am I dissociating ah probably I was traumatized and then when was I traumatized let me think did my father ever touch me inappropriately let me think real hard let me imagine this wow I think he did this is called false memory so dissociation produces false memories and fantasies of trauma and that is true it's been documented many times multiple times therapists who are not skilled and not adept and frankly narcissistic have personality problems of their own these kind of therapists they tend to induce false memories and fantasies of trauma because they force the patients their patients to please them to gratify them and the patient is terrified to lose the therapist so we tell the therapist anything and then the patient convinces herself that she actually hadn't a process known as confabulation so the skeptics say most of the so called traumas are actually fantasies of traumas false memories and so on they say that dissociative disorders are artifactual conditions artifacts not real and they are produced by yatrogenesis I mean the doctor, the therapist creates them in the patient or even by social cultural factors in some societies when things change there's place for redefining some behaviors as trauma for example I grew up in a society where it was perfectly acceptable to physically to beat up to beat up children children were beaten physically, regularly and in that society the physical behavior the physical communication mode the parent was actually proof of love but of course as the context change it's now perceived as physical abuse and even I would say traumatic physical abuse trauma is heavily culture dependent, period dependent society dependent but I must say having presented the skeptics point of view I wholeheartedly, fervently, fervently vehemently and believe me I know many other words disagree because the preponderance and abundance abundance of clinical data and research do not support this view there is clear clear a linear relationship and proportional correlation and causation between childhood abuse and trauma as they are defined even socio-culturally when they are culture or society incongruent so everywhere in the world incest is considered abuse there are things which are universally considered abusive regardless of the culture or society of the period so when we trace back childhood memories of this kind of abuse we end up having dissociation and many many of what today we call personality disorders such as borderline personality so without further ado and to cut a long story even longer let's delve into the issue of dissociation the preeminent scholar of dissociation Freud and Breuer of sight was Genet in 1907 which is when the last dinosaurs still walk the earth and played with me as a kid in 1907 Genet wrote that dissociation is when there are two or more systems of ideas and functions that constitute personality in other words Genet actually was describing what later in the 60s and 70s used to be called multiple personalities when you had the personality fragmented broke down into two discernible selves full-fledged almost which could easily be described as a separate personality that was Genet it's a very restrictive view of dissociation and today we don't hold this view any longer at least not exclusively in other words we don't think that dissociation is only when you have multiple personalities and he said that dissociation is the result of inability to integrate owing to physical illness exhaustion stressors stressful situations and young age and that it leads to pathological alterations in consciousness to greater emotivity to reactive behaviors and beliefs notice the phrase greater emotivity this is what today we call emotional dysregulation and is one of the two hallmarks together with dysfunctional attachment one of the two hallmarks is borderline personality disorder Genet decades, many decades before the diagnosis of borderline personality disorder was even even imagined Genet actually was describing borderline personality disorder pathological alterations in consciousness greater emotivity reactive behaviors reactive beliefs and stable beliefs what today we call identity disturbance it's one of the diagnostic criteria of borderline personality disorder not long afterwards there was a guy called Mitchell in 1922 he suggested that maybe these were not really full-fledged personalities like Genet said but they were not far and here's what he wrote he said when there is dissociation it leads to fragmentation to break down of the personality these psycho-biological systems that result from the dissociation has its own unique combination of perception, cognition affect and behavior each has its own sense of self no matter how rudimentary fast forward a few decades and the American Psychiatric Association in the year 2000 when the Diagnostic and Statistical Manual Edition 4, the previous edition was published in the case said the dissociation is a breakdown or disruption in usually integrated function all these gentlemen and some ladies keep mentioning the word integration it seems that this is the crucial immutable invariable, foundational problem deficient, dysfunctional disrupted breakdown in integrative processes integration will come to it a bit later structural dissociation is a theory of dissociation but it should be distinguished we'll deal with it in a minute we'll dedicate a big part of this video to diving into structural dissociation but before I go there I would like to provide you with some tools to make nuances and finer distinctions than structural dissociation does although it's a very fine theory so first of all there is the issue of dissociative self states or dissociative personality states as the DSM used to call it we do have situations where we see emerging something that is not a personality in any sense of the word in any functional dimensional categorical sense of the word definitional sense of the word it's not a personality but it is a different self so it's I would call it pseudo personality when the borderline for example faces rejection humiliation, abandonment neglect, being ignored stress severe depression or when she is under the influence of substances drinks to excess does drugs the borderline switches moves to another self state which is essentially psychopathy she becomes a secondary psychopath we'll deal with it a bit later but these are distinct self states anyone who has ever been with a borderline treated a borderline spent time with a borderline has witnessed this switching no one no one can deny it and structural dissociation is difficulty accommodating this switch they have something called intrusion which we'll come to a bit later but it's not the same intrusion is like a negotiated process a dance macabre a kind of filling each other out between structures and personalities it's like bargaining thing it's like I withdraw your approach approach avoidance repetition compulsion it's very very ballet like that's not what happens in borderline switching absolutely not it's much closer to what you see in people with dissociative identity disorder multiple personalities where you see one person disappears another person appears a minute before there are smiles and compassion and love and empathy and a minute after this cold hearted stone faced goal oriented machine, disempathic aggressive vindictive so there's this problem of self states which is not fully accounted for in structural dissociation they did develop something called tertiary structural dissociation which we'll come to a bit later but I don't consider this a satisfactory resolution second problem with structural dissociation is that it doesn't cope well it doesn't describe well dissociative phenomena and non-dissociated self states or personality states you see there are situations where people switch between self states and personality states and they remember everything in other words there's no dissociation there's just the switching between states which are so structural dissociation says that's nonsense they call it reification that doesn't exist I have a surprise for all these eminent psychologists if something exists it's denied shockingly it continues to exist so denying it is not a good strategy it's there there are non-dissociated switching there is non-dissociated switching between non-dissociated self states or personality states and someone needs to give an answer or to incorporate it so the total theory of dissociation one needs to deal with this and a bit later I will come to a new diagnosis in the diagnosis of statistical manual 5 atypical DID states atypical states of dissociative identity of multiple personalities okay like every theory in psychology there's a metaphysical layer to dissociation it's the theory suggests that each one of us is born with a psychobiological series of mechanisms or subsystems they're inborn they're self-organizing they're homeostatic they're like operating systems like windows or android so they're like operating systems but they are emotional operating systems and we're all born with them and they're there and we make use of them to cope with experiences and so on and these are called action systems so there are two types of action systems remember these are psychobiological entities something that every person in the world has according to the theory I regard this as metaphysics it's total speculation maybe it's right, maybe it's wrong I don't think it's possible to falsify it it's not amenable to the scientific method in my view so it's not science, it's pseudoscience but if it makes their day not against it, you know anyhow, since this is what they are saying I have to share it with you they said that there are action systems there are two types it's an operating system the first type of action system guides daily living, daily life and has a dimension which has to do with the survival of the species so this is the system that drives us to have children total failure in my case probably I don't have it this is the system that drives us to have sex no comment here so this is the system that drives us to behave in daily life self-efficaciously so as to guarantee favorable outcomes so as to allow us to propagate our genes within the gene pool of the species in other words to guarantee the survival of the species then there is a second action system so this will be an evolutionary action system there's a second action system and that is what is known as the four Fs the freeze the fight, flight, freeze and fall this is a physical defense action system and it's reactive exclusively to threat whenever there's a perceived threat this action system springs into action now if you put these two together if you put the daily life action system and the physical defense under threat action system put the two of them together together they operate in social circumstances where you socialize or where you work or act within social systems because they are they constitute, when you put them together they constitute a social defense against abandonment and rejection so it it would tend to reason that in people with borderline personality disorder both these systems or maybe when these systems work together for a very long time because what happens in borderline personality disorder when there is a perceived risk of abandonment and rejection or when there is actual abandonment and rejection the individual decopensates and acts out becomes reckless self-destructive self-defeating in other words the individual begins to become suicidal begins to destroy himself and everyone around him so in borderline the confluence the combination of these two action systems which usually operate in social circumstances and interpersonal relationships this confluence has a glitch it goes haywire and the borderline when these two systems collude combine cooperate to work within society and they go bad they go haywire the borderline goes haywire becomes self-destructive and other destructive loses empathy for example becomes reckless, becomes defined becomes impulsive, aggressive even violent so this is the first function of the combination of these two action systems and there is you put the two of them together what you also get is what is called the inter-receptive defense inter-receptive defense is the defenses we have against mental content voices, memories you know mental content that is very very upsetting very egodistonic, paralyzing even now we all have these defense inter-receptive defense but in dissociated people in people with borderline personality disorder in my view narcissistic personality disorder the inter-receptive defense again goes haywire it protects against mental content yes and but it protects too effectively too efficiently so as to slice the mental mental content off and cut it off to give no access and that is why for example the narcissist cannot access his emotions this is a very the inter-receptive defense is like all the infantile defense mechanisms put together primitive defenses like splitting combined with some sophisticated defenses like passive aggression and together they are the inter-receptive defense inter-receptive defense again in normal people it is very useful in dissociative and personally disordered people it creates dysfunction because you have no access to big parts of your memory so you have to confabulate of your identity so you have no identity there is identity diffusion and disturbance of you have no access to your emotions so you are emotionally dysregulated like the borderline or emotionally dead like the narcissist and psychopath the inter-receptive defense can go too far like everything else the source of this theory I mean this theory is very old actually the founding father in theory is an army doctor British army doctor his name was Charles Daniel Myers and in 1940 he found himself treating acutely traumatized war veterans already from Dunkerrick and other battle theaters combat theaters in Europe so he was treating badly traumatized war veterans and he came up with the idea of action systems he suggested that when someone is traumatized personality actually breaks in two one part is he called the A&P the apparently normal part so he said when you're traumatized you break and there's a part that is called apparently normal and there's another part, EP and that's the emotional part this is a reaction to trauma it doesn't happen in daily life only when you're exposed to trauma Myers called the A&P the apparently normal part and the emotional part he called them personalities but today we realize these are not personalities so we call them parts action system number one the action system that is in charge of daily life is connected to the A&P to the apparently normal part action system number two the action system that has to do with physical defense under threat is connected to the emotional part to the EP now let's delve a bit deeper into these two structures that materialize suddenly out of thin air in reaction to trauma what is the EP the emotional part the emotional part contains vivid trauma recall in other words you've been exposed to trauma the trauma could be pinpointed it could be a single event a car accident a plane crash you've been at war so your body being blown apart a divorce even a pinpointed divorce a cheating being cheated on the death of a loved one all these are all these creates and so the EP the emotional part contains a vivid recollection of all this but not in the sense that you sit back and say wow I remember the car crash it was really terrible no but you experience the car crash again and if this is really extreme you contain reality apart from your flashback you are in the flashback you feel that you are in the car again having the accident you're absolutely oblivious to your environment your wife talks to you you don't listen which is a normal thing okay forget this your dog barks your television explodes nothing you're in the car you're having the accident all over again you're in the plane you're crashing or you recall the exact event that the twin towers collapsed for the very second where you have learned that your wife is cheated of you these are all traumas and flashbacks are stored in a container and this container is the EP the emotional part the emotional part contains not only the memory but all the emotions that went with the memory and these are known as vehement negative emotions vehement negative emotionality includes fear horror helplessness guilt shame anticipatory anxiety so all these are stored with a vivid flashback of the traumatic event and either you experience these emotions or you are so afraid to experience them that you develop the exact opposite listlessness non-responsiveness and submissiveness submissiveness in the sense that you become a zombie you become a robot you react in slow-mo slow-motion and if you are pushed beyond this you begin to derealize and depersonalize you feel that you are not in reality or what is happening is not real and you feel that it is not you but it is happening to someone else who looks like you very much and you are just mildly amused spectator and so all these are the residents the denizens of the emotional part the flashbacks, the responses and they usually affect the body not the body but how you perceive your body so they bring about body dysmorphia you begin to perceive your body wrongly or parts of your body wrongly and they create a separate sense of self this is extreme event-related pinpointer trauma what we had discovered later much later in the early 90s through the agency of Judith Herman is that repeated exposure to such events creates a much more complex EP complex emotional part we will talk about it a bit later and this is of course complex trauma or CPTSD complex post-traumatic stress so now there is a big disagreement between some of the proponents of this theory and Herman and again we will touch upon it a bit later but there is a general agreement that there are two types of traumatic dissociative reaction to an event-like trauma and to prolonged anticipatory, long-term repetitive, predictable trauma the emotional part had been described by numerous scholars and each one gave his own favorite name to the emotional part Lofer called the emotional part the war self Wong called it the survivor mode Tober who conducted amazing studies of holocaust survivors so Tober called it the child part of the holocaust survivor compound personality Glolinkina and Ryle called it the zombie part in trauma-related borderline personality disorder Claft and Patten called it the alter alternative personalities in DID dissociative identity disorder or used to be called multiple personalities and Bruin called it identities associated with situationally accessible trauma related memories known as ever accused Bruin of being catchy and all these include abuser rage, victim rage and passivity rage of the abuser is internalized actually and there is a rage of victim for having been victimized but the clash between the two creates passivity this is the EP, emotional part what about the apparently normal part the A&P the main role of the A&P is to cut off the EP the main job of the A&P is to make sure the EP never gets access to consciousness never interrupts and intrudes on the conscious functioning, conscious memory conscious identity conscious everything of the person so the A&P represses traumatic memories this structure avoids triggers and it avoids triggering the trauma avoids flashbacks avoids remembering the trauma avoids re-traumatizing avoids re-experiencing the trauma avoids going there tries its best the A&P tries its best to dissociate the trauma and the emotions attendant on the trauma in short the EP so the A&P does this using a variety of mechanisms and techniques and strategies and tools amnesia of course is the most dominant dissociative amnesia but there's many others, there are many others for example sensory anesthesia restricted emotions numbness depersonalization many again the A&P had been previously described and renamed by many others Lofer called it the adaptive search Wong called it the normal personality functioning mode Tober who studied holocaust survivors called it the adult part of the holocaust survivor compound personality Golinkina called it the coping part in borderline it's been called the host personality or the moderator personality in DID and Bruin remember the guy who can never say anything in less than 46 words Bruin called it identities associated with verbally accessible memories of general autobiographical experience and of some elements of traumatic events and yes I'm kidding you're not now there is a war conflict zone in the traumatized person's mind there's an ongoing war belligerence and conflict with many many attendant dissonances between the A&P whose job is to suppress the EP and the EP whose job is insurgency insurrection and acts of terrorism is like the colonies and the A&P is like the colonial power you know keep it away from the media don't let anyone at home know what we're doing here concentration camps killing women and children it's not for the delicate conscious of people at home, back home the Z&P and the EP and they are fighting all the time and the EP interferes with the A&P intrus obstructs, undermines attacks tries to like intrusion detection system tries to find the vulnerabilities, the access points installs malware behind the front lines send spies the EP is in constant war with the A&P because it is a container for trauma-related memories and overwhelming and disorganized emotions and aside many so-called and self-styled empaths actually what they describe is not empathy at all it's this defenselessness defenselessness this lack of skin this being overwhelmed by disorganized emotions and emotional fragments related to a trauma a trauma is like a hand grenade you know it splinters everything, it fragments everything it's a mess it's very easy to confuse this emotional dysregulation with empathy but it's not empathy actually never goes with emotional dysregulation emotional dysregulation leads to the exact opposite of empathy this empathy but that's for another video so the EP is this hand grenade it contains this broken memories damaged goods total chaos in disorganization and it wants to intrude on the A&P because it's repressed and suppressed and has this pent-up energy Freud said when you repress something when you repress a memory when you repress the memory and the energy of the memory and this energy works in the unconscious until it erupts now in psychoanalysis we manage the eruption the eruption is managed and structured and controlled and this is called upreaction but in a classic traumatized person who is not attending therapy in daily life there is this battle going on and the EP has a lot of energy it's like an improvised explosive device it's like a nuclear bomb to be more precise it has a lot of energy and it threatens the precarious balance that the A&P had succeeded to create now the A&P in itself is a pathological structure it is sick and weak it's a last ditch defense against recalling the horrors of the trauma and so this battle if the EP wins if the EP disrupts the A&P the EP the emotional part if it comes to the surface if there is uncontrolled upreaction if it reaches consciousness it's the end it leads to absolute demolition of impulse control impulsive behaviors defiance recklessness anywhere from from security to drug abuse maladaptive reactance reactance is an element of psychopathy so it leads to it leads to a switching if it's in a borderline for example it switches the borderline to psychopathy if it's in a psychopathy it switches the psychopathy to malignant narcissist if it happens to a narcissist it switches the narcissist to a borderline this is the switching mechanism the victory the triumph of the EP over the A&P leads immediately via collapse and modification to switching between the three states overt collapsed and covert and each of these three states is the exact equivalent the parallel of what today we call personality disorders the collapse state of the of the psychopath the covert state of the psychopath is actually grandiose borderline or narcissist the covert state of the narcissist is very very close to borderline the to see that these are simply mirror images mirror images if you look from the left you see borderline but if you look from the right you see a collapsed state of a narcissist if you look from the right you see a psychopath but if you look from the left you see a collapsed state of a borderline that's a psychopath secondary psychopath so it gives a rise to a unifying theory where actually we say okay if trauma management fails whenever trauma management fails via collapse and modification there is switching between alternative parts switching between alternative parts and each of these parts is actually what today we call erroneously a personality disorder so again when the borderline collapses she switches to a part to an EP to a part or to another ANP which is a secondary psychopath which is today what we call secondary psychopath this is a proliferation of entities because what we are doing we are like the three blind wise men who were brought to inspect an elephant one of them had this his leg one of them touched his trunk one of them touched his tail and of course they had three totally different descriptions of the animal because they were blind but he was the same elephant and there is only a single elephant dissociation and trauma related structure in this sense I agree with him structure and within this structure depending on the results of the war between the ANP and the EP we have collapse states and we have covert states the collapse is brought on by this war and part of this war or another name for this war is modification and so when the war when the EP when the trauma when the traumatic element wins the war there is switching from overt to collapse from collapse to covert and each of these states is what today we call personality disorder the ANP of course is conditioned to be afraid of the EP EP is a serious threat to the survival of the individual and more broadly in evolutionary terms survival of the species so the ANP is very afraid of the very fearful of the EP of the emotional part and it reacts to the emotional parts attempts to intrude it reacts to the attacks by the emotional part emotional part is like a virus I mean computer virus or actually like a real virus it tries to infiltrate the system and then replicate so the ANP's job is to prevent this from happening and it uses everything every tool and weapon in its arsenal to prevent the EP from taking over it out alters consciousness it lowers consciousness or even goes unconscious it encourages behaviors which lower consciousness for example substance abuse alcohol abuse addictions, compulsions self-mutilation self-mutilation in such situation is in order to silence the inner voice of the EP to silence the memory of the trauma and the ANP is so terrified of the EP and its recurrent incursions its recurrent insurgency its terrorist attacks is so terrified of this it develops phobia phobias, multiple phobias it's very much like the response of the United States after 9-11 we react to phobias we react with phobias to such incursions so the ANP develops phobias anyhow it's a weakened pathological structure its splinter of the original personality fermented and fractured by the explosion of the original trauma so it's weak to start with it becomes paranoid it begins to develop persecutory ideation and persecutory internalized persecutory objects so it creates phobias it begins to be afraid of thinking of a motive so it develops obsessive-compulsive internalized rituals don't think this don't think about this word or externalized obsessive-compulsive rituals wash your hands 10 times a minute you know so afraid of mental action it begins to be afraid of the dissociative parts it begins to deny and repress and suppress and fight not only the trauma the original trauma but anything remotely that has remotely to do with it so it develops a version of the trigger it becomes terrified of attachment and intimacy of losing attachment so attachment loss phobia of attachment loss because attachment and intimacy can present a panoply a plethora a compendium of triggers when you're in a relationship your chances to be triggered are much higher so the ANP teaches the trauma victim to avoid attachment, avoid intimacy avoid loss, avoid normal life avoid any change and there is a pernicious very sick process called evaluative conditioning evaluative conditioning is when we associate neutral stimuli totally irrelevant stimuli like good morning or would you like coffee or looking at this glass or I don't know a transplant totally neutral stimuli associating neutral stimuli with negative or positive outcomes and with negative or positive feelings this is called evaluative conditioning why is it bad why is it pernicious why is it totally destructive and self-defeating because neutral stimuli are neutral if you evaluate them improperly you are likely to react improperly if you evaluate them negatively you are likely to be re-traumatized suffer be in pain be in fear withdraw from life if you evaluate neutral stimuli positively you are likely to end up with very bad people in regular situations and be sexually assaulted so it's bad to misinterpret the value the value sign of a stimuli stimulus is neutral should be neutral not motivated to action so when a neutral stimulus was previously connected previously previously associated with a negative stimulus the neutral stimulus acquires negative overtones and when a neutral stimulus has been associated with a positive stimulus in the past it acquires positive overtones and this is evaluative conditioning total distortion total distortion of the world and so evaluative conditioning is used by the A&P in the battle against the EP the A&P says let's avoid all negative outcomes let's avoid all negative feelings and let's avoid all the stimuli that had ever been associated however remotely tangentially and indirectly with negativity so this process is called constriction constriction of life constriction of the world your life becomes narrow reduced until it's a single point on the screen an individual can have one A&P and one EP and this is called primary primary dissociation structural dissociation an individual can have one A&P and two or more EP's there will be secondary structural dissociation an individual can have multiple A&P's and multiple EP's and there will be a tertiary structural dissociation and this is actually DID dissociative identity disorder both A&P and EP according to the theory have a rudimentary sense of self there is an I behind each one the EP if it could talk it would say I feel bad I feel angry, I feel ashamed I feel guilty and the A&P if it could talk would have said I am terrified of the EP I must suppress this memory I cannot go through this again if I go through this again I will disintegrate and die etc both of them have a narrative voice which is very close to Jung's constellation or to Freud's perhaps ego because there is an element of inner critique there and both of them have exclusive access to some memories in other words the EP has access to memories that the A&P doesn't have access to because A&P doesn't want the access the A&P doesn't want to be seen dead with his memories he doesn't want to remember them he doesn't want to store them he doesn't want to classify them he wants to forget them so there are memories that only the EP accesses because the A&P gave up on them and of course the other way there are memories that the A&P is using but would not be conducive to maintaining the fresh memory of the trauma the flashbacks so the EP is avoiding these memories again I refer you to my lecture about identity and memory on this channel it's a lecture if I give to my students so dissociative parts vary in many many ways in the degree of intrusion in the avoidance of trauma related cues in affect regulation in psychological defences in capacity for insight in response to stimuli body movements, behaviors cognitive schemes, attention attachment styles sense of self self destructiveness, promiscuity suicidality, flexibility and adaptability in daily life structural division autonomy, number number of substructures subjective experience overt manifestations dissociative symptoms all these so you can't just say EP is this, A&P is this it so crucially depends on the personal history of the individual on the exact type of the trauma on previous reactions to trauma on coping mechanisms et cetera et cetera consider for example dissociative symptoms there are negative symptoms and positive symptoms negative symptoms have to do with loss loss of something so you have amnesia numbness, impaired thinking loss of skills, loss of needs wishes, fantasies, loss of motor functions loss of motor skills loss of sensation all these are losses some people have this, some people have that we have positive dissociative symptoms when mental content of functions of one part intrude on another part so this is very very close to effect to psychotic disorder to schizophrenia these people for example hear voices the war is so big that the EP uses everything to intrude and to break through the defenses like the Siege the famous Sieges of the Middle Ages where you had to break through the fortress fortress walls with copper poles and whatever you had so the EP is using voices we are using psychosis to break through the A&P non volitional behaviors ticks, pains with no reason you have psychoform and somatoform dissociative symptoms somatoform dissociative symptoms is what Freud used to call conversion symptoms and so we should narrow it a bit dissociative symptom is a dissociative symptom only if there is a clear evidence that it comes from some dissociative part of the personality and also if the symptom is found in one or some parts of the personality but never in all of them so if you have a promiscuous woman and in what she is always promiscuous even when she switches as a borderline for example she switches between clearly you know dissociative parts she switches from borderline to secondary psychopath or to nice disease from overt to covert and from covert to collapse with all these switches she is promiscuous so then promiscuity is not a dissociative symptom but if she becomes promiscuous only when she switches from borderline to psychopath or only when she switches from overt to covert that would strongly indicate that it's a dissociative symptom A&P and EP are not totally divorced of course they are in the same skull using the same brain for those of you who have brains they share a lack of full realization of the trauma of course the what the A&P knows EP doesn't know what EP knows A&P doesn't want to know and so there's a kind of Chinese war between the firewall they don't talk too often meaningfully at least they are like very old married couples so they don't realize the trauma fully if they were put together integrated fused you would have a clear full-fledged processing of the trauma which is what we do in therapy but as it is the trauma is segregated both of them have obstructive adaptive deficits both of them are not very adaptive they don't help the person much too much energy is going into separating fighting not me so they are not very adaptive and they both lead to significant dissociative symptoms structural dissociation is a permanent pathological state it requires treatment to fuse the parts and it requires social support and restorative experiences after the trauma as we discovered that having a social safety network just a little affection and comfort having some restorative experiences good experiences after the trauma they buffer they even reverse post-traumatic effects even better than therapy and in therapy we commit usually three mistakes and these mistakes give the emotional part the upper hand we actually re-traumatize the patient we cause damage one, we re-fight the parts that appears after the switching as though we are talking to another person we don't really communicate across the parts but we communicate with each part separately thereby encouraging the emergence of multiple personality disorder that's why many skeptics say that multiple personality disorder is a yatrogenic thing it's induced by the therapist the second mistake is that we put undue emphasis on differences between dissociative parts rather than on the commonalities the third mistake is that we put a premature focus on traumatic memories but in cold therapy these mistakes are the strong points these mistakes are the main techniques because we want to break the narcissist we want the narcissist to re-experience his trauma in the form of a flashback we want the narcissist to go through that horrible, harrowing torturous destructive terrifying period in his life and to go through it really not semantically but episodically to experience the episode to live through it the only hope for destroying for getting rid of the false self so these mistakes are the therapy of classic trauma victims like women with borderline in treating narcissists via cold therapy I took these mistakes and I made them the foundation stones of cold therapy when the ANP is full functioning and dominant PTSD is delayed of course it's the main job of the ANP to keep PTSD at bay and dissociative symptoms are linked but there's a price the ANP consumes a lot of energy and prohibits, proscribes it's prescriptive it prevents, it inhibits certain behaviors so functioning is reduced when the ANP is successful functioning is reduced and even people who delay the PTSD by having a successful ANP they are much less function than people who don't have PTSD at all I have many disagreements with the theory but one of them is that I believe the ANP fluctuates I believe there are periods of high functioning ANP and periods of low functioning ANP and these would tend to explain the collapse I think when the ANP wanes when it wanes there's a collapse and when it walks there's restoration of the overt phase and when it wanes the collapse it leads to a covert state so the ANP goes down there is a collapse via modification there is a covert state and then the overt state even the theory itself structural dissociation they recognize that in some situation there is what they call submission submission, vanishing it's actually the freeze formed in flight parts coupled with submission, coupled with vanishing what do we have? Covert state even structural dissociation describes actually the covert state but just doesn't call it covert when the ANP is less than successful when it has low energy or low consciousness or low self-efficacy when the ANP is not working that well and the EPs is intruding on the turf invading in that stage this leads to covert behaviors and would explain for example why passive aggression comes to the fore as a defense this is associated with EPI collapse and modification are traumatic and they evoke past childhood traumas the child has been told that he is bad and worthy and the collapse and the modification force regression into that phase where the world, the word the logos, the word of the godlike creatures mom and dad they are godlike creatures they are infallible, they are omnipotent they are 7 meters 7 meters high, tall these creatures are telling you that you are bad unworthy, failure you take it absolutely believe it it's very very traumatic because it's terrifying maybe if you are bad and unworthy they will dump you in the nearest garbage bin maybe they will get rid of you maybe they will not feed you maybe they will kill you maybe they will bring another child to take your place it's a terrifying statement and so the collapse and modification force the narcissists or the borderline or even the psychopath regress them to that part of their childhood where they were mortally mortally terrified for their own survival now CPT is the complex trauma borderline personality disorder and a now defunct category called disorders of extreme stress not otherwise specified all of them were considered a part of secondary structural dissociation I would like to focus for a few minutes on a new diagnosis in the latest edition of the DSM DSM 5 published in 2013 and it's called other specified dissociative disorder subtype 1 and it's a it's this is the epitome of the secondary structural dissociation OSDD1 is very similar to DID and and so it's it's not 100% secondary but as opposed to DID there's no amnesia so the person switches between personalities which are not personalities, switches between parts switches between traumatic parts you know but remembers everything the parts are not fully differentiated so and so both the ANP and the EP remember everything this access to memory is amazing because theoretically OSDD1 should have only one ANP and multiple EP but this is sometimes not the case you could have an EP which is of EPs with OSDD1 and but of course these EPs will be not as developed as in full-fledged DID but still you know quite a few of them and very powerful very well developed and so on and there will be traumatic containers and but the nature of the interaction between the ANP and the EP parts will resemble uncannily the way these parts interact in borderline personality disorder and in complex trauma in CPTSD the differentiation is incomplete these authors, alternative personalities are not fully developed they don't have a full-fledged idea of self they're not totally separate they don't recognize each other they don't share the same memory pool in OSDD1 they do so OSDD1 is like BPD or CPTSD on steroids the EPs of OSDD1 handle some aspects of daily life for example you can have EPs that are very playful, like children or they are very curious explore the world grandiose even and indeed most of these EPs self-describe as children and they when they're in a safe environment or when they are triggered sometimes they switch and that appears and sometimes they don't switch it's something called passive influence they kind of flow there's a gradual incremental incremental change they sometimes have arguments, these parts they deny each other or they deny each other's memories or they deny the form of the body that they are occupying and the A&P itself is infected with emotional liability with dysregulation and shame and blame and hatred and it's a big mess OSDD is a big mess and OSDD seems to me the kind of primordial state primordial dissociative state that once more developed becomes borderline personality disorder and CPTSD CPTSD symptoms sound almost to the letter like the symptoms of borderline personality disorder the two foundational characteristics of borderline personality disorder insecure attachment and emotional dysregulation exist in CPTSD and in BPD and in the next edition of the ICD edition 11 the International Classification of Diseases CPTSD is going to be a recognized diagnosis and it's going to include as diagnostic criteria insecure attachment and emotional dysregulation which raises the question why the proliferation of entities why do we need CPTSD or complex trauma and BPD if they share 90% of all the diagnostic characteristics CPTSD if CPTSD is founded on a particular attachment and emotional dysregulation then it's not only a trauma reaction it's what we would call today a personality disorder but of course we can reverse the argument maybe a personality disorder is a trauma reaction maybe we are getting it backwards we say wait a minute CPTSD sounds like a personality disorder maybe it's not a trauma reaction but wait a minute maybe it's the opposite borderline sounds like CPTSD so maybe it's not a personality disorder maybe it's a trauma reaction in both cases there are traumas of childhood subtle, severe nuanced, real, ambient but there's no borderline personality disorder without some kind of trauma the trauma doesn't have to be overt it doesn't have to be physical beating or incis sexual abuse trauma can be ambient can be parental expectations can be conditional love can be what we call lack of parental attunement the famous pediatrician turned psychologist he called it being dropped by the mind of the mother he said the mother should be good enough you know and if she's not good enough if she drops the child in her mind that's trauma Judith Herman Driesen McLean Gallop and a zillion other scholars argue repeatedly that CPTSD is misdiagnosed as borderline personality disorder and that borderline personality disorder should be abolished as a separate diagnostic and clinical entity I go even further all personality disorders should be abolished there should be a single personality disorder and it should be moved moved in the DSM to the post traumatic conditions section it should be a form of CPTSD CPTSD dissociative CPTSD I mean when CPTSD is coupled with dissociation it leads to what today we call personality disorders personality disorders are the dissociative states of trauma as Herman says the data on this point are beyond contention 50 to 60 percent of psychiatric inpatients 40 to 60 percent of outpatients report childhood histories of physical or sexual abuse of both in borderline and in CPTSD what happens with narcissistic personality disorder borderline personality disorder there is childhood trauma in one way or another there are 100 ways to abuse a child many of them are not overt and these subtle ambient underground ways are even worse, more pernicious so there is an abuse there is trauma and some people with premobile personalities react to this trauma by dissociating they create an A&B and EP they have a model you want to use I don't care they dissociate it dissociation by definition is a fragmentation and fracturing of personality presto you have narcissistic personality disorder two personalities you have borderline personality disorder effectively multiple personalities are switching you have the psychopath secondary and primary you have overt states co-vert states, co-lub states perfectly all we have to do is stop being obstinate look at the data and accept that at the root cause of all this is trauma and dissociation separately and sometimes co-jointly