Tami Simon: Hello, friends. My name is Tami Simon, and I’m the founder of Sounds True, and I want to welcome you to the Sounds True podcast, Insights at the Edge.
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In this episode of Insights at the Edge, my guest is MaryCatherine McDonald, PhD. MaryCatherine, who is called by many of her students and clients “MC,” is a research professor and life coach who specializes in the psychology and philosophy of trauma. She’s been researching, lecturing, and publishing on the neuroscience, psychology, and lived experience of trauma since completing her PhD in 2016. She’s published two academic books and many research papers and is the creator of a trauma-based curriculum that serves previously incarcerated people and veterans. With Sounds True, MaryCatherine McDonald is the author of a new book. It’s called Unbroken: The Trauma Response Is Never Wrong—and Other Things You Need to Know to Take Back Your Life.
MC is an unusual person. In her own words, she’s an “academic who’s gone rogue.” My experience is that she’s a deeply feeling person, a deeply caring person, someone who wants to take research and neuroscience out of ivory towers and bring it directly to all of us so it can be helpful and applied to the suffering that we’re facing. Here’s my conversation with the very brilliant and helpful MaryCatherine McDonald on why the trauma response is never wrong.
To begin, MC, and as a way to better introduce you to our listeners here of Insights at the Edge, tell us a little bit about how trauma research became the focus, really, of your professional life.
MaryCatherine McDonald: That’s a great question. It was actually kind of an accident. I was studying identity, and there was this huge debate in the philosophy of psychology at the time about narrative and whether or not and to what extent human beings’ identity owes itself to a story or conforms to story form. I felt very strongly that we are constructed psychologically through a story and that we have a narrative arc, both for the events in our day-to-day lives, but also our larger story arc, our larger life path. I was meeting a ton of resistance to that. There was this argument on the other side that we are not narrative nor should we try to be, that this is actually harmful. So I wanted to look for case studies that would show that there’s a narrative there, even if we don’t identify with it or notice it necessarily, but that we are constructed in some way by a story.
I reached for trauma as that case study, because every account of trauma that I encountered in popular culture and anywhere, in my own life and in the lives of friends and family members, people talked about the narrative shattering, that they had this expectation, this story about the life, about their life, about the way that the world works, that got shattered by the trauma. So I reached for that as a case study and thought sort of hilariously like, “Oh, I’m just going to have this little foray into trauma research and then come back and use it as a case study and move on.” And I fell down a rabbit hole and then I moved in.
Tami Simon: Now, in your own life, trauma is also part of your own formation, the narrative that formed you. Would you say your own personal narrative was shattered in a certain kind of way? And if so, how?
MaryCatherine McDonald: Absolutely. So the most—I had some early life trauma, but the biggest shattering experience was the sudden death of my father in 2005. He was very healthy, we thought. It turned out he had been—there had been a late-stage colon cancer that was growing for a long time, that we were unaware of. He didn’t have symptoms, and he went from kind of being at work and living normal life to being dead within 10 days. He died on Christmas morning, and my dad was one of these people—I think everyone says this about people in their lives who have died, but he really was one of these people who is an angel on earth. Everyone would say that he was an amazing presence and a very good person by all accounts. His death exploded every structure of meaning that I had, and I didn’t have any idea that I even had those structures of meaning.
You operate on these beliefs that bad things don’t happen to good people, and then something bad happens to the best person you know, and all of a sudden you don’t know what to believe. It shattered in probably a thousand different ways, because there was also this story that I was telling about how my father would be present in the rest of my life. He would be along for the ride. He was only 62 when he died. So I thought I have at least another 20 years of my father in this life, and that shattered as well. Then you have these ideas about what grief might look like that shatter as you move into it. So those are just a couple of examples. Absolutely, it felt like there was this map of the world that I had been drawing for my whole 24 years, and someone just ran in the house, grabbed it from the wall, and smashed it into a million pieces, and I had to figure out where am I? Where am I going? And how do you make a path?
Tami Simon: MC, I think you’re such an interesting writer and professor because you have this academic training, you have a PhD, you’ve studied the neuroscience of trauma deeply, and yet you yourself are also a brilliant storyteller. In Unbroken, you draw on composite stories of people that you’ve worked with, you draw on your own history, and you really present a view of trauma that I think is so important for us to appreciate. And you write about it as we need to update what we understand about trauma, that many of our notions are outdated and that this updated view is going to give us more empowerment in relationship to trauma. So let’s start there, digging in a bit. What is it in our perspective about trauma that you think needs to be updated?
MaryCatherine McDonald: So many things, but I think they all sort of source back to this fundamental belief that trauma equals weakness. That if you have been traumatized, if you’ve been through a stressor and the result has been traumatic symptoms or you’ve struggled with that, that there’s something wrong with you. And this comes from a very outdated understanding of trauma that stretches all the way back to the 1800s. The reason I talk about updating the definition is because there are remnants of that old definition around. We still use the language of weakness. We still have societal judgment about people who have trauma. And what we know now after 150 years of study, and the advent of technology that enables us to look at the brain and understand the trauma responses in the body, what we know to be true now is that the trauma response is the body’s natural response to threat. It is not a sign of weakness or disorder, and if I have one goal in life, it’s to make sure that that message gets out there.
Tami Simon: And how did we get this notion that it’s a sign of weakness, a sign that there’s something wrong with me that I’m having this level of response to X, Y, Z event?
MaryCatherine McDonald: I think a lot of it had to do with the way that we were studying trauma, so the history of the study of trauma is fascinating in the way that it began and the different sort of peaks and valleys that it’s had in those last 150 years. When we started looking at trauma, all we knew was that we had a subset of the population that showed up with symptoms that didn’t respond to treatment and didn’t seem to make sense, given the current psychological theoretical construct. So the belief then was if you take that piece of the population in comparison to the rest of the population, these symptoms must be because of some disorder or weakness within those people.
That from a theoretical perspective makes sense, right? Let’s figure out what is causing these symptoms in this group of people. As we went on, we realized that it wasn’t—that it wasn’t something wrong with those people, it was that what they had been exposed to had created this response in their body that was very normal and natural and adaptive and important, but we didn’t have any of that scientific knowledge at the time, so all we had is hypothesis. I think sometimes people forget that science, and in particular psychology and psychiatry, work on hypothesis until we have knowledge. Then, even then, that knowledge often gets overturned by future knowledge. So what was true in the 1800s is not true anymore, but there’s no way to go back and sort of select all and delete those things.
We inherit those definitions, and we continue to use them. So we still carry around this belief that if you’re traumatized, yeah, it might be because you went through something difficult, we’ll allow you that, but also it’s probably because you have some inherent flaw.
Tami Simon: So I think people can appreciate there’s intelligence in the trauma response. This is my body, my psyche, my mind, responding intelligently, but it doesn’t feel very intelligent when the trauma response is something that we feel stuck in many decades after the event, and in fact, it’s causing us a lot of suffering. So maybe you can help us understand that, because it’s like, “Oh, I’m stuck in trauma. And yet here MC is saying there’s nothing wrong with the trauma response.”
MaryCatherine McDonald: Right.
Tami Simon: “Well, it sure feels wrong.”
MaryCatherine McDonald: It does, and it causes all sorts of disorder in your life and pain, and I don’t mean to minimize that at all. I think when we understand the miracle of human adaptation—we as biological beings adapt all the time, all day, every day. We’re adapting to the temperature in the room, to the dynamic conversation that we’re having, to our levels of fullness and thirst and all that kind of stuff. For the most part, our adaptations work for us, and the thing that happens with trauma is that when we have a stressor that is sufficiently overwhelming, sometimes we get stuck in the trauma response. This is what causes the chronic symptoms of stress and hypervigilance that we see in PTSD and CPTSD.
The thing that we’re missing is the idea that—so those symptoms are not a sign that the trauma response is wrong. The symptoms are a sign that your body is stuck in overdrive. The answer to that is not to shame the system or to say that you are weak because you got stuck here. The answer is to unstick yourself and readapt to the world again, which I don’t think we talk about enough, because I don’t think people really understand how possible it is to recalibrate the nervous system after it has gotten stuck.
Tami Simon: OK, so we’re going to have to go into your perspective on getting unstuck and then recalibrating.
MaryCatherine McDonald: Yes.
Tami Simon: So tell me more in terms of your understanding about both of those very important ideas.
MaryCatherine McDonald: OK, so can we start with memories and why they get stuck?
Tami Simon: Sure.
MaryCatherine McDonald: So if you think about your brain—I always say that if I won the lottery, I want to make a Pixar movie just about memory because it’s so fascinating and so poorly understood by most of society. If you think of—there’s a part of your brain called the hippocampus, which you can think of as a huge file room. And all of your memories are stored in file folders that have narrative content, emotional content, and some sort of meaning tag so that your brain can find the information quickly. The reason your brain does that is because it’s trying to adapt to the ever-changing outside world and keep you alive. So the better you can remember things, the more likely it is that you’ll survive. “Oh, that mushroom is the poisonous one. That one is the safe one.” That’s really important to file away.
So that filing system is running all the time, and when we have kind of normal things going on in our lives, we have full access to the file room, all the workers are in there, they’re doing their job, everything that happens to us is getting put in a correct file and labeled correctly and all that. When we have something that is wildly overwhelming, our brain adapts to that by taking some of the energy from the file room and sending it somewhere else. Again, that’s adaptive and that’s designed for us to be more likely to survive, but the upshot, or the down shot you may say, is that the file folder doesn’t get organized in the way that it would with your other memories. The little people in the file room, if you can imagine the little Pixar animation, don’t like a disorganized file.
So every time they see something in your perceptual horizon that looks like something from that file, they see that as an opportunity to push the file to the front of your mind so you can have the chance to organize it. The problem is that the alarm system part of your brain is recognizing that material as a dangerous mushroom, a fearful thing, and setting off the alarm system, just from the memory, not even from the re-experience of it. So a critical part of this process of recalibration is reorganizing the memory file so that you have a coherent narrative in the file—beginning, middle, and end; appropriate emotional content; and a tag of meanings that allows you to put the file away in the larger sort of story of your life or in the larger file room.
So in the kind of acute phases of healing from trauma, a lot of the work that’s going to happen is going to be about figuring out what’s in the file folder—that you can imagine a bunch of Post-it notes that have random words on them. What do they mean? How are you going to tell a story about them? How are you going to feel through some of the overwhelming emotional content, and how are you going to put that in a file cabinet that makes sense? When that piece is sort of integrated, when the memory gets integrated and looks like the rest of your memories, you also have—and you can do this simultaneously, I’m presenting this as if it’s an arc, but you can do it at the same time.
You also have to deal with the somatic reality, which is that your body was along for the ride. The trauma didn’t just happen to your psyche, it didn’t just happen to your memory, it also happened to your body. So another part of the recalibration process that’s really critical is teaching your body that you are safe in the world again and with other people. So when you can complete that process, which I think talking about it in terms of completion is a little bit misguided, because it’s likely a lifelong path, you can—what you will experience is a recalibrated nervous system that no longer responds inappropriately to benign stimuli in your environment. Does that make sense?
Tami Simon: It does, and it was a powerful explanation. Let’s use your own situation as illustration if that’s OK, because you told the story of your father’s sudden death, quick death, 10 days, and he was just 62. We could call that wildly overwhelming, to use the language that you used with disorganized memories. What was the process for you that allowed you to make it “look like” other memories? And how did you know like, “Oh, I’ve reached a point of integration. This looks like other memories now.”
MaryCatherine McDonald: Yeah, so I’ll start actually there with the end of your question, which is how do we know when we’ve integrated something? So I can talk now about my father’s death. We could talk about this for a half an hour, which means I’m pulling out the file. I could tell the story about his life. I could tell the story about the way that he died, what the impact was immediately on the family. My mother’s death soon after, all that. I will feel some of the emotional content. If I go into great depth about who my father was or what the morning was like when he passed away, I might tear up a little bit. I will certainly feel sad, but I can put that file folder away as soon as you change the subject and continue talking about whatever else, however else the conversation goes.
So I know when a memory is integrated when you can pull it to the front of your mind, feel the emotional content, tell the story, and then put it back with relative ease. How did I get there with the death of my father? It was a very long process. Grief—I think we live in a grief-phobic culture for the most part, and we don’t allow people the space or opportunity to grieve in ways that are helpful. So I think that what is a very long path ends up much longer and more painful than it has to be. I spent the first six months after my father died basically pretending everything was fine, charge forward, keep working, and things will just sort of piece themselves back together.
Then, six months in, I was completely taken out by panic and started having panic attacks, everywhere, all the time. I made this sort of hilarious phone call to a therapist, and I said, “I had this death in the family, and I’ve been experience—and everything’s fine, but I’ve been experiencing these panic attacks and now they’re getting in the way of work. So I’d like to do maybe 6 or 12 sessions and clear that up.” She told the story much later that she laughed at the phone call because it was so indicative of where I was and what I thought the process was supposed to look like.
Tami Simon: Yeah.
MaryCatherine McDonald: And that gets mirrored back by psychology that says—DSM says, “You’ve got six months to grieve, and if you are still grieving after six months, then we have to start talking about major depression or prolonged grief disorder.” So I embarked on a therapy journey that’s still going on. I’m still in therapy, and the kind of irony of ironies was that I was writing my master’s degree on grief when this happened. I had chosen that before either of my parents died, and by the time I was finished with it, both of them had died. So I was accessing it from an academic space, which I think was incredibly healing. It showed me that I wasn’t alone, that I could access difficult emotions and experiences from a place that felt intellectual and therefore safe for me. Then going through this process of therapy and really diving into grief, and understanding what it feels like, the lived experience.
I don’t think it’s over. I think that to grieve is to submit unwillingly to a lifelong path of reconciliation that the person that you didn’t think was going to be gone, is. So that still comes up, but I think the difference now is that when I experience grief or a wave of grief, I don’t worry about it. I don’t shame myself. I don’t say, for the most part, “Oh my God, I can’t believe we’re back here again. It’s been so many years, and I can’t believe we’re still feeling this, and you’re not healed and you’re never going to be healed.” I’m just like, “Oh, there’s a wave. What’s this one got?”
Tami Simon: OK. So that’s the integration, if you will, at the narrative—
MaryCatherine McDonald: Yes.
Tami Simon: —level. You also mentioned the second step, which is working at the body level, the somatic level. Tell me about that and the connection, if you will, between these two levels of trauma healing.
MaryCatherine McDonald: Yeah, I think that we don’t recognize that our—because we talk about the mind and the body as if they’re two separate things, and we need to, to some extent, but I think we don’t really realize that they are in a dynamic unity. So whatever is going on in your brain is going on in your body, and whatever is going on in your body is going on in your brain, and there’s been this incredibly slow awakening to that in society and in the Western world. So you can do all of the narrative work and still feel just as bad as if you didn’t do any of the narrative work, right? So you can have, I think, a somewhat integrated narrative memory, but every time the memory comes up, you have a very outsized response in your body.
So that would look like, if I talk about my father with you today that I cry for the rest of the day, and maybe I can tell a coherent story and I can tell you that there’s sadness in there, but the somatic piece of it really takes over. What that suggests is that the body doesn’t feel safe in the world yet to experience that emotion, to sustain the experience of being hit by that wave and coming back to baseline. So when you think about how to do that work, that’s something that can happen. There are a lot of modalities that are very helpful when it comes to somatic healing. I’m thinking of Peter Levine’s work and Somatic Experiencing where a lot of what he describes is about pendulation; it’s about bringing your body into an emotional experience and then bringing your body back out.
So you bring yourself into the grief, you feel a little bit of it, and then you’re led by a clinician or a therapist to come back to baseline. Over time, you experience that you are safe to go through that experience of getting hit by that wave. Yoga is another modality that’s very helpful, because Bessel van der Kolk has said that it helps you learn how to come home to your body, which I love. I think when we have a fragmented narrative, often the reverberation of that in our body is that the body thinks it’s not safe. What’s even weirder is that probably everything in your outside world is safe. So you cognitively know that, but your body is having this response. You’re triggered and you’re at work and you’re panicked, but you’re saying to yourself, “I’m at work. What’s happening? Pull yourself together.”
The experience, the practice of yoga where you come—you connect breath with movement and notice how you’re feeling through different poses can help you learn how to kind of land back in your body, come back home to your body, which then in turn helps you experience those waves with less struggle.
Tami Simon: Now MC, one of the things I want to check out with you, listening to you now, is sometimes I’ve heard people say, “Look, if you don’t work at the level of the body, at the level of the stored memories, you’re not going to really make any progress when it comes to trauma healing.” And they’re dismissive, if you will, of a more narrative approach, like “I’ve told the story to a therapist. I’ve been talking to a therapist. I’ve gone over and over it. Nothing is changing.” But what I hear you saying, this is what I want to check out, is that both approaches actually work together and perhaps even that we need both, is that what you’re saying?
MaryCatherine McDonald: Yeah, I absolutely think we need both. I think we need to work holistically when it comes to trauma, again because it’s not the case that it only happens to your psyche. It’s not the case that you have a problem within your psychology somewhere that your body is not involved in; your body is along for the ride. So you can work—I encourage clients often and people that I’m talking to, if you feel more comfortable working narratively first, start there. And if you feel more comfortable working somatically first, start there. But just know that at some point, those two things have to meet in order for you to really get to your full level of recalibration.
Tami Simon: Now, I want to also talk just a little bit more here about this connection between loss, grief, and trauma, because I think I’ve had this notion that there’s something like healthy grief or that’s a reasonable grieving process or something, which is a really bizarre sentence to even say. Then there’s traumatic grief, like a sudden loss, and that these are different in some way. I’m curious what your view is of that, the relationship between trauma and just grieving the losses in our life of which we all have so many.
MaryCatherine McDonald: That’s a great question, and I have to say before I start, that this is something that I’m constantly evolving in my own life, because I think about loss maybe more than anything else, because to be in relationship is to be in a situation where you have a potential loss. So even when it isn’t present for you immediately and urgent, it’s still kind of hanging out around there as a possibility. So I may change my tune on this at some point, but I don’t think that you can have a loss that isn’t traumatic. I know that sounds maybe like an exaggeration, but I don’t think—so if we think about the definition of trauma, the definition of trauma that I use is “when you have an unbearable emotional experience that lacks a relational home,” and we can unpack that later.
When we think about the experiences in our lives that meet the criteria for unbearability, I think loss may be the first and most common thing that comes to mind, because even in cases where we have prepared cognitively for a loss—we know that it’s coming, someone has lived a long and healthy life and they’ve contributed and they are reconciled with their own death and things like that. The brain still has this incredible job of remapping without that person, and the grieving process and the mourning process has to happen, which involves kind of imagining and understanding and encountering all of the ways that you thought someone was going to be in your life and kind of cutting that off. Realizing that that’s not true. That’s not going to happen.
So I think that there’s probably a scale. There are some losses that are far more traumatic than others. I’m not sure that we have loss that isn’t traumatic. Does that square?
Tami Simon: It does. I think the question I have about this definition of traumatic experience that you’re offering—“unbearable emotional experience that lacks a relational home”—I think the part about having a relational home, I can understand and appreciate. That means I can share it with you, I can talk about it, it belongs, it belongs with myself, I can be with it, other people—so I get that part.
MaryCatherine McDonald: Yep.
Tami Simon: It’s what is unbearable emotional experience? Because, obviously, I’m bearing it.
MaryCatherine McDonald: Right.
Tami Simon: It’s excruciating, but I’m bearing it. What does that word “unbearable” mean?
MaryCatherine McDonald: I love this question, because that’s the link between the mind and the body. So in a sense, I love the word because it—just the word “unbearable” does so much work for exactly that reason. We know, we think that we have borne something because time has gone by and we’ve moved on—
Tami Simon: Yeah, I made it through. I made it through. I’m here.
MaryCatherine McDonald: Right, I’m still going to work. I’m making sense. Things are OK. I’ve borne it. But your nervous system, if it’s still responding as if that experience is present, has not borne the experience. So that’s the thing that has to get worked on in order for you to really get through that initial process.
Tami Simon: How do we know if our nervous system is experiencing something as unbearable? How do we know?
MaryCatherine McDonald: We have to learn how to become—how to be in tune with the barometer that is our body. I think we live in a culture that separates us from our body. We think the mind and the body are distinct. We think we can manage everything that’s going on in the body and that that’s part of our role, that the seat of the subject is sort of up here in the brain and that the mind is sort of an afterthought and it has annoying things that need to be coped with sometimes. It’s our job to manage it and quash that. I think what we miss out on then is that our body is constantly giving us information about how it is experiencing what we are cognitively experiencing. Those two things can be very different.
So cognitively I can think, well, this isn’t a big deal. I’ve dealt with the fact that my father died. It happens, which was very much where I was in those first six months. My body, on the other hand, was experiencing any fluctuation in the external world or inside my body as a threat of death. You are going to die. You have just seen that your father has died unexpectedly. Everyone you love is going to die. They’re going to die unexpectedly and immediately and in front of you, right? That’s a huge sign that my body has not integrated what I think I have cognitively integrated. So I think when we tune in to the channel that our body is on that tells us all this information, then we can learn that—again, I keep saying this—but it’s along for the ride and it has its own experience of that. So we can think that we’re cognitively over something, and we’re not.
The temporality of unbearability I think is really interesting as well, because I think sometimes we sort of slap a Band-Aid on something and think that that means we’ve healed. In some sense, it’s true, except when there’s a festering infection underneath the Band-Aid that will eventually make itself known and could be fatal. There were all of these research studies and there’s a lot of work on Holocaust survivors who die by suicide years later, 40 years later. There’s this kind of very common expression of like, “Oh, well, Primo Levi was successful. He was an amazing writer. And he died by suicide 40 or something years later, 42 years later. How can that be?”
I think it’s because sometimes what feels like it is bearable is getting heavier over time. I can hold a two-pound weight for this whole conversation. I can probably physically manage that. At the beginning of the conversation, the two-pound weight is going to feel very manageable. At minute 40, I’m going to be feeling like that two-pound weight is 40 pounds. I think the same thing is true with emotional experience. Just because time has gone by and we are still here does not mean that we have done the work of bearing the difficult emotions.
Tami Simon: What’s your suggestion to someone who’s listening to this and they’re like, “God, I know there are times I can tell my body is having a response, of whether it’s hypervigilance or anxiety or I’m not OK. I get that, but I don’t quite know what the trigger is. I don’t really know what’s going on. I don’t have the associated narrative in this moment to even know.”
MaryCatherine McDonald: I’m so glad you brought that up, because I think one of the main misconceptions about triggers is that we always are cognitively aware of them. We talk about them as if we know what they are, and that’s not true. Triggers are often buried deep in the unconscious, and we’re not conscious of them.
So the first stage is this awareness of like, “Oh, I’m feeling discomfort, and that discomfort could be coming from a trigger. How do I figure out what that is?” The first thing I think is to turn up that awareness as far as it can go. So you’re noticing discomfort. What does that discomfort look like? You mentioned anxiety. How does that anxiety take shape? Journal that, write it down, and then try to, if it feels comfortable to you, think about where that feeling has appeared in your life before then. So, “Oh, I’m feeling really anxious, and that anxiety looks like a stomachache. For some reason I can remember having this same kind of stomachache when I was six, and I was humiliated for the first time in front of my class.”
Then you start to draw the connections. This is work that is always great to do with a trusted person, whether that’s a therapist or someone who has your best interest in heart and knows you well and who can help you come back to baseline if you get panicked and overwhelmed in the telling.
But, I think, to go back to triggers and two other really quick misconceptions, we think that if we have a trigger, this is a sign that we should avoid something for the rest of our lives. So I think sometimes we think the work is done when I say, “OK, I’m triggered by the smell of spaghetti sauce.” So, cool, I just don’t have spaghetti for the rest of my life. That’s not that big of a deal. But triggers are signs that something needs to be worked on and integrated. Even if you feel like you’ve worked on it and integrated it, this is a sign that it continues to need to be worked on and integrated, and that’s not a failure on your part. That’s a testament to the miracle of your adaptive brain and body.
Then the last thing is we think we’ve healed when we feel nothing. So we think, “OK, I’ll know that my trigger is all set when I don’t have it anymore at all.” That’s not how our memory files work. The truth is that our memory files contain emotional content, and they’re supposed to.
So the spaghetti sauce example is actually a real one for me. For about five or six years, I could not handle the smell of spaghetti sauce. It would make me instantly nauseous, and I had no idea about why. I didn’t get a stomach flu from that. I had never been sick from that. It just was completely random.
Then, out of nowhere, one day, probably five or six years after my father’s death, I remembered that spaghetti with meat sauce was the last thing that he ate. So my adaptive, amazing, brilliant little body was coding spaghetti sauce as mortal danger. So it was like this huge realization of this is why I have been nauseous from that. OK, this needs to be integrated. And then I have to tell my poor little body like, “It wasn’t the spaghetti sauce. Spaghetti sauce doesn’t equal death, and oh, that’s so scary for you,” and kind of turn to yourself and hold that as a true and valid part of your experience.
Then, going back to pendulation, can you try spaghetti sauce? Can you smell it and see if it still makes you nauseous, now that you have this sort of reeducation process in your head? OK, could you try to eat it? What does that feel like? And kind of wander into that experience to give yourself the opposite experience. You can eat spaghetti sauce and not die. That’s a very silly example but illustrative, hopefully.
Tami Simon: Tell me, MC, this definition that you offered us about trauma: unbearable emotional experience that lacks a relational home. Tell me why you like that definition so much.
MaryCatherine McDonald: So one of the things when I first started studying trauma that I was really shocked about was that we were still having an argument about which things—about what trauma was. I thought, “OK, I’m going to go to this trauma conference. I’m going to figure out what trauma is. I’m going to pull that into my dissertation, clean and done.” I went to the trauma conference, and everyone was arguing about which kind of events are trauma, which kinds are not, what does that mean? I was just flabbergasted by that.
I say that because there’s—on either end of the spectrum, there’s a compelling argument. One is that if we count every kind of event as potentially traumatic, then we kind of stretch the word “trauma” to the point of meaninglessness. It doesn’t really matter anymore, because everyone is traumatized by everything, and it’s kind of like the common cold. We don’t really need to think about that. We don’t need to study that. It’s part of life. I think that’s a real concern.
The concern on the other side is that if we don’t get the definition correct, clinically, we are going to miss it. When people are coming in and having the symptoms of trauma, we’re going to misdiagnose and mistreat and sometimes to somebody’s—to someone’s peril in one way or another.
There’s this belief—I always go to these conferences, and I sort of laugh at how pessimistic the view of human nature can be in academic spheres. I think we’re fully capable of finding a definition in the middle of those two extremes.
I think that the one that I have adapted from a clinician, Robert Stolorow—unbearable emotional experience that lacks relational home—does a lot of that work. Because what it says is not everything can count as traumatic. You have to meet the criteria of unbearability. So if you have a negative experience that’s upsetting in one way or another, that’s true and valid and worthy of looking at, but does it actually meet the criteria, does it meet the bar, the high bar of unbearability? No. OK, that’s good to know. It also has a great correlate to the neuroscience, because when we look at what’s going on in the brain and the body, when you are sufficiently overwhelmed, the brain processes that you need to cognitively understand and file away your experience, get shut down adaptively, so that you can be better prepared to handle threat. So I like that unbearability piece, because it does work in a lot of different ways societally and also kind of maps onto the neuroscience beautifully.
The relational home piece I think is really interesting because it helps us understand, without pathologizing the individual who’s traumatized, what makes something more likely to become lasting trauma. Some of the research that I’ve done, and also research that has been done, has shown that when you have someone to share the really difficult, overwhelming emotions with right away, you are far less likely to develop the symptoms of lasting trauma. So there is something about traumatic experience that actually has nothing to do with the type of experience and nothing to do with the nervous system on which it lands and everything to do with the community surrounding that individual.
Tami Simon: Now, you also write that you are not invested in this distinction, that I’ve heard a lot of psychologists and other people in the trauma field refer to, something called “big T” and “little T.” You don’t seem to think this is a valid distinction, a worthy distinction?
MaryCatherine McDonald: No, I think it’s—
Tami Simon: Explain, what are people saying about big T and little T, and why do you say that this distinction is not important?
MaryCatherine McDonald: So the distinction comes from the clinical world, and I think there are many ways in which psychology is a really interesting field. Since psychological truths affect all of us so deeply, we all go reaching for access to information about it. And this is great, we get access to clinical information, but we don’t get the context often enough. So, if I understand correctly, the distinction between big T and little T trauma actually kind of got into the clinical world because of Francine Shapiro’s work. She’s the founder of EMDR: eye movement desensitization and reprocessing. At the time when she developed that modality, they were working with what they called “simple traumas,” singular traumatic events that they thought this modality would be helpful in integrating.
So EMDR works by occupying your visual cortex while you talk through—or your body while you talk through—a traumatic event and helps you kind of reorganize that file. So it’s somatic and narrative at the same time. She had gotten funding for working with singular traumatic events. She thought, and she wrote this in her textbook, “Hey, I think that this modality might actually work for traumas that are a little bit more ambiguous, a little bit more vague. Traumas that occur over the course of a period of time and are not necessarily recognized as big T traumas.” Little T traumas like being bullied at school was her example, might cause the same set of symptoms, and those symptoms might also be mediated by this modality. So she was trying to advocate to level the playing field so that we can see that the body is imprinting all traumatic experiences the same, whether it’s bullying on the schoolyard or a catastrophic assault.
She was right. EMDR is effective in both ways, and instead of taking that as, “OK, now we can level the playing field and we can all talk about trauma and say, OK, your trauma is different than mine and unique in certain ways, but our bodies are imprinting trauma in the same way, in either case,” instead of that, we take the language and we twist it and we say, “Well, I don’t have big T trauma, so my experience doesn’t count and I don’t have—” or I see this in clients, actually, and this is where it’s really destructive. One client, one member of a couple, will have widely recognized big T trauma. They’ve been deployed. They had an alcoholic parent. They’ve had some widely recognized traumatic things. The other member of the couple maybe has had a 10-year verbally abusive relationship, and their trauma is not recognized in the couple because it’s not “capital T” trauma.
That’s really corrosive. So I think we need to understand it. Yes, traumatic experiences are all in some sense unique and different, and the parts of the brain that are registering overwhelm are not sophisticated enough to say, “Oh, this fear is just from being bullied, or this fear is from this 10-year verbally abusive relationship. That fear is a big one.” It doesn’t do that, and so why are we instilling this distinction that isn’t there?
Tami Simon: OK, so let me just check this out with you once again.
MaryCatherine McDonald: Yeah.
Tami Simon: So if I understand you correctly, if we drop the distinction between big T and little T, then we’re coming more from the inner experience of was this unbearable in some way? Did my body freak out, and did it not become cataloged like a memory but instead was this disorganized thing, and if that happened, it’s trauma. Don’t say what size the T is.
MaryCatherine McDonald: Exactly.
Tami Simon: That’s not the important thing. OK. Well, that’s very helpful.
MaryCatherine McDonald: There’s a study in the book that’s—all the stories as you said are composites, so this is one person’s story and many persons’ story where I had a client who came in who had all the symptoms for PTSD, but the thing that was the “big T” trauma in her life wasn’t the thing that was causing the symptoms. It was a very shocking breakup that she had had, and she was missing—she was about to quit her job, which she loved, and change her life in ways that were unnecessary, because nobody was pointing out that the thing might be something else in her life and that it’s OK, sometimes a breakup is shattering. It depends on the context and the story. So that could be the thing that you’re responding to. If so, it’s really important to treat that thing at its source.
Tami Simon: OK, MC. I’m going to talk to you about the insight from the book that, for me, hit me the most emotionally and was the most profound for me. It had to do in the very beginning as we were talking, and you said, “When something traumatic happens, our whole entire sense of how we think the world’s supposed to operate can unravel.” And you talk about how sometimes when we become very in tune with a certain type of vulnerability, how vulnerable we are in a situation, it suddenly connects us to ultimate vulnerability, extreme vulnerability, how uncertain everything is. Before you know it, it’s hard to get up and make a cup of coffee. It’s hard to do anything, really. I wonder if you can share somehow your actual work with clients and your research shows this connection between trauma and ultimate vulnerability.
MaryCatherine McDonald: That’s a great question. This part I think is probably the part of the work that’s nearest and dearest to me, because it’s reflective of my own experience. I think that we were talking earlier about what sets of beliefs shatter. I think that we do a lot of work to box in our vulnerability and to think that we are—yeah, we’re vulnerable. We like to use that word now. So we’ll bring it around and say we’re vulnerable emotionally with each other and we have intimacy and we connect and all this other stuff, but I think we try really hard to not look at the radical vulnerability that is underneath everything, like a root system that’s underneath all of our experiences, all of our desires, all of our relationships. When we’ve had a traumatic experience, I think it brings us unwillingly face-to-face with the fact that we are vulnerable and there’s nothing we can do about it.
I mean radically vulnerable, not vulnerable like I might share something with you that you then turn and betray me about. I mean, I might connect to you, we might become entangled, and I might lose you. Then I don’t even know how to give an account of what I’ve lost, because we are entangled and part of who I am is now gone because you’re gone, and I don’t know how to account for that. What have I lost? The whole thing starts to unravel. I think that there are people who haven’t experienced that. So they live in denial of it, and I think once you have experienced it, you can’t deny it anymore. It’s a truth that is; you can’t unknow. I think a lot of traditional therapy models don’t address that. Don’t stand at the edge with somebody and say, “Yeah, you are radically vulnerable. That has always been true. That will always be true, and there’s nothing you can do about it.” The reason that most traditional models don’t do that is that it sounds really dire, but I think if we really can sit in that feeling and that experience—and trust me, I understand how hard this is—we can gain access to a beauty in that vulnerability that is wildly expansive and can change and add color to the rest of our lives in ways that are amazing and beautiful.
Tami Simon: I think more people perhaps are in touch with this now, post-pandemic, in the sense that so many things can happen that we don’t have control over. With the climate crisis impacting us the way that it is, gun violence, so many different things, there’s this sense of, “Will I and my children and my family and those I love wake up safe tomorrow? Don’t know. Don’t know.” So what do you know from your work with people about what gives us the inner strength, the inner capacity, to live with that awareness and not be in a traumatized state, but to be grounded and resourceful and calm, knowing that we and those we love might not wake up tomorrow?
MaryCatherine McDonald: Yeah, I think that—like I said, it’s a daily battle, and I think there are days and moments that really amplify the anxiety there. And I think we’ve seen that as a culture. I don’t think we have even begun to integrate the pandemic on a global level, and that’s a reckoning that is coming, which is one of the reasons why it’s so important that we all get on the same page about trauma.
When it comes to how do you live with it, I think that you kind of have to take the mindset of existentialism, which is a philosophical movement that says, “Look, life has no meaning. Whether you’re religious or not, you’re not going to get a Post-it note from anywhere that says, ‘This is your path, and this is what life means.’” That’s the beginning of the story, not the end, because what that means is that you are radically responsible for your life and what you create and the legacy that you leave.
There’s an incredible subversive power in the recognition that there might not be any meaning and therefore, because of that, I am going to paint my canvas in a totally unique way, a totally intentional way, totally authentic way, because there’s no meaning that’s going to float down and I could be taken out at any moment. I think that that is—what’s different now is this idea that we don’t know what kind of legacy there’s going to be anymore because of—I think we’re really on a societal level finally reckoning with the idea that there might be an end. So it’s not just that we might pass away or that our grandparents or our grandchildren won’t survive or something like that, but that there will be no humanity and what then?
I think we’re kind of staring down the barrel of that terror, which adds more urgency, frankly, to what we do here. What does it mean if there isn’t going to be a legacy? I don’t know how to answer that, but I think that the first step is to stand in it and say, “Yep, that’s real. That’s here. Now what?”
Tami Simon: When you talk about the urgency you feel about this new updated understanding of trauma helping us during this time, can you help connect that for me? How will it help us here where we are right now at this time?
MaryCatherine McDonald: I think if we can understand better our trauma response, how it works biologically, just in general, if we can get this out to the world and people can really understand what’s happening, then we can suffer a lot less, individually. I also think we can—when we understand what a relational home is, and that this is something that can be incredibly healing in the face of trauma, we can provide it for one another. One of the scariest things that I see that I get really nervous about is this idea that you can’t talk about trauma unless you’re in the closed four walls of a therapist’s office, because I think while that’s incredibly important, as I’ve said in my own process and will continue to be, we also heal in relation to everyone in our lives.
If we can understand what it means to provide a relational home to one another, then we can heal as a community, as a global community, instead of continuing to add insult to injury by having traumatic events happen and then failing to help each other integrate them. So I think the first step in this—there’s many—is to understand without shame what is happening when we’re traumatized. Then the second step is to figure out, OK, what then does the integration process look like and how can we all help each other out?
Tami Simon: When you say “provide a relational home,” not in a therapist’s office but to the people in our lives, our family members, our friends, tell me more what that means. I know sometimes when I’m talking to people and I really do my darnedest to listen and attune, but then I feel a little helpless and a little like, “I wonder how much I helped, and I held the space,” but what does it actually mean?
MaryCatherine McDonald: Yeah, that’s a great question. I think that when we feel like we have to do all the work ourselves, we’re doomed. If I have to have a relational home and hold it, and I have to be the single relational home for you, then that’s doomed, because there will be moments where, yeah, I can attune, but there will be moments where I fail to understand or I have something else going on in my life and so I’m not as present, so I can’t be as attuned. But I think that when I talk about this with my college students, they get very frustrated about the concept of relational home. “What the hell does that mean, Professor McDonald? I don’t understand what that is. What’s a relational home? You’re being vague again. You like pretty words, but they don’t mean anything.”
I ask them what their protocol is when a friend of theirs goes through a breakup, and instantly, they’re like, “Oh, no problem. First we do this. We go over to the house, we cry, we eat ice cream, then we delete the person’s phone number and make sure to block them on social media. And then we go out and we have fun and we watch these movies and blah, blah, blah, blah.” They have a whole protocol set up for when their friends go through something difficult. I think to a large extent, we know how to do this already. We turn ourselves into weirdos by second-guessing it. And then when we’re weird in relation to other people, that gets in the way of a relational home.
I think that, as you mentioned, attunement and connection and holding space are critical. I also think that honesty is really important. When I was first working with—I did a lot of research with my partner, Gary Senecal, and we were working with veterans. We were both really shocked at how often veterans would turn to me and say, “Oh, MC, you get it.” And I would say like, “No, no, I don’t, actually. I haven’t been deployed. I don’t get it. What do you mean?” We did some follow-up research on that, and it turned out that one of the things that made a relational home possible was someone’s willingness to say, “I don’t understand that experience you had, but I know what it’s like to feel trapped. For me, that felt like this. What did it feel like for you?” So the ability to explain to someone who precisely does not know what you’ve been through enables you to communicate, to really organize the memory file in your head, and also feel heard by someone else who hasn’t been through what you’ve been through. That I think is a tremendous help.
Tami Simon: All right, to end, MC, I’m going to ask if you’ll share with our listeners one of the composite stories that you describe in Unbroken that really moved me. It’s the story of Gabe. I think the reason I’d love for you to share this story is we touched on this notion of ultimate vulnerability and how we’re going to go ahead and keep functioning in our lives. I think the story of Gabe really illustrates this, and I’d love to know kind of where you and Gabe ended up, that gave Gabe the ability to do this. So go ahead and share that story.
MaryCatherine McDonald: Yeah. So Gabe was someone whose father died of a heart attack in front of him when he was very young. So this was obviously a traumatic event. Then, to contribute to that, Gabe inherited the same cardiovascular issue that would mean that he could potentially have a heart attack very young and die. So as a result, he had a defibrillator implanted in his chest to make sure that that didn’t happen. So life-saving surgery. What a wonderful thing that your father had this thing that you recognized you have, and now you’re able to survive. The trick, the irony which—and this maps onto the trauma response in such interesting ways—was that the defibrillator in his chest that’s designed to keep him alive sometimes malfunctions.
When that happens—it’s called an electrical storm, I think. When that happens, it would send Gabe—the defibrillator would shock him when it didn’t need to—so that would send him sometimes careening across the room and could also kill him. So as a result, he became incredibly hypervigilant to his own fluctuations in his heartbeat, which most of us kind of don’t notice. So if you don’t have anxiety or you’ve never really thought about your heartbeat, you don’t really pay attention to the fluctuations, but you can tune in and become hyper-attuned to those fluctuations. So that was where he was at, and he couldn’t tell the story without getting activated and having his heart rate go up. He couldn’t go to the gym. He was having trouble leaving his house. It was becoming—his life was getting smaller and smaller and smaller.
So we went through this process of remembering the death of his father, kind of reliving that, working through that memory, talking through the experience of the defibrillator malfunctions, which were each traumatic experiences of their own. Then working on bottom-up regulation, which is where you regulate your nervous system using your body by sort of manually turning on the rest-and-digest part of the nervous system, the parasympathetic nervous system. We did a whole bunch of breathing exercises and did those every single day until Gabe started to feel like he had mastery over his nervous system, and therefore over his heart rate, and therefore over his life.
So even just that tiny little bit of mastery over himself made a huge difference. He can’t control whether the malfunctions happen again, but the way that he exists in his body today is wildly different than it was before.
Tami Simon: You make this point, and you’re referring to it here, these tiny actions of mastery, that it doesn’t have to be some big global shift. That even when we do these tiny things, it can really change our inner perception. I wonder if that might be a good note for us to end on, the tiny things we can do that make a big difference.
MaryCatherine McDonald: Yeah. I think we get the calculus wrong and it makes so much sense, but we think that if we have a big bad thing, then we need a big good thing to counter it. If we have a big response in our body, then we need total control over our body. That’s not true in either case. Tiny little joys can anchor you in the midst of incredible loss, and tiny little exercises that you do every day can make you feel completely different in your own body. So breathing exercises—one of the other exercises in the book that I talk about is Tetris, which helps you regulate your nervous system from the top down, from your brain to your body, by occupying your prefrontal cortex through a game. These things are tiny. Playing Tetris for 20 minutes a day is a very small thing, but it can really decrease your anxiety response.
I think every time we find a tool—I love to think about empowering clients and students and readers to have a whole toolbox full of things that helps them regulate their nervous systems. Every time we have access to a tool and we learn how to use it, we get this incredibly empowering feeling that we have a say. We can’t change the default responses in our body, nor would we want to. We need the trauma response because it helps keep us alive, but we can intervene on those processes once they kick off. Every time we get a tool and we see that that works, there’s this huge blast of empowerment that helps us feel at home in our bodies. So I think when we can kind of gather these little things, they actually turn into something much, much bigger.
Tami Simon: Now, I have to ask a follow-up question about Tetris.
MaryCatherine McDonald: Yes.
Tami Simon: Who would’ve thought a video game was going to help me retrain myself in relationship to trauma? You would think that it was an escape approach, that’s like a numbing-out escape thing, but you’re describing it in a different way. So I think this is an important idea to clarify.
MaryCatherine McDonald: Yes. Tetris—and this is something, this isn’t just me. There have been many FMRI studies, functional magnetic resonance imaging studies, where they’re looking at blood flow in the brains of people that have PTSD, where they will show the person something that they know, a stimulus that they know will trigger an anxiety response. They will have them play 20 to 40 minutes of Tetris, and then they watch the brain regulate. So the reason that that works is because when you have a traumatic event or you have a traumatic stimulus that’s coming into your environment, your whole brain reprioritizes its function in order to better adapt to that threat or that perception of threat.
So one of the things that happens is you get a whole bunch of energy and blood flow pulled away from the prefrontal cortex, which is kind of your rational brain. That’s where working memory is. It’s right behind your eyes, right behind your visual cortex. So when you play Tetris, which makes a continuous bid on your prefrontal cortex, you are manually pushing blood flow and electrical activity into the part of the brain that just got disconnected.
Now when it comes to this idea of numbing, I think we really need to get clear on what that means, because I’m seeing this so often. It’s not numbing if it’s regulating. If you are playing Tetris for 14 hours a day, then we should look at whether that’s numbing and what’s happening there, but if you’re playing Tetris for an hour every night and it’s helping you get to sleep sooner and feel appropriately disconnected from your day, then that’s healing.
Tami Simon: Well, it’s interesting because I think a lot of people find things regulating, like I find working very regulating, to work. When is that avoidance and when is that, “Oh, that’s healthy regulation.” How do we know the difference?
MaryCatherine McDonald: I think I’m laughing because I relate so much. For me, I think working often crosses the boundary into numbing and an unhealthy coping. I think the way that I see that is that it starts to dysregulate me. So I’ll notice that in my body, if I’m paying attention, that I’m not actually feeling the sense of accomplishment and positive contribution to the world or whatever. I’m feeling actually more overwhelmed in my body. That’s a sign that working has gone too far. The other sign is that it will start to interrupt your life, like anything. It will start to get in the way of [life]. Your concentration, your relationships, you’re maybe doing—not doing other things that you used to love because you are working too much. And that’s a sign.
So those are the two things for me, but I think to some extent it depends. We have to look at what our horizon typically looks like and understand what dysregulation looks like for us, because it might be slightly different.
Tami Simon: I have to say, I enjoy talking to you so much. It’s so rare to meet someone who has the kind of academic chops that you have and talent and also deep-feeling nature, all wrapped in one kind, caring person. You’ve written a gorgeous and helpful book. It’s called Unbroken: The Trauma Response Is Never Wrong—and Other Things You Need to Know to Take Back Your Life. It’s a gift at this time that you’ve put this book into the world and poured yourself into it. Thank you.
MaryCatherine McDonald: Thank you so much. It’s been an honor to talk to you.
Tami Simon: I’ve been talking with MaryCatherine McDonald, the author of Unbroken: The Trauma Response Is Never Wrong. If you’d like to watch Insights at the Edge on video and participate in after-the-show Q&A conversations with featured presenters and have the chance to ask your questions, come join us on Sounds True One, a new membership community that features premium shows, live classes, and community events. Let’s learn and grow together. Come join us at join.soundstrue.com. Sounds True: waking up the world.
