Anisa Khalifa 0:00
Hey y'all, this is Anisa. A heads up before we get into today's program: we're going to be discussing trauma and abuse including sexual and childhood abuse as well as police brutality. Please take care of yourselves.
Trauma is an inescapable part of the human experience. Depictions of the long term impact of grief and trauma go all the way back to the ancient epic of Gilgamesh.
Post traumatic stress disorder, or PTSD, is commonly seen in American pop culture — from Terminator 2 to Law and Order SVU — as we collectively try to process a world full of war and natural disaster, gun violence and abuse.
But those portrayals of PTSD often frame it as a result of a single devastating event. We don't often talk about the way that prolonged repeated trauma shows up in our minds and bodies. For me, healing from my own trauma caused by severe chronic illness by growing up racially marginalized in a white supremacist society, and by the bone and cell deep pain passed down from my ancestors — who struggled under 200 years of colonial violence — has been a more complex journey.
This is Embodied. I'm an Anisa Khalifa, the host of WUNC's new podcast, the Broadside, sitting in for Anita Rao.
Complex Post Traumatic Stress Disorder, or CPTSD, entered mental health conversations in the early 1990s. Pioneers of the term like psychiatrist Judith Herman proposed it as a way to describe what happens when people experience ongoing trauma over months, even years.
Fariha Roisin 1:55
I was chronically ill since I was a child, you know, I always had asthma or eczema. All of those things sort of started to get a little more clear because this veil had been lifted of what had happened and — and also what I'd really been denying to myself for for so many years.
Anisa Khalifa 2:13
That's Fariha Roisin. She's a multidisciplinary artist, author and editor based in Los Angeles. At age 29, she began uncovering memories of the years of sexual abuse she experienced as a child at the hands of her mother. After feeling dissociated from herself for a lot of her adult life, which is a common symptom of CPTSD, she started on the long road to healing.
Fariha Roisin 2:36
In order to heal, you have to understand the many different dimensions of that traumatic experience. And I think my healing journey was very much trying to understand my mother and trying to understand the harm that had happened to her. And I think my family and my ancestors survived 200, almost 300 years of colonization. My grandparents survived partition, my parents directly survived the liberation war in Bangladesh where 3 million people were murdered in 1971. So this is very recent history in my own DNA and my own lineage. And so for me, going to those places has allowed me to understand that no one is a demon. No one is a monster. People are complicated. I think with that has come a certain kind of elasticity. Because I also know what is my truth, and I know what has happened to me, I'm not denying that for myself anymore. And I think all of that is really necessary when you begin to heal.
Anisa Khalifa 3:41
That's so well said and yes, absolutely. I mean, I also come from the South Asian diaspora and my grandfather as a child went through partition, and he was not an easy person to grow up with. And understanding the trauma that he really only started talking about maybe 10 years ago really helped me to process and understand, you know, how he approaches the world, and why he lives in the world the way that he does and towards his family, and, you know, all of that. So to pivot a little bit to your art, you've explored themes of trauma and healing through fiction, nonfiction, poetry, guided journal, how do each of these genres or mediums help you process your trauma differently? What do each of them do that helps you approach this topic in its own way?
Fariha Roisin 4:29
Poerty allows me to speak to myself in a way. Like I'm speaking to my mother, but I'm speaking to myself. It allows me to have this amazing imagination to kind of move through that feeling and arrive at different places within myself. I love poetry for that.
I think my novel 'Like a Bird' is significant because I started writing it when I was 12. And it is an act of documentation and self witnessing that I didn't know that I was doing. Even though it's not my own story, Talea — the main character — is a vehicle with how I explore and was exploring sexual abuse. And really what creates that kind of dissonance and a lack of connectivity within family, and how do we separate from one another.
So much of what my existence has been has been unknown to others. Being Muslim, being Bangladeshi, being all of these different things, those identities are not known in the western imagination. And my work is to not only insert myself in those spaces, but to speak. And that there are people who are telling their stories and their histories. And there are people that deserve your recognition, deserve your ear, deserve your attention, and deserve your acknowledgement. And that is what I write for, and that those are the people I write for.
Anonymous Listener 1 6:07
So how did I discover that I had a CPTSD? Well, it was not at age 11, when I was first diagnosed with depression. It was not in college when I sought help for social anxiety. It was through my terrible relationship at age 28. That is when I saw a trauma experienced therapist who told me, "Yeah, this relationship is abusive, and you do need to leave. But what about your childhood now?" That is the day that my life changed.
Anonymous Listener 2 6:44
I tried to sweep everything under the rug in a way for the first 20 years of my adult life. And that worked for a while in a way. But now that I'm mostly healed, I can look back and see how I was. And I would never go back to that way of being again.
Tanner Wallace 7:01
I really wish I could say it was my parenting that had me wake up and start searching more deeply for what was going on that was so problematic. But the truth is, for me, it was really the intimate partnership that was such a mirror back to me. Where parenting and the dysfunctional parenting felt so familiar, I couldn't even see myself in it until I was further along in my recovery.
Hope 7:31
My therapist is trauma informed, and has confirmed that I objectively suffered abuse. This was important because I believed my childhood was normal. The nature of complex trauma means it is often hidden and goes unrecognized. That needs to change.
Anisa Khalifa 7:57
One way that more and more folks are recognizing Complex PTSD is by examining its connection to chronic illness. When our minds undergo intense trauma, our bodies often translate the psychological pain into physical symptoms, and those ongoing physical symptoms can in turn become part of the trauma. That's something psychotherapist Dr. Karen Winkler has studied deeply.
Dr. Karen Winkler 8:19
Certainly a history of chronic trauma, and what are sometimes called the ACEs — Adverse Childhood Experiences or Events. In some ways, you know, the intense stress of that can disregulate the body, disregulate the nervous system, and lead to various sorts of chronic illnesses later in life. But as well, getting a diagnosis of chronic illness can be traumatic and in a different sort of way because the the threat is in the body. It comes from the body. All the symptoms that we think of with complex PTSD, like re experiencing or avoidance or hyper arousal and hyper vigilance and a fear of death, really is something that's ongoing for people with many sorts of chronic illnesses that can contribute to chronic PTSD.
Anisa Khalifa 9:13
Karen has spent years as a public health advocate and trauma researcher in New York City. She's also a nurse with a PhD in Clinical Psychology. All of this background, plus experiencing chronic illness herself, gave her the tools to understand the social structures that lead to chronic illness. That's something that Fariha has been uncovering as she investigates her experience with Irritable Bowel Syndrome, or IBS.
Fariha Roisin 9:36
I've had IBS for the last 20 years. I've had it since I was 14. And, you know, I was diagnosed with it at a time where doctors were like, "Well, you know, we can't actually say that you have this thing, but, you know, if you were to have it, yes, maybe—" It was never, like, direct.
I think having a chronic illness has been lighthouse for me, because I have been able to uncover so much of my own past, but also my family's past through my body. And the things that have happened to them are actually stored in me. And the power of that, I mean, the debilitating nature of that is really overwhelming when you have so much that you have to work on constantly, consistently.
I often say that my body has been in revolt ever since I was a child. And I think that we live in a very ablest world that allows that kind of conditioning. Like when your body doesn't work a certain way, or, like, for me, when I was a kid, it was always, like, "I can't eat junk food, I can't eat all of these things that all of the other kids eat, why? Why can't I just have a normal body?" And, you know, it took me 20 years to realize that it was actually quite a gift to be able to have your body directly communicate to you, and to tell you what it likes, what it doesn't like, why this hurts, why that doesn't feel good. And it's not just about the mind. So I think I feel grateful that I've reprioritized my own body in my life.
Anisa Khalifa 11:16
Karen, I want to talk about trauma informed medical care. As Fariha mentioned, a lot of times people with chronic illness don't get the kind of response that they need from doctors and, you know, are not believed, or — I've also had the same kinds of experiences, and so then that gives you even more trauma. So how does trauma informed medical care — which is when doctors will try to understand a patient's life experiences in order to deliver effective treatments, which seems really important for people with chronic illnesses. How does trauma informed care look when it's done properly?
Dr. Karen Winkler 11:54
Well, I think it means really taking into account the emotional and psychological and social sides of life with chronic illness. You know, which are so often passed over or dismissed by physicians and — and other health care providers.
It means having a more holistic picture and relationship and encounter with the person who's come to you for help with their illness. It means a doctor needing to really ask, you know, "What does it feel like to hear this? What might get in the way of you doing these things?" And then tolerate the emotions that may come up, you know, which may include tears, and because of the way our healthcare system is structured, many doctors— A) they haven't been trained in trauma informed care, they haven't been trained in the emotional and psychological aspects of the very illnesses that they're providing care for. And they are working often at an incredibly fast pace, because that's how they get their insurance reimbursements. So, you know, when you have 15 minutes, or even less to see a patient who may have a complex medical situation may have multiple chronic illnesses, it is hard. It's objectively hard to make the space for a conversation about emotional life.
I've had patients who've been in years of therapy before, who almost never spoke to their prior therapists about their chronic illness. You know, I learned that early on. And it was— it was really shocking to me and a wake up call. And it really, I think, changed the way I practiced as a therapist.
Anisa Khalifa 13:39
I appreciate you bringing together all of these elements, right? Of the medical side and the— the therapy side, and also the time aspect, which is so important, right? If you want to have that communication, that understanding, but you don't have time with your doctor. And so often it's just about communicating and being heard. And sometimes you can't necessarily do much to improve your health. But having a doctor that hears you and understands you is so important. So, you know, thank you for that. I want to ask Karen, what have been the most effective healing practices that you've seen with your patients?
Dr. Karen Winkler 14:18
Well, one of the things that I think has been really important within the psychotherapy piece is really listening to a person's symptoms and also the practices that they need to — to do to manage their illness, to sort of be able to be there as a witness and as somebody who is accompanying them. Because I think that it's a very isolating experience to live in a chronically ill body. So I find that talk therapy is incredibly important in a way that — that focuses on putting the body into words. And by the same token, I often encourage people to journal and meditation to help sort of make us space to just be and to have some quiet. So I do think that finding a place to meditate, finding a way to integrate meditation and— and also journaling has been very important to folks.
Anisa Khalifa 15:27
Seems like writing is saving lives.
Dr. Karen Winkler 15:30
Absolutely. I think Virginia Woolf may have said that, actually. But yeah.
Anisa Khalifa 15:35
Yeah. Fariha, in your writing about chronic illness, you've talked about the difficult journey of acceptance, but which you've also found to be liberating, what has helped you the most to accept and love your body as it is, and also just to find joy?
Fariha Roisin 15:53
I think there's something extraordinary in accepting your circumstances, and finding peace with that. For me in my own life, being so explicit about who I am, what I've experienced, has been extremely healing for me. I feel grateful for the things that have happened to me, the person that I am, the trials and tribulations that my body has experienced, all of it. Because I understand the tapestry of all of it around me.
And I think that I really see healing as— as a— as a gateway towards enlightenment. In a lot of indigenous understanding of this, there's, you know, there's this awareness of like seven generations. If you heal, you can heal seven generations ahead of you and seven generations behind you, and that's sort of the work of this lifetime. And I think about that a lot. The responsibility that I have to my ancestors and the responsibility that I have to the people of the earth, the people that are coming. I think it's it's extraordinary, to accept and to reap the rewards of that healing in that wisdom that comes with all of those lessons.
Anonymous Listener 3 17:32
In 2005, my seventh therapist diagnosed me with PTSD. But I struggled for about 10 years with the diagnosis because it didn't make sense to me that I had no memory of ever living through a near death experience, like a war or a house fire. I didn't know why I had PTSD. It was about seven years ago was the first time I'd ever heard the term complex PTSD, which is what helped it makes sense for me. complex PTSD explained how my trauma was complex rather than a single event. And it was basically from being raised from birth around narcissists who put their shame onto me and made me feel unwelcome on this earth.
Johanna Draconis 18:19
I realized something was off in my early 20s when I saw weird shadow figure following me. What saved me and has been helping me the most is honestly the scientific method. I test if something helps, and if something works, then I keep it and expand on it. I didn't even try to cure myself. I just tried to make the suffering less. But steadily I got there. And it was such a difficult road, but definitely worth it.
Anonymous Listener 2 18:58
The more therapy I do, the more both professionals and I myself realize how badly I'm affected by CPTSD. What has helped me most in healing, being respected by therapists and treated as a competent adult with health problems. Being heard and being believed by safe non judgmental people, including my fellow survivors on the forum Out Of The Storm. Third, learning bit by bit to accept myself as I am.
Anisa Khalifa 19:30
The road to healing after a complex PTSD diagnosis is not always linear. Folks must develop their own map to guide them through. And for people of color, the path to healing can be particularly difficult to navigate.
Dr. Monnica Williams 19:43
I was working in a treatment center at a top university that specialized in PTSD.
Anisa Khalifa 19:49
That's Dr. Monnica Williams. She's a clinical psychologist in Canada.
Dr. Monnica Williams 19:53
We had a very standardized and effective treatment for PTSD called prolonged exposure. It's a very difficult treatment, but it works really well. And in the course of that treatment the client has to revisit their trauma over and over again. It's a very difficult process. But they learned that the memory of the trauma isn't the same as the trauma and the fear of the memory itself goes away, and the fear of the traumatizing thing goes away.
But for this particular client, she did overcome her fear of the traumatizing event, but she was still too afraid to go back to work. And what we uncovered was that it was her experience of racism that hadn't adequately been captured in the process of treatment such that she felt she could resume her life and so that she felt safe in the world again. And that's the piece we didn't address because people don't tend to think of racism as a trauma.
Anisa Khalifa 20:56
That experience with a Black patient at the PTSD treatment center was early on in Dr. Williams career. And it was a piece of evidence for the reality that racism from overt aggression like police brutality, to micro aggressions — like being confused for the only other non white person in the room — can lead to trauma and complex PTSD. Dr. Williams is now a professor of psychology at the University of Ottawa, and the Canada Research Chair in mental health disparities. And she uses her training as a cognitive behavioral therapist, which is a type of talk therapy that helps to identify and change negative thought patterns to help folks with that trauma.
Dr. Monnica Williams 21:33
I find that it's good to be able to explain to your clients exactly what you're going to do and how you're going to do it, and what you expect the outcomes to be, as opposed to other types of therapies that are a little more opaque. And it leaves the client guessing. And I think, for people of color, particularly people who've had experiences of racism, there's going to be a bigger hurdle in terms of developing trust with your clinician. And if you're going to get therapy, you don't understand how it works, and the therapist is rather opaque in the way they talk to you about your problem, that's going to really make it hard to build that trust. Whereas I think the very direct, clear, and transparent nature of CBT really could be a fantastic way to help people understand what that therapy is going to be like and buy into it a lot quicker.
Anisa Khalifa 22:25
Definitely. We have previously explored generational trauma on Embodied and it's an important part of this conversation. Can you talk about the generational component of racial trauma?
Dr. Monnica Williams 22:37
Yes, so, people in many cultural groups have had historical traumas. Traumas that have affected a whole ethnic group. And that trauma can be carried from generation to generation. It can be carried through social transmission — through the way parents talk about the experience to their children. It can also be transmitted genetically, epigenetics explains and demonstrates that when parents have a trauma, that trauma, the symptoms of that trauma, can be visited onto the children, and even the grandchildren. So cultural traumas are carried with a group. And that already creates a layer of stress that people in those cultural groups just have to live with and manage. And so when there's more traumas piled on top of that, even little things like microaggressions, that increases the burden of stress and ultimately increases the burden of trauma that that person has to carry.
Anisa Khalifa 23:37
Yeah, for sure. Like, my grandparents lived through the partition of India in 1947. And that's something that as a family we have carried for generations, and it definitely lives with us. And then there are things we are living with now as well. As you mentioned, for example, the news cycle often includes graphic and traumatic video footage of police brutality, especially of Black people. And you've said that these videos can cause PTSD in Black folks who watch it. How can they cope with the psychological impact of these endless videos?
Dr. Monnica Williams 23:37
Yeah, and that's a good question too, because it really can be traumatizing. If you think about even just sort of the history of Black people in this country. You know, law enforcement has been used as an arm of punishment and oppression on Black people, even today that's happening with racial profiling, and, you know, the sky high rates of incarceration.
I remember growing up whenever we would just go for a drive someplace, my dad was always looking out the window nervously to see if there are police and he would often tell me and my sisters, "Look out the back is that person a police? Is that a police car?" So even growing up we learned to be afraid of police because of how dangerous they are. And even today when I see police, I feel afraid I carry that with me. And so it If I see footage on the news or hear about police having harmed other Black people, of course, that can be triggering. That can cause distress, anxiety, all sorts of even trauma symptoms that you wouldn't necessarily experience if you didn't have that same history.
Anisa Khalifa 25:20
As a person of color, it's already a struggle to find, you know, a therapist that understands where you're coming from. And with racial trauma, there's a scarcity of therapists who are trained in treating this specifically. What do you recommend for someone who's looking to access care for racially caused PTSD?
Dr. Monnica Williams 25:40
Yes, and this is really the unfortunate piece of it, because so few clinicians are trained in how to identify and treat racial trauma. And we know from research that most clinicians have seen people with racial trauma in their practices, but not even a quarter of them were taught how to identify it, and not even 80% are taught how to treat it. So most clinicians are going to have no idea what to do with that. You know, a safe bet might be to look for a clinician of color, someone who has experienced racism themselves. So you know that the basics are going to be covered.
Hopefully, you won't experience racism from your therapist. But that can't even really be guaranteed, because the therapists, even the therapists of color, are usually getting the same training that White therapists are, which doesn't include training on how to treat racial trauma. So this is a question you should ask your clinicians at the onset of starting to even before meeting with them on the phone before you see them, or definitely the first session. What do you do to treat racial trauma? How do you address this? How do you help people who are suffering as a result of racism?And then see how they respond. And if they seem at all hesitant, this is not the person for you, right? You want somebody that is going to be very clear about how they approach this. And it's going to help you as a person if you've experienced racial trauma, to feel supported, and safe and validated. And so those are the first things I look for if I was going to find someone to help me with my racial trauma.
Anisa Khalifa 27:15
That's really helpful. Thank you. Apart from finding care, like in therapy, or there are other kinds of support that can be helpful in your healing journey?
Dr. Monnica Williams 27:24
Well, anyone who's suffered from trauma generally needs to find ways to process those traumatic experiences, so that they can move on. And we know that therapy is not an option for everyone. And so if you have good supportive friends that you can talk to, friends or family or spiritual advisors that you feel safe with, that understand it, that get it, that validate you, that don't make you feel ashamed for something that happened to you that wasn't your fault. These are good people to talk to. And the more you talk about what you went through, the more healing that you'll have.
But also, it's really important to learn new ways of responding to racism in order to feel empowered. Because one of the things about racism is you don't know when it's going to happen, it's unpredictable. That's a recipe for anxiety. And people feel helpless and they don't do anything about it, which is a recipe for depression. So it's important to be able to anticipate what sorts of situations you may encounter racism, and have strategies for responding to racism when it happens. So that you don't always feel victimized by it.
Anisa Khalifa 28:43
Dr. Williams has a new workbook for therapists coming out soon to give them more tools to help clients who are suffering from racial trauma. It starts with the foundation of being an anti racist therapist before providing a roadmap for validated treatment techniques.
Fariha also has a new piece of writing. Her latest book of poetry entitled 'Survival Takes a Wild Imagination.' It's her message to all those who've experienced trauma, expressing her own journey toward courage, love and self acceptance, and I hope for others to begin to imagine healing for themselves.
Fariha Roisin 29:17
I started trauma therapy soon after the memories of my sexual abuse as a child came back to me. And alongside that, I started to sit with the plant medicine grandmother, Ayahuasca. Those two experiences really taught me a lot about the bravery and the courage that it takes to survive, but also how my own individual experience of survival was actually so much to do with my imagination. Writing 'Like a Bird' my novel when I was 12, it was a direct way that I was able to sort of alchemize my own frustrations, my own pain, my own sadness, my own darkness. All of those things, I found a way to kind of put them into my art.
And I think these, you know, therapy really allowed me to see that that is something that needs to be talked about. It needs to be remembered that we owe ourselves imagination. And we owe ourselves the ability to dream. I believe in Utopia, I believe in these principles of goodness, and justice, you know, and I think that robbing children of imagination, wherever that may be, and there's so many children that are robbed of that. I want to speak to them directly and tell them that even if you experience the most harm that you possibly can, you still have this beauty inside of you that you can locate. And that takes imagination, but it takes courage as well. And I want— I want to tell people that and I want to tell people that it's not lost, even when it feels lost, it's— it's still there, and it's worth fighting for, it's worth defending, and it's worth protecting.
Anisa Khalifa 31:23
Embodied is a production of North Carolina public radio WUNC, a listener supported station. If you want to lend your support to this podcast, consider a contribution at wunc.org now.
You can find out more about all the guests we talked to today in the show notes of this episode. A special thanks to Dr. Tanner Wallace, Jess, Johanna Draconis and the members of the Out Of The Storm forum for contributing to this week's show.
This episode was produced by Paige Miranda and edited by Kaia Findlay. Gabriella Glueck also produces for our show. Skylar Chadwick is our intern and Jenni Lawson is our sound engineer. Quilla wrote our theme music.
Thanks for listening to Embodied and if you liked this show, please spread the word to your own networks. Word of mouth recommendations are the best way to support our podcast and we'd so appreciate your support.
Please also take a moment to check out WUNC's new podcast the Broadside. I host the show where we investigate stories about the American South.
Until next time, I'm Anisa Khalifa.