Dr. Cathy Kezelman - The Journey of Healing

Cathy Kezelman Interview Transcript

SPEAKERS

Cathy, Nick 

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Nick

0:04

Welcome to Don't Quit on Me the podcast series, where we consider alternative ways to manage the inevitability of stress and pain. Speaking with a wide range of people who share their stories, strategies and perspectives, we aim to inspire hope, confidence and the belief in the fact that the things can get better, no matter where you are. Dr. Cathy Kezelman, AM is president of the Blue Knot Foundation, the National Center for Excellence for Complex Trauma. Cathy is a medical practitioner by training and has a lived experience of childhood sexual and emotional abuse. She is committed to supporting people who have experienced violence, abuse and neglect to find pathways to healing and a trauma informed approach to care, which puts the humanity back into services. 

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Nick

1:13

Dr. Cathy Kezelman, welcome and thank you. 

C

Cathy

1:17

It's a pleasure. Thank you. 

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Nick

1:19

I'm very much looking forward to our chat. I think it's a predictable question. But would you mind talking a little bit about your story and what led to you being president at the Blue Knot Foundation? 

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Nick

1:34

Look, I have my own personal story of childhood trauma, child sexual and emotional abuse. Like many people, unfortunately, and I suppose I first approached, the pre runner of blue knot Foundation, which was called ASCA, when I was looking for my own support. Now, I'd been a medical practitioner for, you know, 20 odd years when I started to have to deal with my own trauma. And what I discovered in that process was that my medical training had not prepared me at all to understand what was going on. And it was very hard to find help. And so it was my own journey of looking for support and looking for information that took me to, as I say, then ASCA, and now Blueknot Foundation. And that's over 20 years ago. 

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Nick

2:32

That's, that's, that's a big journey. Can you talk about, I guess, what trauma is and how it can show up?

C

Cathy

2:41

Look, I mean, trauma is a very broad term, and it means a wound and what it is an event or events, which often have quite a damaging impact on the person who's experienced them. Blue knot, works with what we call complex trauma. And what that means is repeated, often ongoing, often extreme trauma that occurs between human beings, interpersonal trauma, such as abuse, violence, neglect. And sadly, there are lots of ways in which children, young people and adults experience that trauma is different from what we call the trauma of a single incident, a bushfire a flood, an accident, an assault as an adult, and not to minimize anyone's experience of trauma, it's very important to say there's no hierarchy of trauma. However, there is a difference between complex trauma and that of a single incident, in terms of the impact on someone's sense of self, and their relationship with themselves and with others and with the world. their health, physical, mental health, and those need to function in the world. And so, you know, complex trauma is, unfortunately, very, very common. It impacts, you know, by conservative estimates, more than one in four Australian adults. But it's very important to state up front that people can absolutely do recover from, you know, even an extremely early trauma. But what's really important is to get the right information, and the right support. And to understand that, you know, a lot of what people experience relates very much to their biology and their survival responses and it's not their fault. It's really, really important to know that,

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Nick

4:43

Thank you, you talked about survival. And I'm wondering how a sense of safety and an experience of complex trauma, play into how people can behave or how behavior can manifest for someone. 

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Cathy

4:58

Look, you know, some people who've grown up, you know, just imagine your as a child that you grew up in an unsafe environment, you didn't have a parent, or a caregiver, who was able to help you make sense of things. In fact, there may have been dangerous, but you depended on them. It's incredibly confusing for a child that, you know, someone that you know, has meant to nurture and protect you is harming is. So what do you what do you do with that, so that child has probably never felt safe. And that lack of a sense of safety can continue, you know, right into adulthood. And it explains why many people who've experienced this sort of trauma, really struggled to trust, struggle to relate to human beings, because you've learned that you can only rely on yourself if you haven't had a secure or safe bond or attachment along the way. And so struggling to find a place of safety can be an enormous journey, then I suppose what that often presents, as is someone using all of the coping strategies they have, so everything that they have in their toolbox, to try and make them feel safe. And whether that's using alcohol and drugs, excessive work, or sports, or eating, or self harm, or avoidance, isolating yourself, there's all sorts of ways that people have tried to feel safe. Because they've had to learn to cope with a world that was dangerous, and with a world where they were being harmed. And I suppose as a society, what we tend to do is really judged the way different ways that people do try and keep safe. And we often don't understand that safety can be such an elusive experience for someone who's never experienced before. And we can also try and impose our sense of safety on someone, someone else. And as a result of people's experiences, often, they are also physically and emotionally unsafe in the prison as well. And so the journey to safety is a very substantial one, and one that can take a long time. And if you're walking alongside a survivor, or even interacting with someone who's experienced trauma, it's really important to understand that, you know, what they may be displaying in the ways they're struggling, makes total sense in the context of what they've experienced, and the way that they've had to try and survive.

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Nick

7:55

Thank you, Cathy. That kind of leads quite perfectly into the next question, which is, what does it mean to be trauma informed? And how important is it for friends and family, and even, I guess, mainstream supports to understand the lens of trauma, when providing support

C

Cathy

8:15

Being trauma informed is a term that is used a lot now, and it tended to lose a bit of meaning. But what it means is understanding that we all have experiences along life's journey. And they've all impacted us in various ways. And we all come with their own set of experiences and contexts, contexts. And that determines how we go through the world. So the way someone reacts or presents is often dependent on on those experiences. Now, we don't need to know what they are. But being trauma informed, means being aware of the possibility of trauma, understanding that a lot of people have experienced it along the way, and maybe exhibiting all sorts of different survival responses, they may have a nervous system that's on very high alert, because they've been used to being under threat, and being in dangerous, you know, ready to fight or flee, or maybe very shut down and withdrawn. And those presentations, which often come with extreme emotions make total sense in the terms of the physiology of trauma. And so when you're trauma informed, you're aware that if someone is triggered by something that may seem very mundane to you, that means that their nervous system suddenly reacts. That probably makes a lot of sense in the context of what they've experienced. It may have thrown them back into something from the past, not consciously, but their nervous system has been aroused, and triggered. And then they're back in the trauma and experiencing all of the all of the reactions that they experienced during that time of trauma in the present. So being trauma informed means that you don't judge that you're not punitive in your responses, you're empathic, you're compassionate, understanding, and you do what you can to support someone to feel safe, to help to build a sense of trust, to show that you're reliable. You provide people with choice, because often people who've experienced trauma have really had no choice. And you share the power that there is in any relationship. So you truly collaborate with someone, a lot of our systems impose things on people seeking care. There's there are hierarchies of care, whereas a trauma informed system works with someone and helps to empower them. So they can become in a much have developed a much greater sense of agency in their own life. And it's about respecting people regardless of who they are, where they've come from, what they're struggling with. And so, you know, treating people with dignity, and just being sensitive to culture and background and religion and, and all the differences that make us unique human beings, but for which we're often judged.

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Nick

11:57

Yes, far too far too often far too harshly and readily. Yes. So do you often see, I guess, from a medical standpoint, complex trauma, because of, I guess, the heightened continuous stress response, having coexistence with things like chronic illnesses?

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Cathy

12:19

Yes, look, look, we know that there are a lot of, as we said, the physiological reactions and a nervous system that's heightened causes the release of a lot of chemicals of cortisol and adrenaline. And we know that when that happens over over time, and they're chronically elevated, that it can impact all sorts of physical health issues such as immune conditions, vowel conditions, gastrointestinal conditions, chronic fatigue, musculoskeletal issues, as well as cardiovascular lung conditions. Unfortunately, it's a very significant range of physical health issues. And, and, you know, my medical training did not alert me to the fact that, you know, particularly adverse childhood experiences are very often associated with an increased prevalence of a lot of physical health conditions. And it's very, very important that people working in the medical fraternity are aware of that and have it on their radar. Because we know that, you know, as we said, before, people can and do recover from trauma. And as you start to do with your trauma, you can start to regulate your nervous system, and those highs and lows of those, those chemicals and hormones which are released and which cause the damage.

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Nick

13:52

How are traumatic memories stored because they're not stored in the same way as, I guess, non traumatic memories are they?

C

Cathy

14:00

So there's a lot of misunderstanding about memory. Everyone thinks of memory is the ability to talk about something that's happened in the past. And that's called explicit memory where you can you can name things you can tell the narrative, we've got the chronological detail. There's another very, very important sort of memory called implicit memory and implicit memory is stored in the body. And we know that pre verbal memory before children can speak, you know, their, their implicit memory is very much alive. But we also know that people who've experienced trauma, a lot of the traumatic memories are stored in the body and we were talking earlier about triggers. And those triggers can be sensory cues smell, a sight, a sound that can throw someone back into the past, it can also be an anniversary, or reaching an age at which something happened. And so what that does is reactivate those memories from the body. And those body memories are often incredibly intense, they come with all of the physical sensations and the movements from the time of the original trauma. And we know from what happens with the stress response that different parts of the brain are impacted during the time of trauma, which means that memory is the sort of explicit memories we're talking about when you can tell the narrative stored in a section of the brain called the hippocampus, and that shuts down. But the alarm system of the brain, the amygdala, is heightened in the time of trauma, and that's why these body memories is so intense. And so, you know, people often experience flashbacks, and flashbacks. And I experienced these, myself, when I was dealing with my own trauma, I'd be in my mid 40s, and something would trigger me and I'd be thrown back into being a young child in terror, experiencing all sorts of weird sensations and movements, and just fragments bits and pieces. Which is very frightening. Because it's really hard to piece them together. And what it is, is just the way that memory is stored in the body in bits. But with very heightened sensation, and very readily triggered.

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Nick

16:52

Wow, it's incredible insight. That also begs the question or comments as well that it would have been so good to know about this so long ago. But it is wonderful that we are beginning to become more aware, I guess, of the impacts. But nothing

C

Cathy

17:14

We are more aware. But I think this information still needs to reach a lot of people who need to know, I mean, we're talking about and talking about the legal system for medical system. There's a lot of research there. And it's very well substantiated. But it takes a while for it to filter through, and to actually inform practice and inform understanding. Because it explains, for example, why people who've experienced child abuse can't go in and say, you know, this happened to me on the 28th of whatever and, and just have a flow to their story, and be able to nail the details and the time because that's not the way the memory has been stored. So a lot of people have not been believed. Because in terms of the onus of proof, particularly of legal onus of proof. There's a disconnect between memory and and the law. And, you know, somehow that needs to be bridged. Because, you know, many survivors have been disbelieved because it sounds as if they're unreliable witnesses, but it's actually the physiology of trauma that they're living.

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Nick

18:38

That is shockingly sad. In that. Yeah, there definitely needs to be a more appropriate system to to look at the evidence as it is and not as we think it should be. Or, as some people think it should be. And the next question, I suppose, covers this as well, but it's more of more aimed, I suppose, the general population but how important is empathic holding of space for people who've experienced complex trauma? And how can the uninitiated do that? If someone's never heard of holding space? What does it mean to to do that for someone

C

Cathy

19:16

Look at for someone who's never experienced that, firstly, it can be profoundly unique, but also initially quite threatening. And it can be taken takes me back to the time that the Royal Commission into institutional responses to child sexual abuse was was announced and and i was there with a group of survivors in kirribilli house and some of them were so overwhelmed that something good was happening. They were completely unable to cope with that, because there was so used to bad things happening. To not being heard, and not being believed. So, holding space absolutely is critical. But I suppose it's also doing it at a pace that the survivor is able to manage that because it is such an alien concept and experience. And as we said before, betrayal, also is so profound that to be able to trust that someone can walk alongside you can keep you in mind. And Can he you see you believe you is the best, the most bottom line for any survivor. And I suppose if you're supporting a survivor, what can you do, the best thing you can do is to just show that you consistently there. And that's not easy at times, because of everything we've just spoken about. To not judge to listen, and to be empathic and compassionate be not to try and fix it. You can't fix us, we find a lot of people in our whole plants, it's quite amazing. They just being heard, is such a unique experience not being interrupted, not being told this happened to me or this happened to a friend, but just sitting with someone's story. And what they want to tell you and it's not as we also need to remember, I don't like the word story. It's not a story. It's people's experience. And it's the core of the lived experience. And so yeah, being there, consistently, I had a friend when I was, you know, dealing with my stuff, who was able to say, I don't know what to say, but I'm here. And that's precisely what you need. She was also very, very good in giving me jelly bones, babies, which I found were very therapeutic. But literally just having someone there was gonna say unconditionally, but it's very hard to be there unconditionally. Yeah. But what's very, very important for someone who is in a holding space, is also to get their own support. Because witnessing people's stress, distress, and trauma is very challenging. And it's very important that you look after yourself, while you're while you're supporting someone as well. So that's a very critical part. And I suppose the other important thing to say is, you know, it's not about hearing all of the gory details of what happened, you know, survivors will, may or may not want to say, some elements of that, but it's definitely not about revisiting the story. And particularly, you know, if you're not trained, it's about being there. What does someone need right now? In the present? How can I, how can I help, and you can help by being there and listening and believing.

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Nick

23:24

Beautiful, thank you. You mentioned earlier on a sense of thinking, I guess, disbelief around things when they do go well, that almost you imagined that they are going to be short lived, or that they'll just dissipate because things have been? So I guess, chaotic previously, is that like a common occurrence that people who've been through complex trauma.

C

Cathy

23:52

Yeah, look, I think we all have scripts in our head about, you know, what we anticipate the world to be and what we anticipate will happen. And if your experience is largely that you're going to be hurt, you're going to be betrayed, and that people are not trustworthy. And you're in an experience where you're receiving different messages. It's gonna take you a while to trust that and to feel safe with that, because we all go back to what's familiar. And, you know, we find that many survivors and we call this reenactment will fall back down the same hole repeatedly, despite having similar awareness, and over time, that will they will stop but you tend to go back there because it's familiar. It's a bit like a magnet. And it's the reason many survivors find it hard to reach out and seek help. Many survivors are not very good at looking after themselves, getting middle and medical and health, tilt checks, dental checks, because you don't trust and you particularly don't trust people in authority. It takes time. And that builds slowly.

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Nick

25:12

Thank you. How do we, how can you validate someone's emotions? So if part of holding space, if someone is telling you about a range of intense emotions, how is it best to validate without kind of templating your own stuff on top of it?

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Cathy

25:28

No. Well, it's it's literally about deep, active listening. You know, it's not about making trite statements, or it's about showing someone new hearing. reiterating that, you know, you're there. Your listing, you've heard so much about what you do is about being there. I think I'm just holding that space.

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Nick

25:57

Commenting, I guess if someone has said, a statement that indicates they're fearful then saying, that sounds like that would have been quite a frightening you really just talking to the point but nothing else and giving them an opportunity is Thank you. Yes. Could you just discuss whether or not it's common for survivors of complex trauma to question their own narrative narrative? Hmm.

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Nick

26:29

Well look into. Yeah, I mean, I can talk personally about my own experience that, as I described earlier, I experienced a lot of flashbacks.

C

Cathy

26:39

And

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Nick

26:42

in my recovery, became very aware that I dissociated loss associated into all sorts of traumatic experiences. And initially, those experiences as I tried to put them together, into a narrative seemed to be outside of my own experience. And that sounds very strange, but we haven't spoken about dissociation. But dissociation, there are many ways of looking at it. But it's, it's a defense, whereby the mind compartmentalizes experiences, so that when you think about someone who has experienced trauma, and a young child, who would be overwhelmed by the brain being assaulted by all that trauma at once, what the brain does is divided up into bite sized chunks, which aren't connected. And so you know, your emotions and your thoughts and memory, not working together, like they would usually. And so it's a defense mechanism, which, which stops you being so overwhelmed, and makes total sense. 

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Cathy

27:58

I mean, I think dissociation has been very poorly understood. And it's, it's good to understand that in terms of continuum. So we all can daydream, where we lose total awareness in the present. dissociation, which is associated trauma becomes much more extreme than that. But yet, it's a way of protecting ourselves from the unbearable, and not being so aware. But what that does, of course, is is create incredible fragmentation in your own history. And makes it very, very hard to put that story together into a narrative. And a lot of what I had dissociated, was quite horrendous, horrendous experiences. And when I relived them as part of what happened in the flashbacks, when my system just took me over and threw me back into those spaces, absolutely didn't believe in what I was experiencing. And survivors are the very first to, to question a lot of their experiences. But I suppose what we know about memory is that all memory is reconstructed to some degree. And, you know, what studies has shown is that people who experience recovered memories, like I did, the reliability of those memories is just as reliable as people who've never forgotten their memories. And I think that's a very, very important element here. So, yes, survivors don't believe because it's really hard to believe that you use have experienced some pretty horrible things that you would hope human beings never do to one another.

C

Cathy

30:12

Or people have grown up in an environment where what they experienced was not thought of abuse, because it was just what happened to them. So there's all sorts of degrees of awareness and amnesia, not remembering or just being in nude to your experiences. And so understanding them for what they are and naming them for what they are, and accepting them as part of what's happened to you along life's journey. But then getting to a point where they don't overwhelm you anymore. And they're not all of you. They're a part of that journey. And you've processed them to a degree that you can not ever deny that they happened, but they don't control you. They don't take over as they once did. It's not surprising, is it that we should have such an intense response? And that, that memory shouldn't, I guess, follow the usual path when something so significant happens that it defies either everything that we've been told about what is true, and what is not true of life, that gets shattered, that is not surprising that there should be an equal and opposite or equal and similar response in the way that I guess the memories get stored. Yeah, when you when you think about it, the mind is its genius, really, that the mind has a mechanism to protect. And I'm talking a lot about young children in particular, to stop the person, you know, completely dissolving. And that's what happens with dissociation. It's it's a protective mechanism,

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Nick

32:04

I am mindful of the time progressing, but I would love to ask you to talk a little bit about the resources that Blueknot offer, which I have to say are absolutely outstanding. So could you talk about, I guess, the counselling line that's on offer and some of the other offerings?

C

Cathy

32:20

Yeah. Yeah. So look, we run a couple of different helpline services. One is for adults who have experience childhood trauma, as well as the people who support them, both personally and professionally. And the other is a lot of people with disability, who've had experiences of violence, abuse, neglect, originally set up to support people affected by the disability Royal Commission, but now it's a more general brief. And so we have trauma counselors on those on those lines, who, who work with people too, as I've discussed, to meet them, where they are, to support them to feel safe, to find out what it is they need in the present, to provide them with some education about you know, really, how what happened to them may have affected them and how it may be affecting them now and support them to find a pathway and tools to towards healing that we know is absolutely possible and out there. We also have developed some pretty seminal publications, which have helped to guide both therapists who support people with complex trauma, as well as people, general public, people in just about every service sector, around trauma informed principles about how to work in a trauma informed way. We have a wealth of fact sheets, I'm told, we're now up to 40 plus fact sheets, videos, lots of things on our website. In fact, we're, we're about to launch a second website. So you know, we're going to have a professional community website, which will have tools and resources for professionals and then one for survivors and supporters so we can better support the different people in different needs. And a lot of what we do is really putting complex trauma out there. So that people understand what it is and understand why we need to be patient with people who've experienced it. But to hold on to that hope and possibility for healing and recovery, but enable the pathways so that people can experience that and start to begin to have a life that everyone deserves.

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Nick

34:50

That that's beautiful and like I say that the resources that that I'm familiar with rom Blueknot are just just amazing. So, if someone is listening and they feel maybe they would like to take a step. I can strongly recommend Blueknot. Cathy, are there any questions that I haven't asked or things that you would like to talk about before we ...?

C

Cathy

35:14

know I think that we've covered a whole range of things.

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Nick

35:21

We have, I think, definitely, from my experience when things are understood from a lens of trauma, and when they met with compassion, there's not much that can't be fixed. And I've also seen the absence of compassion and understanding, take things the other way very quickly. So it's, it's exciting to understand that really, it just takes people a second to suspend their judgment and practice compassion. And things can move.

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Nick

35:54

Yeah, and I suppose we hear that on our helpline all the time, that for the first time, people are being listened to and they feel like human beings. When when they go back into various systems, they're not experiencing the same thing. And that's just just awful. Yes, we're all human beings. And, you know, we all need to be treated in the best possible way. 

N

Nick

36:21

Dr. Cathy Kezelman, thank you so much. 

C

Cathy

36:27

It's a pleasure. Thank you. 

N

Nick

36:30

Thanks so much for listening. If you've enjoyed the show, please feel free to add a review to Apple or Google podcasts or wherever you listen to your podcasts. And if you feel inclined, you can also support the show by making a small donation at the website. Don't quit on.me thanks and take good care.

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