Psychologist George Bonanno on Trauma, PTSD & Resilience

* Note: Video is unavailable for this interview.

An Interview with Psychologist George Bonanno

George Bonanno, Ph.D. is a professor of clinical psychology at Columbia University's Teacher College. His research specializes in human resilience in the face of loss and potential trauma.

Tori Steffen:  Hi, everybody. Thank you for joining us today for this installment of The Seattle Psychiatrist Interview Series. I'm Tori Steffan, research intern at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology and psychotherapy practice specializing in anxiety disorders. I'd like to welcome with us today psychologist George Bonanno. Dr. Bonanno is a professor of clinical psychology at Columbia University's Teacher College. Dr. Bonanno is recognized for his pioneering research on human resilience in the face of loss and potential trauma. In addition to the books, The End of Trauma and The Other Side of Sadness, he's published hundreds of peer reviewed scientific articles, many appearing in leading journals. So before we get started today, could you please let us know a little bit more about yourself and what made you interested in studying trauma and resilience?

George Bonanno:  Oh, that's a good question. I have a long and a short answer to that question. The shorter answer I guess is I had the opportunity when I finished my doctoral program. I was trained, I think, pretty well in experimental research and in this general research methodology part of my clinical psychology degree. And the first position I took was in San Francisco, the bereavement project when I was given basically free range to design this massive study with the resources there. And so we just basically used methods that hadn't been used before with this kind of phenomenon. A lot of the work is mostly clinical and with people who were suffering. So the assumption at the time was that most people were suffering greatly with disease of the brain. Same thing with the trauma one. And when we used a different approach, more of a I think... we would get a broader... Okay, I was going to say epidemiological.

We did a broad swatch of people, anyone who had gone through a loss and then eventually did that in the trauma too. Anyone who'd gone through a particular event, we were interested in, and we would interview them and do experimental work with them and questionnaires as soon as we could after the event, and then following them. Right away, we began to see that so many, many people were showing, they had a difficult time talking about it when they had to, but they were basically functioning really well in their lives. And we found that right away and so we began to document that. And then I thought, "Well, this is kind of remarkable." So I was interested in this and we just kept pursuing it. And before I even realized it, I've now been studying that for 30 years. I didn't really intend that, but that's what we've been doing.

Tori Steffen:  Right. Yeah, it's funny how one study can kind of lead you down a road that way.

George Bonanno:  Exactly, yeah.

Tori Steffen:  Yeah. Well, I ended up reading your book, The End of Trauma, which was very interesting and investigates why some people might develop PTSD after traumatic events and then some might not. So could you kind of explain that for the audience a little bit?

George Bonanno:  Well, as I mentioned, we were finding these patterns for years. We called one the resilience pattern or the resilience trajectory, and those are people who they go through an event, everybody is distressed and disturbed by a major stressor or a major, I use the word 'potential trauma', but everybody has those reactions. And I'd say just about everybody and maybe 85% of the people exposed by a major life-threatening event or a major loss, or something like that. But for most people, it seems to abate within a few weeks, sometimes a little bit longer, sometimes a little bit less. And so we've replicated this now so many times and other people have now as well, dozens maybe. I think the last count it was something like 80 or 90 studies showing this. So of course over time, I was busy just simply verifying this and looking at it from this way and that way to make sure we were correct in this assumption, that these people were really resilient, they're not just telling us. So we had alternative methods. We usually talk to multiple people.

So then of course, naturally we began to ask, “What causes this? Why is it that these people are so resilient and other people not?” And that's a question I'm still trying to understand today. There's a longer answer to that one and also a shorter answer. The shorter answer if I can give you it quickly is that, so there are many factors that can be identified that correlate with resilience, and we've identified these factors and other people have too. And there's a widespread assumption that there's sort of several key factors that make people resilient and resilient people have these. And after really thinking about this and studying this for years, I think they've come to the realization that there aren't key factors. There's so many correlatives, so many predictors that they're just a multitude, well over 50 and counting.

And so how do we make sense of that? But it turns out all these things also are pretty small effects. In other words, they only really explain a little bit. There isn't any one factor that really makes you resilient or not. In fact, people aren't resilient. And that led that people have to become resilient. Resilience I think of as an outcome. So all those, I'm flying a lot of this past everybody. But the answer becomes what I call regulatory flexibility. Every time we're confronted with an event, we'd have to work it out. We'd have to embrace the event and find out for ourselves what works in this situation. And we do that through a process of trial and error. And that's very much the way humans cope, very much the way humans do the world. We are equipped for that. We try things, if it doesn't work, we try something else. So that's really the answer. We've studied flexibility now in detail, we have many different components of flexibility. We identified the pieces of us and we try to keep it simple, but life is not always simple.

Tori Steffen:  There's so many aspects and variables that kind of go into resilience. And I remember reading about the resilience paradox, and I think you listed, like you were saying, about 50 variables that could go into why somebody might be resilient after experiencing trauma. One variable that I remember being pretty significant is having a support group or people around you to support you after experiencing trauma. How significant would you say that particular variable is?

George Bonanno:  Well, I think there are some factors, social support, emotional support, instrumental support. If you break down social support or what we call interpersonal support, it's actually not one thing, it's many things. And people need different things at different times. So sometimes they need help with the daily aspects of living, instrumental support. Sometimes they need the emotional support. Sometimes they just simply need the group to belong to, it's about identity. So there are lots of different pieces of that. And we tend to assume that social support, anyone of this broader umbrella of support is really the "that's always good". But the research shows pretty clearly, it's not always good. It comes with a cost. Everything comes with a cost. Benefits and cost. And the cost of support have been studied research wise, and people have told me different costs that sometimes people just aren't able to engage in the kind of reciprocity that's required for support.

Sometimes the support is well intended, but not very helpful. Sometimes the support might undermine a person's sense of efficacy and sometimes it's just not what people need. Sometimes people need to be isolated, they need to be alone and work something out for themselves. Sometimes people don't want to be around other people because of whatever the event was that they experienced. And so in particular moments, it's not always the answer. And another piece of that is that when we cope with something major, it doesn't go away, as every good therapist... No, it doesn't go away and when you say, "Here's what I need you to do," bing - now it's gone. It takes time. And so what we do at any one time is different to what we do at another time. And so being around other people and just hanging out with other people, just enjoying their company and not thinking about the event is what we need maybe a little bit later down the road.

Maybe what we need immediately is just to be comforted by someone. Maybe we need help, as I mentioned, instrumental support and that comes somewhere in the middle. It all depends. And sometimes, as I said, we just want to be alone for some point of it. So it's really a matter of, we're not talking about, if your social supports always good, this is what we've been... What's good at this moment? And that's really what we see as being helpful.

Tori Steffen:  Right. Yeah, I can see that it would definitely vary between participants that you've interviewed. One situation might work out a little bit better. So it definitely just varies across the population. And the flexibility sequence that you had mentioned earlier, I remember in your book it stated somebody asking themselves after a traumatic event, what am I able to do versus what do I need to do. How might that distinction help one be more flexible?

George Bonanno:  Well, that distinction that's when we break it down and move to different components. So part of being flexibly adapting, which you'd say, is reading the situation first. A lot of people... We assess what's happening and ask, "Well, what do I need to do here?" We've grown up doing that, but we do this normally without thinking. Part of what I think is important clinically is bringing that to people's awareness, that we do that and that that's how they get through an event. They have to think about it, kind of embrace it even for a short time and ask those questions. The question about what am I able to do comes next. And we sense that what I need to do here is I'm ruminating, I need to stop myself from ruminating, or I'm thinking about this all the time, or I'm afraid to go back to this place. I'm even afraid to go out. Or I can't sleep, what do I need to do?

I need to find a way to sleep tonight or sleep for the next few days. I need to consult people. I need to ask people, I need to figure out what do I have... But then we get to the question of what am I able to do? And that comes to our repertoire. What do we have at our disposal? What do we already know how to do? And I'm a big fan of having people think about this when they're not in a terrible bad shape. Because once we're really upset about something and we amidst of a crisis, it's really hard to think clearly. It's really hard to even think, what am I able to do? I'm not able to do anything right now. And that's a real fact of life.

When people are really upset, we don't think very clearly. So it's a good idea to think about these things in advance. And so we ask ourselves, what do I need to do here? What can I do? What are the tools I have? And then we try something. And we get to the last step, which is, did this work? Do I feel better? Did the situation change? If not, then we try something else. And I find this last step is where a lot of people stumble also. They stumble and they can stumble at any one of these steps, but the last step is when we ask ourselves, is this working? Because people often find out, "Well, no, I still feel terrible. It didn't work."

And they give up because their assumption is, "Well, I'm not good at this. I can't cope. I'm not a resilient person." But nobody can do everything every time exactly the right way. It's how we learn, it's how we become healthy people. Even the healthiest people don't always have an answer. They try things. It doesn't work, you try something else, especially if it's a major event, especially if you're in bad shape, you try something else. And that's just really how we do get through things. So I think that's also another important thing, clinical teaching moment for people to realize that.

Tori Steffen:  Right.

George Bonanno:  It's how it works.

Tori Steffen:  Yeah, absolutely. I remember a case in your book about a girl named Maren who suffered a spinal cord injury from a horse incident.

George Bonanno:  Yes, yes.

Tori Steffen:  And I remember the key part of her recovery was her own optimism and motivation.

George Bonanno:  Yes.

Tori Steffen:  Do you think that those two things, motivation and optimism led her towards recovering so well?

George Bonanno:  Sure. I think Maren's optimism, if I can speak colloquially, was off the charts. It was really extreme. And they told her she was paralyzed for the rest of her life and not only did she say I'm going to walk again, she believed she would walk again. But optimism, few other pieces like that, maybe confidence, our ability to cope, a sense of I'll get through things, I'll get through this, I'll work it out. And even if the goal is just to accept what's happened, I will work this out somehow. I'll find a way to live with this and be happy again.

And that motivation is really important for all the things that I've just said up until now. Because it's not easy when you're hurting, last thing you want to do is think about it and embrace it. What we really want to do is just push it away, cover our face in a pillow, feel lousy and just hate the world. Those are much easier, but we have to actually face what's happened and think about it enough to work out what do I need to do then and what's going to get me through this? And you need to be motivated to do that. So Maren was super motivated, but a lot of people are. I think none of these are that extreme. Maren is a great person, but she's not a superhero. She just had the will to do this.

Tori Steffen:  Right. Yeah, I think that's a large part of it, your own personal mindset and believing that you can recover. But I mean, in a situation like that, it's just really interesting that that would have such a significant impact on her healing journey. So that's a great case to study. Well, Dr. Bonanno, I really appreciate your time. Are there any final words of advice that you'd like to share with the listeners today?

George Bonanno:  Yeah, I would. Another thing that I mentioned in the book is what I call coping arguments, that we sometimes need to do something that doesn't quite seem like it's healthy. It's something we maybe never thought about doing. It's something that we're told is not a healthy thing to do. But in this moment, it may be, and I'm not going to mention too many examples, but I think things like, sometimes people, I hope the listeners don't mind me saying this, sometimes people get drunk and just for the evening. And we wouldn't think of it as a healthy coping behavior. But for one night, and it doesn't... The next day you feel lousy. It's not gone. But people feel like, okay, but I decided to do that and I'm in control. Now what do I need to do here? And they get through the morning to make themselves feel a little bit better.

Then they still have the question. I did something last night, it didn't work, but I did something. What do I need to do now? And it does seem to sometimes give people just a little break. So the other thing, I won't name any other examples, but I'm sure people can think of them, they just get us through that moment and then we take the next step. So John Lennon has a song called Whatever Gets You Thru The Night. And I think I mentioned that in the book, but it's like the song because it's really kind of what it's about. When we're coping with really difficult things, we just want to get through it. It doesn't need to be pretty, it doesn't need to make us super healthy people. We just need to get through it. So I think that's an important thing also to keep in mind.

Tori Steffen:  Awesome. Yeah, that's great advice. And yeah, there's plenty of great information in the book too. I definitely recommend everybody checks out The End of Trauma by Dr. Bonanno. So yeah, thank you so much for sharing your knowledge with us today. And thank you everybody for tuning in and we'll see everybody next time. Thank you.

George Bonanno:  Okay, thank you. Thank you, Tori, nice to meet you.

Tori Steffen:  Thank you, you as well.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychiatrist Evelyn Nelson on Psychiatric Care

An Interview with Psychiatrist Evelyn Nelson

Evelyn Nelson, MD is psychiatrist at Seattle Anxiety Specialists, PLLC. Dr. Nelson specializes in the treatment and medication management of anxiety related disorders.

Jennifer Ghahari:  Hey, thanks for joining us today for this installment of The Seattle Psychiatrist Interview Series. I'm Dr. Jennifer Ghahari, Research Director at Seattle Anxiety Specialists. I'd like to welcome with us psychiatrist Evelyn Nelson who's one of the psychiatric providers at Seattle Anxiety Specialists.

Evelyn specializes in the medication management of anxiety related disorders and utilizes a holistic approach in her patients' care. Before we get started today, can you tell our listeners a little bit about yourself?

Evelyn Nelson:  Yeah, sure. Thank you for the introduction. I'm Dr. Evelyn Nelson, I am an adult psychiatrist. I live in Seattle, and I live with my husband and two-year-old daughter, Emmi. And so, we just moved into the area about a year ago, so we're just kind of getting used to the area, loving exploring, being outdoors. And originally I'm from California and so, it's a very different climate, very different environment, but yeah - just getting used to the area.

Jennifer Ghahari:  Nice. What are your favorite parts of the Seattle area, or Washington as a whole?

Evelyn Nelson:  Oh, I love being outdoors, and I love the greenery. I've always lived around water, so that's really important to me. So, being around the water, being around greenery, taking ferries just seeing the islands just is my absolute favorite, and was a big reason why I wanted to move into the area. And so, just the outdoors scene, and the greenery is just the best part honestly.

Jennifer Ghahari:  Do you have a favorite outdoor activity, or is it like everything?

Evelyn Nelson:  I love hiking with my daughter just because we're starting to get into hiking with her. And so, there are a lot of new things, and seeing her just kind of explore the trees, and slugs, and different animals is very cool and exciting.

Jennifer Ghahari:  Wow, that's awesome. Great. Thank you for sharing that.

Going back a little bit and a few years back now, what is it that got you interested in becoming a psychiatrist?

Evelyn Nelson:  Yeah so, it originally started with just an interest in, at baseline, “What motivates people? What drives people to do what they do?” And so, that interest started with my majoring in religious studies as an undergrad. So, that's kind of where this theme started. And over time, as I started to study religion and psychology, my interest expanded into more of an interest in being more active in that study, and being more active in the role of helping people. And then, so that's kind of how that developed into psychiatry.

There was a point where I was considering becoming a therapist. But I also was very interested in medication management. And so, that's why I went down the psychiatry route.

Jennifer Ghahari:  It's like the best of both worlds in your case.

Evelyn Nelson:  Exactly. And I wanted to make sure that I had the full realm of ability to help people. And I wanted to make sure that I wasn't kind of ruling anything out. And so, going into medical school, I actually knew that I wanted to be a psychiatrist. I was kind of one of those rare cases where I went into medical school to do psychiatry. Whereas, I think, a lot of people go in with an open mind, see what is interesting to them. And I always knew.

Jennifer Ghahari:  Wow, that's great. It was kind of a long-term calling for you.

Evelyn Nelson:  Exactly, yeah.

Jennifer Ghahari:  Can you speak to the reasons why a person may see, or should see a psychiatrist?

Evelyn Nelson:  Yeah, of course. So, I mean, the reasons that people see a psychiatrist are just so expansive. I think there's a misconception that you have to be really struggling, or really not functioning, or just things have to be dire to see a psychiatrist. And that's just not true.

I see a full range of people. So, people who have been engaged in mental health care for years and are very involved in the system. But then, I also see people who don't really know what psychiatry is, don't even know if they want to take medications. They tell me their struggles, and sometimes we decide maybe medication isn't appropriate. So, I see a full range.

And so, what I hope for people is that they're not scared out of a misconception that we're going to push medication on you. Or you have to be at a certain point in your life to see a psychiatrist. It's a huge range. And really it's not harmful to just have a conversation to be able to just see what's going on, and see how I could potentially help. And sometimes it's not medication, sometimes it's therapy. Sometimes there's just kind of a natural transition in life, but it's hard to know without that initial conversation. So, the reasons are just huge.

Jennifer Ghahari:  Great. And at its core you are, as you said, a doctor, you went to medical school. And so, I think what might be helpful for people to know too is that they shouldn't be afraid to see a psychiatrist. It's really akin to going to any doctor in many regards.

Evelyn Nelson:  Exactly right. And you don't have to have an established diagnosis. You don't have to know that you want to take medication. That's part of our job to see if medication is even appropriate. In an intake and follow up appointments that's part of the conversation. People don't go into visits 100% needing medication. That's just not the reality. And so, it's important for people to know that.

Jennifer Ghahari:  Thank you.

Are there any disorders that you specialize in?

Evelyn Nelson:  Yeah, so I specialize in anxiety disorders, PTSD, mood disorders, so including bipolar disorder and depression, and ADHD. Those are the multiple things that I specialize in, but I see a huge range of diagnoses.

Jennifer Ghahari:  And can you talk a little bit about your treatment approach?

Evelyn Nelson:  Yeah. So, the most important thing is that the person coming to me is on board with whatever plan that we have. So, the way that I approach medication management is just getting input from my patient, and just making sure I have an understanding of what's going on with them, and what is really bothersome for them. And then, understanding what they're feelings about medication is.

And then, from there, getting a sense of comfort level. Are they afraid of a certain type of medication? Are they afraid of a certain type of side effect? And it's really important for me to know these things before I even suggest a medication just because there are so many things that are avoidable, or things that we can kind of work around. Or if someone's really afraid of something, it's just so important for me to know. So, that's kind of my approach is just taking a team approach with my patient. And then, going from there.

I also tend to be pretty conservative in terms of starting medication slowly, monitoring for side effects. And that's just always been my approach. And I think it's helpful for people, especially who are afraid of taking medication to have that approach.

Jennifer Ghahari:  And, from my point of view anyway, it's really nice to hear that things are very customizable. It's not a one size fits all type of treatment where everybody just gets the same type of thing. So, that's great that you really take the time, and trust people's fears and concerns.

Evelyn Nelson:  Yeah, exactly.

Jennifer Ghahari:  So, let's say, that I sign up for an appointment with you. And right now, I have no idea what to expect from the process. I presume that there's some type of paperwork to fill out, like when I go to any doctor.

Evelyn Nelson:  Yeah.

Jennifer Ghahari:  Can you explain what the process actually is, and what I can expect in a first session with you?

Evelyn Nelson:  Yeah. So, initially, if somebody signs up for an appointment with me there's some paperwork, just getting some basic medical history, getting information about the medications they're on. And then, basic assessments in terms of mood, and anxiety, and other kind of psychiatric symptoms, just so I can get a sense of what the person can be potentially coming in with so I can prepare for the visit. So that's initially. And once the visit comes, the intake is usually scheduled for 60 minutes. And our interaction would be like 45 to 60 minutes is usually standard. And then, so initially what we talk about is just what's bringing them into the visit? What's been bothersome? What concerns do they have? So kind of getting a sense of current symptoms. And naturally, that can kind of go into some history. But then, we talk about any history with mental health, any medical history.

And then, after that, I get a sense of who they are as a person. Like what is day-to-day life for them? How is their life affected by what's been going on in terms of their current symptoms? What it was like for them growing up? Just to kind of get to know who they are as a whole person 'cause it all relates. It all comes together. And then, toward the end of the visit I take a pause and I say, "Is there anything that we didn't talk about or you feel like is important for me to know to kind of move forward?" And a lot of times people do bring things up because it's hard for me to know what's going on in the person's mind without taking that pause. And sometimes things are hard to bring up, or things can be scary, or embarrassing. And I just, I like to give that space and that option for people.

And then, after that, we just talk about if I can get a sense of diagnosis... Sometimes I can't there are a lot of times where in a intake appointment, I just got a lot of general information. But I do give some ideas. And then, I talk about how I could potentially help in terms of the plan. And, again, that can include changes to medication, starting a medication, or even not starting medication at all, or just referral to therapy. So, the ways that we can kind of go toward the end of the visit are pretty varied.

Jennifer Ghahari:  Great.

And you actually bring up a good point. So, if someone is receiving psychiatric care somewhere else, and it's maybe been a while, they're on certain medications, and they're maybe wondering, "Is this the right path for me?" They could always come to you for an intake maybe to see if they are on the right track, right path, or maybe there's another option?

Evelyn Nelson:  Yeah, exactly. And so, just because we have an intake appointment doesn't mean that we necessarily have to continue. I can always throw out options, and my kind of opinion and recommendations. And they can see if that sits well with them.

Even if they have another psychiatrist that is managing their medications, I can throw out ideas. A lot of times I validate what their other psychiatrist is doing. But then, ultimately, we like to have people just have one psychiatrist managing medication, just so it's less confusion, and more safe. But there are a lot of times where I can kind of give my recommendation. And then, I give them the space to think about it, and they can always let me know. There's never any pressure to go down a certain route, or continue with me.

Jennifer Ghahari:  Fantastic.

At our practice, we have a form of psychiatric concierge care. Can you explain what that is and how it differs from a traditional practice?

Evelyn Nelson:  Yeah. So, that's a really good question. So, with the concierge model, people pay a monthly fee. And with that monthly fee it includes any follow up appointments. It includes any contact with me, so emails, or messaging, or phone calls. And follow up appointments we just charge a dollar, meaning that it's a really low fee. So, we can follow up as many times as we need to. And a lot of times people need a good amount of follow up, especially if they're kind of in this really acute phase, and maybe things are really difficult.

And so, in that way, people won't have to worry about paying for each follow up visit. And I can just follow up with them as many times as I feel like I need to with taking out that financial aspect. Whereas with other kind of private practices, they tend to charge per visit.

And so, this can work for a lot of people. But I think, for me, I prefer the concierge model because I think what dictates follow up is just based on clinical need, and not if they can pay for this next follow up visit or not, or if they want to pay for the next follow up visit. So, it's nice to just have this kind of catch all. All services are just kind of available with me without having to think about that financial aspect.

Jennifer Ghahari:

Great.  And you brought up a good point before that some people can have some trepidation, or nervousness about starting a new medication, or there might be side effects that... With any pill, you wonder, "Wait a minute, is this normal? Is this okay?" And so with our practice, patients would be able to reach out to you at any point, like you said, through an email, or a call, and that's all included there's no extra charges, right?

Evelyn Nelson:  Exactly.

Jennifer Ghahari:  That would provide some peace of mind, and also help get the right dosage, right?

Evelyn Nelson:  Yeah, exactly. And so, the most common way that I communicate with my patients is through secure messaging. And I always encourage, especially if we're making a medication change, or if we're starting a medication for them to message me. I always counsel about side effects, but things can come up and people have questions about it. And so, a lot of times we don't need to have a follow up appointment. They can just ask me like, "This is going on. Is this normal? Will this go away? What do you think?" And it's really easy for me to just message back. And so, I love having that ability to communicate with my patients without thinking about charging an extra fee. It puts the patient at ease. And I think, for me, it's nice to be helpful in that kind of quick way.

Jennifer Ghahari:  That's great. It sounds like there's peace of mind on both ends. That sounds really helpful.

Evelyn Nelson:  Yeah, absolutely.

Jennifer Ghahari:  Wow.

Well, this has been flying by. So, for our final question, do you have any final words of advice, or anything else that you would like to say to our listeners today?

Evelyn Nelson:  Yeah. So, a couple of things. So, number one, is that no matter what provider you have, whether it's me, or anybody else, it's really important that you feel heard, and you feel like your concerns are being taken seriously. That is extremely important. And you deserve that relationship with your mental health provider. You just do. And so, for anybody pursuing care in mental health, I know it's really hard to even find a provider, but just know that you deserve that trust, and that kind of relationship.

The other thing too, is that if you are feeling apprehensive or afraid, it's okay to voice that to your provider. I think it's really helpful to be able to say that so that we can take a little bit more time into talking about the concerns, because a lot of times that's just as important as the symptoms that are going on. That can be a huge barrier to care. And so, I just encourage people to kind of advocate for themselves, and speak up to any fears, or concerns that they have because, again, they deserve to be open with their mental health provider. If you can be vulnerable and open with anybody, it should be your mental health provider.

So, I think those are the biggest things. And it's really important for my patients to know that and my future patients to know that.

Jennifer Ghahari:  Dr. Nelson, thank you so much for finding this time in your schedule to speak with us today...

If anyone is interested in scheduling an appointment with Dr. Nelson to discuss psychiatric care, any concerns that they may have, or medication management you can do so at seattleanxiety.com and we will be happy to set you up.

Thanks so much.

Evelyn Nelson:  Thank you.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychologist Bethany Brand on PTSD & Dissociation

An Interview with Psychologist Bethany Brand

Dr. Bethany Brand is a Clinical Psychologist and Professor of Psychology at Towson University. She is an expert in trauma and specializes in the assessment and treatment of trauma-related disorders, including PTSD and dissociative disorders.

Amelia Worley:  Thanks for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Amelia Worley, a research intern at Seattle Anxiety Specialist. I'd like to welcome Dr. Bethany Brand. Dr. Brand is a professor in the Department of Psychology at Towson University. She also maintains an independent practice in clinical psychology, specializing in the treatment of trauma disorders, including dissociative disorders and post-traumatic stress disorders. She has numerous publications on trauma and dissociative disorders, including one of her most recent publications on the topic, “An Examination of the Relations Between Emotional Dysregulation, Dissociation and Non-suicidal Self-injury Among Dissociative Disorder Patients.” Before we get started Dr. Brand, can you please let us know a little more about yourself and what made you interested in studying trauma?

Bethany Brand:  Yes. Thanks for having me. Well, if we go way back, I had a friend in high school and she had been traumatized, and so had her sisters, and they had very different responses, and it just intrigued me trying to figure out how could people go through similar traumas and have very different outcomes? So then when I was in graduate school, I started pursuing it more seriously and asking supervisors if I could treat trauma. Then, I did my master’s and my dissertation on trauma. When I looked for my first position after grad school, I found a postdoc at Sheppard Pratt, and at that point they had a trauma disorders unit that was just opening. So, in that case, I was at the right place at the right time, and I got to work on their unit, which had mostly people with serious dissociative disorders, so I got great training early on.

Amelia Worley:  Wow. So, to begin, would you mind defining what dissociation is?

Bethany Brand:  Sure. Dissociation is a disconnection of what are normally integrated psychological constructs or functions. So, for example, a person may feel disconnected from their body. They may literally see themselves at a distance and be looking down on themselves, or they may feel very numb when they should have emotion. It's an emotional time. They're talking about something with that they might normally feel terrified about or ashamed about, and they feel nothing. So, that's that kind of disconnection. You can also have disconnection from your environment. So, it may be they're in a place that's familiar or with somebody they know well, and suddenly they don't look familiar or they don't recognize fully who that person is. They have some sense that they know them, but they can't really place them. They may have a disconnection in their memory where they feel like there's gaps in their memory.

They can't recall, it might be hours, days, or even potentially, from childhood. There might be years that they really don't recall. Within their identity, they may have a sense of being kind of fragmented where they feel like, more than people who are non-dissociative because we all have parts, but they may feel like they act so differently, seem so differently, behave so differently that at different times they feel as if they're almost different people, although nobody can have more than one person inside them. It's states, dissociative-self states. They also may have disconnection from behavior. So, they may find themselves doing something, see themselves doing it, and they literally can't stop what they're doing. Those are just some of the examples.

Amelia Worley:  How is dissociation linked to trauma? Are some traumatic experiences more likely to cause dissociative disorders?

Bethany Brand:  Yes, they are. So, we know that if it's particularly life-threatening, you might be more prone to dissociation. We know that children are more likely to dissociate, and they lose that ability a little bit over time. So, for example, if there's ongoing childhood abuse, and especially if it's done by a caretaker, somebody who's in charge of the child, should be protecting them, and instead they're betraying them, we know from betrayal trauma theory that they're more likely in those situations to dissociate. So, it's particularly severe, ongoing trauma, but it can even happen for a one-time really serious car accident. Like I know somebody who, when they were in a car accident, they were actually seriously injured, but they didn't feel any of the injury. It wasn't, they hadn't had nerve damage. It was that they were at for a little while having what's called very traumatic dissociation, which is dissociation during the actual trauma itself.

Amelia Worley:  Wow. How might someone know whether or not they're suffering from trauma-related dissociation? What does it feel like?

Bethany Brand:  It's a good question, but it feels very different according to which one of those constructs is, they're disconnected from. So, do they, generally speaking, have emotions? Do they generally feel like the body is theirs or do they sometimes feel like that's not my body? It's not like, it's not a person getting older and looking at themselves thinking, that's not how I look. It's more profound than that. Like they might look child-like, or they may feel like they look at themselves and suddenly they look decades older, and it just, it's a strange sensation. They may look in a mirror and not recognize themselves. If a person is, has experienced or is experiencing a number of the things I've talked about, problems with feeling connected to their body, connected to their emotions, connected and oriented and aware of their surroundings, that probably means that they don't dissociate much.

But if sometimes their surroundings look far away, even though let's say, if they're hand looks like it's a mile away, like their arm has suddenly grown, there's really a huge distance, that's a type of depersonalization. Or if, let's say they're talking to a therapist and suddenly the room looks foggy, that's derealization. The world around them looks different. Or they can't hear their therapist speaking, even though there's nothing wrong with their hearing, that's a type of derealization. So, if somebody's experiencing any of these things, that might give them some indication that they possibly have trauma-related dissociation, and of course, have they been exposed to some kind of trauma? That's a prerequisite for trauma-related dissociation.

Amelia Worley:  So, what can trigger dissociation in an individual after the traumatic event has occurred?

Bethany Brand:  It may be that they're just hearing a sound that reminds them, a trigger. It could be a sound, an image of the light being a certain way. They might hear, they might smell a certain smell. Smells are very, very likely to trigger traumatic associations. So, it's when they feel triggered that then they may also start to dissociate. So, I'm careful, I'm a little cautious that some listeners might be a little triggered about what I'm going to say. So, I'm going to advise them if they want to just tune me out for a minute, but let's go with the example of smells. So, if somebody was traumatized by somebody who'd been drinking alcohol, if later, they smell alcohol, they can be triggered by that, and start to have their heart race, feel terribly vulnerable, like something dreadful is going to happen, or they may do that for a bit, and then disassociate, start feeling numbed out, kind of like things around them looking surreal in some way, or they might just really rapidly go to a dissociative state.

Amelia Worley:  That's really interesting. In your publication I mentioned earlier, “An Examination of the Relations Between Emotional Dysregulation, Dissociation and Non-suicidal Self-injury Among Dissociative Disorder Patients”, you talk about how this idea of emotional dysregulation. Can you explain what emotional dysregulation is, and how it relates to trauma-related dissociation?

Bethany Brand:  Yes. So, you know how we like to have very big terms in our field? Emotion dysregulation is basically difficulty dealing with emotions. Okay? So, people who have got, who've experienced a lot of trauma, whether they're highly dissociative or not, they tend to feel too much or too little. So, for example, let me go back to that past trigger example I gave you. Maybe that person normally has normal feelings. They can feel some happiness, some sadness, some anxiety before a test, whatever. But when they get around, let's say they are abused by a man. When they get around men, then they start feeling really scared. Their heart starts to race. They feel like, oh, I've got to watch behind me. I've got to watch this guy. That's feeling too much. The opposite can also happen where they feel too little. The examples I gave where somebody is numbed out, they don't feel connected to their body.

So, emotion regulation is when you have the capacity to know what you're feeling. They can identify the emotions, and emotions, how do we know we're feeling emotions? It's in our bodies. So, if somebody's angry, they might feel I'm imitating it for anybody who's not watching the video. I'm clenching my hands. I'm kind of raising my shoulders. I'm tensing up muscles. A lot of people feel that kind of muscle tension and agitation energy in their body when they're angry. If you're feeling, if you go back and forth between too much feeling, too little, if somebody starts getting angry and they're very uncomfortable with that emotion, they may shut it down and disconnect from their body. Maybe anger is very scary, because maybe they were in a relationship that was physically abusive, and so they disconnect if there's anger. So, what happens when somebody's traumatized, trauma by its definition, it's overwhelming.

They may feel at risk for their life, and so the feelings are huge, way, way, way too big. Like that example I gave earlier with somebody who had peritraumatic dissociation, if you're so terrified, sometimes the brain, it's an automatic kind of a brain-based response, may start shutting down emotion. The person's not willing it to happen. It just starts to happen. Parts of our brain start kind of metaphorically going offline. They're not very active. So, later on, if that happened during trauma, that the person started dissociating when they felt too much, if later on after the trauma, they're starting to get overwhelmed with feeling too much, they may get scared of that, and at first, they may consciously, like, I don't want to feel this. I don't want to feel this. I don't want to think about this, and they kind of push it away.

That's normal PTSD is you try and push away emotions and remembrances and memories, images. But over time, if somebody's also disassociated or starts to learn to dissociate, they can numb out and disconnect. If they avoid thinking about something enough or it's so awful, they really just, they're, they don't go there in their minds. Over time, they may have less access to that memory, and so they start maybe having the memory problems I talked about earlier. So, emotion regulation is intricately tied in with dissociation, because dissociation is a way of dealing with emotion, and a terribly threatening situation.

So, what we've looked at in some of these studies is, can we teach people who have very high levels of trauma-related disassociation other ways to identify what they're feeling, to not be so afraid of emotions, help them learn how emotions are helpful, and how to healthfully manage them in a range that's tolerable, so they're not flooded. They're not numbed out. They don't have too much or too little emotion. We found in this treatment study we did with dissociative disorders, folks, that as you teach them emotion regulation skills, then dissociation began to decrease some. They weren't needing to dissociate so much. We also found that self-harm decreased, PTSD symptoms decreased. Helping people learn to regulate their emotions is a really fundamental, crucial skill, in other words.

Amelia Worley:  So, continuing on that idea, can you talk a little bit about the most effective treatment approaches for trauma-related disassociation?

Bethany Brand:  Yes. So, the study I was just referencing indirectly is one called “The Treatment of Patients With Dissociative Disorders.” It's TOP DD, and that's for people who have really serious dissociative symptoms. We're in the process of doing a randomized controlled trial treatment, where we're checking out the program I was just referencing. So, we get people who have very high levels of dissociation, plus their therapist, who agree to be in the study. We have a number of videos where we teach them what trauma does in general, various symptoms related to trauma, then we get to dissociation what it is and how that was helpful, but also how in adulthood, when you're safer, if you're safer now, how it can get in the way. So, somebody not always knowing what they're feeling, maybe they're tuning out some important clues from their body, from their mind that a relationship's not safe, but if they're not in touch with their emotions, they may not feel that.

So, we know from research that people with lots of dissociation have high rates of being re-traumatized in adulthood. So, it's really important to help them learn to identify their emotions, and to gradually use less dissociation. So, we're, in that program, that's some of things that we're teaching and that's in general, whether somebody's in that treatment study or whether they're working with a therapist. The therapist, generally speaking, teaches them what dissociation is, the symptoms of PTSD, because they often have both. Then there's a technique called a grounding technique. So, let me, and I'm talking this out loud, just in case somebody can't see the screen. Dissociation’s on a continuum. At one end of the continuum is somebody is grounded and oriented in present reality. They can feel their body. They know where they are. They know what the date is. They're really hooked into present reality.

The other end is profoundly dissociated, where they don't necessarily, they don't recognize where they are. They're not feeling their body. They're really severely dissociated. Then in between, there's this whole range. What a therapist can help a client learn to do is recognize the early signs that they're beginning to dissociate. So, they might feel spacey or tingly. Those are just examples. So, the client learns when they start recognizing that warning sign, then they use these grounding techniques, and I'll just explain a very basic one that lots of people know. You can use this with panic attacks, all kinds of things, not just disassociation. But you put your feet on the floor. I'm going to do it, because when I teach people, I always do it along with them. So, I'm pushing my feet into the floor, and trying to really notice what that feels like. That is using muscle movement, contractions, and trying to get them to feel that part of their body, assuming they're okay with feeling that.

Then I would also be having them look around where they are. If it's a Zoom therapy session, look around the room where they are. If we're meeting together, look around my office and find something that they can describe with all the senses. So, I've got a cup of water here. If they've got something to drink, can they feel the weight of the cup? Can they feel the coldness or the warmth, taste it, using all their senses? That actually helps wake up metaphorically, the parts of the brain that have shifted, and kind of gone offline while they're dissociating. So, you use the senses, all five senses to get the brain back online in the normal way that it should be. Those are grounding techniques. So, a therapist would be teaching them grounding techniques and having them practice that in session, and then also, out of session. Those are just some of the basic tools we use when folks have got a lot of trauma-related disassociation.

Amelia Worley:  Wow. Lastly, do you have any advice or anything you want to share with our listeners suffering from trauma-related disassociation?

Bethany Brand:  Yes. I would say one of the most important things you can do is to learn exactly what I was just talking about. Learn grounding techniques, and practice them, and learn healthy ways of taking care of yourself emotionally. So, many, many, many people who've been terribly traumatized feel ashamed of themselves, feel dirty. They feel like they're bad people. That's, those are symptoms of being traumatized. It's not the reality of who they are. It's a symptom. So, hopefully they can start thinking about that, looking into that. There are good books out there to read for trauma recovery. If somebody has a really serious, a lot of dissociative symptoms, if they have a therapist, if they want, and they can look into this treatment of patients with dissociative disorders study, TOPDDstudy.com, and we have that website. They can go there and look and see if we're still running the study.

There's also a professional website that has a lot of information for consumers and therapists. I'll say it slowly. It's ISSTD. It stands for the International Society for the Study of Trauma and Dissociation. That organization does a lot of training for therapists, and they have frequently asked questions on their website about disassociation. They have some questionnaires, people could even try and fill out and find out do they seem to be scoring fairly high, and learn a little bit about, do they have dissociative symptoms, where to go to get help. They have a Find a Therapist page on that website.

Amelia Worley:  That's great. Well, thank you so much, Dr. Brand. It was wonderful having you on our series today.

Bethany Brand:  Thank you so much. It's been an honor to be here.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Sociologist Peter J. Stein on Genocide & Discrimination

An Interview with Sociologist Peter J. Stein

Dr. Peter J. Stein is a Professor Emeritus of Sociology at William Paterson University and a Holocaust scholar.

Jennifer Ghahari:  Hey, thanks for joining us today. I'm Dr. Jennifer Ghahari, Research Director at Seattle Anxiety Specialists. I'd like to welcome with us Sociologist, Peter Stein. Dr. Stein has a Doctorate in Sociology from Princeton University, and has been a professor of sociology for 33 years, primarily at William Paterson University in New Jersey. Most recently he was a senior research scientist at UNC Chapel Hill. Since 2018 Dr. Stein has been volunteering, educating groups about the Holocaust at the United States Holocaust Memorial Museum. Author of nine books, his most recent includes; “A Boy's Journey: From Nazi-Occupied Prague to Freedom in America.” Before we get started, can you please let our listeners know a little bit more about yourself and what made you interested in studying the Holocaust?

Peter Stein:  Thank you for the introduction, Jennifer, and I'm glad to be here. I was born about two years before the Nazis and Hitler occupied, Czechoslovakia. I was born in Prague. First couple of years of my life were fine. But on June 15th, 1939, Germans came in, and the Holocaust started not much after that. My dad was Jewish, Viktor Stein, and he married a Catholic woman, my mother, Helen Zdenka Kvetonova. They had mutual interests. They liked music, they liked dancing. They fell in love, they married. And the fact that my Jewish father married a Christian woman, pretty much saved his life.

Jennifer Ghahari:  Wow.

Peter Stein:  Because unlike the other eight members of his family, his brothers and sisters and his mother, were all sent to concentration camps in 1942. My dad was not sent until two years later. He was doing slave labor. That is manual labor in and around Prague, which was difficult and demanding, but he survived. So, then he sent to Terezin in Czech or, quote, "Theresienstadt" in German, which was a ghetto-labor camp about an hour northwest of Prague. He was forced - he worked on wood manufacturing, is what he did before the war. That is, he had the Bentwood Manufacturing Factory. So, they made chairs. Anything with bentwood. Tennis rackets, skis, ping pong paddles, and so on...

So, he was able to apply some of those skills in Terezin. He came back in 1945. I remember him jumping off a Soviet truck. About 12 Russian soldiers brought back survivors of the Holocaust. He was still wearing a yellow star, which was required. So, then we went back to democracy, but the communist party came into power, and it took my parents almost two years to get an American visa. We came to the states the same night that Harry Truman upset Thomas Dewey for the presidency in 1948. Sailed by, The Statue of Liberty, her crown lit up, the torch lit up, and I saw downtown Manhattan. And I wanted to stay up all night. Why? Because I was looking for king Kong and Fay – climbing the edifice with Fay Wray. Finally, my mother said, no, go to bed. So, we came to the States. My father came two years later. It's a long story, but basically he was arrested by the communists for trying to get his factory back. My mom was a governess for a family with two children. And we lived with them in Larchmont, New York. I learned English. I went to City College. Then I went to Princeton for my PhD degree and I've taught in and around the New York area, primarily William Paterson. Jennifer's alma mater and where we also met and the rest is history.

Jennifer Ghahari:  Great. Well thank you for sharing that with us and I'm sorry for everything that you and your family have been through, again, even begin to imagine. And again, thank you for speaking with us today. In terms of antisemitism that I think it's used fairly often. Can you explain to our listeners, what does that term actually mean?

Peter Stein:  It's interesting. Historians and scholars still research and write about it. And most recently the current Biden administration appointed Deborah Lipstadt, who's a historian of the Holocaust, to a position overseeing Holocaust and genocide developments. So, it's come to that level of importance. And basically goes back to the Nazi ideology that Jews are inferior. They're inferior physically, they're inferior mentally and intellectually. And basically they have no right to survive. I mean, that's the essence of the Nazi ideology. That they're less than humans. And one film that the Nazi's produced shows Jews as vermin, as roaches to be destroyed...

And many people hope that the use of that term and attitude towards Jews would change with the end of World War II. However, all kinds of studies, one by ADL, the Anti-Defamation League shows an increase in antisemitism, both in the United States and in Europe. So, much so the latest study is a 2021 study. And I want to make sure that I report the figures correctly.

Jennifer Ghahari:  Thank you.

Peter Stein:  They do something where they count anti-Semitic incidents in the year 2021. They discovered 2,717 antisemitic incidents ranging from vandalism, putting a swastika or something of that sort, to violence in the synagogue and Pittsburgh, most notably the Tree of Life Synagogue and others. So, the antisemitism continues and I have to quote one noted authority. My mother. And when she was still alive, I asked her, well, why do you think there was so much antisemitism in Czechoslovakia?

She said envy. And I think there's something about envy. The Jews for millennia in Europe were segregated into ghettos, they were limited in what they can do. But in the 17th, 18th centuries in Europe, they were given more latitude, more opportunities. And they went into the professions, law, medicine, manufacturing, banking, and they were succeeding quite well. And I think the envy came in there because for generations, Jews were seen as inferior, less than human, to be avoided. And suddenly Jews had power and some had wealth. But I have to be very clear that yes, there were rich Jews and there were also very poor Jews. Many of them, the poorer ones in Eastern Europe, in agricultural areas. But that antisemitism had been spreading for generations before Hitler ever came on the scene.

Jennifer Ghahari:  Wow. And as you said, it's spiking again. And it seems that hate groups are on the rise again. And aside from antisemitic attacks, there's also been a large increase in anti-Asian sentiments and attacks in the US. And it seems to correspond, especially with Asian Americans, with the outbreak of the coronavirus pandemic. And in America, we're talking about Jewish Americans and we're talking about Asian Americans. They're not outsiders, but some people are treating them as such. So, sociologically speaking, how can we overcome as a society, this discrimination against our own subgroups.

Peter Stein:  I think you hit the nail on the head with the use of the word outsiders. I think one way to look at all of these issues is who's the insider, who's the outsider - who are the we, who are the they, who are the people with power and influence and who are those with limited? And I dare to say that in every society that we know of, there have been some people with more power and they can use the power to label other people as different that as outsiders. And among outsiders, if you look at it historically, were women, African Americans, Asians, Jews, people with disabilities, people with different sexual orientations. Any number of those people who then can be painted as dangerous, as different, as our kids shouldn't associate with them. And you quite right about Asians. It's been an ongoing struggle that we're now more aware of...

And Asian community are saying, we want protection. We want equal opportunities. We want equal rights. Chinese of course were built sent to your neck of the woods, the West Coast, to build railroads, primarily male workers, very few women. And so they were doing that kind of labor. The Japanese were the “good” group. They were the ideal group to the World War II when they were suspected of being pro German and sent to internment camps, which is a different word for concentration camps. And they suffered. And if you look at just one quick figure I was looking at, if you look at the proportion of Asians in technical jobs, chemistry, other sciences, is quite high. If you look at the proportion of CEOs in American corporations with Asian backgrounds it’s about 2%. So, they're promoted up to a certain point and then I think the stereotypes come in.

Jennifer Ghahari:  Wow. Thank you. Sadly, and unfortunately, obviously it seems that you have firsthand experienced of the damage that extreme prejudice and discrimination can do. And are you comfortable to share some of your childhood experiences in Prague with our listeners?

Peter Stein:  For those people looking for holiday gifts? There's a wonderful book - my memoir.

Jennifer Ghahari:  It is a great book. I read it probably in two sittings.

Peter Stein:  Wonderful. You didn't have some Czech wine with it, I hope. I hope it was Czech beer. It was difficult. My dad, would disappear for periods of time and I always would ask, this is during the war, during the Nazi occupation, during the Holocaust, I would ask my mother where's dad. And also where's my uncle Richard, my favorite uncle, brother of his, who would always bring me stuffed animals and toys. He was wonderful. My mom's standard answer was, “Your dad's on a business trip. He'll be back as soon as he can.” I checked with my cousin Gerti. Gerti also has a Catholic mother, Jewish father and her mother had the exact same answer that her sister did. That is, “Your dad is on a business trip. He'll be home as soon as possible.” So, I had no idea. I of course, had no sense of what Holocaust, what concentration camps were...
 
None of that. I went to school. But we had German soldiers all around. And in my classroom, every classroom in the front, there was a picture of Adolf Hitler and the Nazi flag. The teachers were Czech, but they were instructed to be quite reverential of Hitler and the Nazis. So, I'll give you one quick example of what I experienced as cognitive dissonance. Monday through Friday, we were told in class, when it came up that the Germans were winning. They even took us to a couple of parades to honor German soldiers coming back from the east. But on Sundays, I and my mother would visit my Catholic grandparents. And my grandmother was a wonderful cook, wonderful baker, always had a good meal, despite food shortages. She could put a chicken on the table at six o'clock like clockwork. Every Sunday when we were there, my grandfather invited me and my cousin, Robert, who was nine months older than I into a study. He would put on his Blaupunkt short wave radio and listen to the BBC, the British Broadcasting Corporation, which started with the chimes of Big Ben then Beethoven’s 5th (sings a few notes).

Jennifer Ghahari:  That's very dramatic.

Peter Stein:  And we'd have a bulletin of the news. And my grandfather spread a map of Europe on his desk. He had a stack of black checkers, which indicated the German positions and red checkers indicating the Allied positions, including D-Day in Normandy. And it was just amazing. And whenever we finished with him at his home, he would say, “Don't worry, your dad will come back.” He told both of us. Sadly, my dad did come back, he survived - my cousin's father, Leo Perutz was killed in Auschwitz. But that dissonance, what was happening: so, for a seven or eight year old, who do you listen to? Well, I went with my grandfather, but he said never about this in school...
 
If the teachers get a wind of it, you could get into trouble. So, the whole thing, the war years were difficult, including a couple of bombings of Prague. I have a whole chapter about that, where an American squadron flew over Prague, the same day they were supposed to bomb Dresden in Germany. They mistook the topography. It's very similar rivers. And so we lived through that. That was one of the scariest moments, because my school is in downtown Prague and they hit some buildings, the church, so on. So, the whole thing, the war was there, but somehow we managed and my mother was terrific. She looked after me, made sure we ate and all of that. And at the end of the war, she and I both became vegetarians. Why? We couldn't get any meat. So, I had fresh bread, which I loved with several different mustards. No meat. No hotdogs. Not a problem in Seattle these days.

Jennifer Ghahari:  Exactly. You didn't stick with the vegetarianism. Did you?

Peter Stein:  It ended as soon as the war ended. Butchers opened businesses, stores.

Jennifer Ghahari:  Nice. Thank you for sharing that with us. It definitely helps to visualize what you and your family experienced. And now looking at what's going on in Ukraine, I think people might be able to see some connections. For those who aren't familiar on February 24th, Russian President Vladimir Putin ordered his army to invade Ukraine. And for those who have seen images on TV at home, the images and the stories are just gut wrenching and actually anxiety inducing. So, I can only imagine what you feel, seeing something like that. Cause it seems you some type of similar things that you went through back in Prague. From your own personal experience, can you speak of what you see going on in Ukraine? And are there any similarities?

Peter Stein:  How many days do we have for this?

Jennifer Ghahari:  Exactly.

Peter Stein:  It's quite tragic, I must say. A couple of historical examples come to mind. In 1938, before Hitler invaded the whole country, he went to liberate an area called the Sudetenland. Sudetenland: about three million Czech citizens who spoke German as their native language. And Hitler used that pretext to liberate them from the Czechs, who he accused of oppressing. Putin’s take on it certainly is influenced by that kind of structuring. Then in 1948, the communists came into power in February and again in one day dictated censorship. So, my dad came home from his office in February midday, and he showed me the newspaper. He said, democracy has died in Czechoslovakia. I said, what do you mean? He shows me the newspaper and there're several columns, completely white. Those are stories that were never printed. Critical of, in this case, the communist takeover, what was called a putch.

And so Czechs had to flee. 20 years later, 1968, the Soviet army, well, the Warsaw Pact Nations in invade Czechoslovakia. People are probably familiar with that. And rest of my family, the Czech Jewish family that survived the war, left Prague one person at a time, because the rumor was that if you try to take your whole family out, you're likely to be questioned, even arrested. So, I spent a week in Vienna with my dad and every afternoon at three o'clock, we'd go to the railroad station to see if any relatives, and it literally took two weeks for the father, the mother, the daughter, and the son to come out. And you see it, people weren't being bombed, but they were limited to one suitcase.

And since I was there, I did a little study. I interviewed people for a couple of days. Most of them were in their thirties or forties, single or young parents, doctors, lawyers, nurses, social workers, teachers. What we would call a brain drain. And I think we haven't looked at the full impact in Ukraine of the Russian attack. How many other people have fled, had skills that are necessary. And it's very close to a genocide. Certainly they’re war crimes, the bombing of hospitals, of children's centers, of theaters, killing women and children, tying them up “in the name of freedom.” And it's hard not to think about domestic situation. I'm not going to go there, but the use of the concept of freedom and helping people themselves, you have to ask, who's doing the talking and what are the actions like? What's the behavior. It's not propaganda. It's what they do. And it's troubling. And now, as you know yesterday, the Secretary of Foreign Affairs for Russia, Mr. Lavrov, is talking about, they “have nuclear weapons,” while we know that, but that's...

Jennifer Ghahari:  The similarities are highly disturbing, especially because it seems like you said that, it is ethnic cleansing, even though it's framed in the terms of liberation. But as you said, everything that they're doing is not liberation. It's the exact opposite.

Peter Stein:  Brave Ukrainians. I don't know how many people would do that to risk their lives.

Jennifer Ghahari:  Sure. And as you mentioned too, it's not only a brain drain. So, it's affecting Ukraine itself negatively because they're losing all of essential workers. And by essential, I also mean what you were saying, like doctors and people that keep society running. Like all of these people, it's millions have fled. But then also if you think of the flip side that now these people are refugees coming to different countries. I know out here in Seattle, we're supposed to get, I'm not sure how many refugees from Ukraine, but there's supposed to be several coming. And if they don't have a good handle on the English language, so you have someone like a doctor or professor or any profession, to get started over in a brand new country and to have lost so much. It's really heartbreaking. And I hope that when refugees go wherever they end up, whether it's here, whether it's the UK or anywhere, I hope people are cognizant of that. That these people are not here because they want to be. It's not that they left because they wanted to. Similar to you and your family. You left because you had to survive. And it wasn't an easy thing to do. Obviously you were a child when you came here and your English is perfect. But for older adults just getting a start, I can't imagine how difficult it is.

Peter Stein:  Even my little example. (phone ringing) Sorry.

Jennifer Ghahari:  No worries.

Peter Stein:  I don't know how to quiet this.

Jennifer Ghahari:  It wasn't me calling.

Peter Stein:  Okay. My first few days in an American school with my lousy English, couple of kids thought I was German. Stein. I said, Stein, I'm Czech. I'm Jewish, I'm not German. And so imagine if you come... As you have said to be an immigrant, it's a difficult status. And is there anybody there? Fortunately had a wonderful teacher, Mrs. Murray in the seventh grade who took me under her wing and she helped me with English and writing and she was wonderful. And you think about the importance of teaching for immigrants English as a second language. My dad took one of those classes. He spoke Czech, he spoke German, he spoke French, but he didn't speak English.

Jennifer Ghahari:  Wow.

Peter Stein:  So, he had to come up to snuff and pass the citizenship exam. And you're so right, because it takes you out of your home. Out of settings of familiarity, to a brand-new country where they may or may not welcome you. And yet immigrants have done so much to build up this country. I mean the number of immigrants from Southeast Asia, from Asia. Seattle is certainly one place.

Jennifer Ghahari:  And anxiety that comes from that type of move, especially when it's forced upon you. It's really detrimental. So, again, I hope that people are just a little bit more aware and a little bit more sensitive and will just kind of maybe take an extra step to try to help people however possible.

Peter Stein:  And government policy is so critical. We won't speak about the former president who wanted to stop the incoming of any Muslims, of anybody. I mean, just willy-nilly. Well, so then it's not surprising that when they come, some Americans are upset. “You shouldn't be here, go back to where you came from.” And that kind of antisemitism and anti-minorities just makes being an immigrant that much more difficult. And I got to put a plug in for education because I think that's critical. That schools ought to welcome different points of view, different languages, different cultural patterns. And not start burning, taking books away. And no, you can't learn about this one or that one. That kind of blinders that some folks have.

Jennifer Ghahari:  So, it sounds like multiculturalism and education are pretty much key to overcoming this anti-racism, antisemitism, basically all types of anti-discrimination. Correct?

Peter Stein:  I would certainly hope so, because you may get it at home, but you may not. And so that's critical. Speaking one other point about antisemitism that the ADL League found, they're now looking at social media and the spread of antisemitism there. And they found that in one year in the United States, there were 4.2 million antisemitic tweets. And they go into their methodology, which is quite sophisticated, but 4.2 million antisemitic tweets.

Jennifer Ghahari:  Wow.

Peter Stein:  So, somebody's writing it, somebody's reading it, somebody's sending it out. And that's new. I don't think anyone else looks at the use of the media in that way.

Jennifer Ghahari:  Right.

Peter Stein:  Now one gentleman just bought a big media outfit and we'll see how goes.

Jennifer Ghahari:  That should be interesting. Well, thank you. And so, as someone who specializes in antisemitism and wartime atrocities, do you have any other advice or any parting words for our listeners? Anything else that you want to add?

Peter Stein:  Well, again to educate not only in schools, but educate yourself because the media, as, as lovely as it is, can be influenced. Who's saying it? Where does the message come from? Who's got what kind of vested interest in having you, accept this as a fact, as opposed to just an opinion. But also to communicate, to talk to other people, to talk against people who have racist jokes or sexist jokes, or rather than just ignore it and laugh, suggest how does this impact other people. Anti-gay or lesbian jokes, or what have you, and to support the right to vote. Another key issue that maybe needs more attention and the democracy supposedly is helping people, encouraging people to vote, to express their opinions. Well, if you make it more and more difficult, it's easier for people of one opinion to get in it and not others. So, I just would hope for more tolerance, more understanding of other people, as the salvation and the Golden Rule is to do unto others, as you would have them do unto you. And I think that's an important rule to keep in mind in our lives.

Jennifer Ghahari:  Great. Well, thank you so much. And again, thank you for sharing with us, what you and your family had gone through. And I'm very sorry that you have experienced all of that. And if we could have you back sometime, we definitely will. Again, thank you for talking with us today.

Peter Stein:  Thank you so much for inviting me. If anybody has any questions after they see the tape, feel free to communicate with me or through Jen. Glad to answer and thank you for what you are doing.

Jennifer Ghahari:  Perfect. And you had mentioned that there may maybe some photos that we could add along with the interview.

Peter Stein:  Sure.

Jennifer Ghahari: Perfect. So, for those listening we'll put that into the transcript section on our website and you'd be able to access that along with the link to Dr. Stein's book.

Peter Stein:  Thank you.

Jennifer Ghahari:  Thank you again.

Photo gallery images courtesy of Dr. Peter J. Stein:

Zdenka Kvetonova and Viktor Stein (Peter Stein’s parents), married in Prague’s Old Town Hall, May 1934.

Peter Stein and his Mother (left).

School children in Prague (2nd grade).

Photo taken during the May 5-8,1948 uprising by Czech partisans battling remaining German troops--eventually chasing them out of town.

1946 Prague: Peter Stein’s family along with Kurt Fuhr (Peter’s Father’s cousin) and his wife, Malvinka. Both Kurt and Malvinka were Jewish and Captains in the Czech Army, fighting with the Soviet Army against the German Army. They each received medals for bravery (he was wounded in battle and she was a nurse).

Arriving to the U.S. and seeing the Statue of Liberty for the first time.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.