Transcription
I have my own belief system about trigger warnings, which is I mostly don't believe in them. And I was intrigued when I was in treatment with a lot of suicidal people, that we had complete access to our computers. We could look up how to kill ourselves if we wanted. We could say offensive things to each other if we wanted. We did. And that was kind of novel in a treatment setting to be able to do that. And I actually thought it was wonderful because I mean you can't control the world, so you might as well play out some of the problems that you're going to interface with so you can learn how to manage yourself around those problems.
I think that people just vary a lot and they've been taught different things and they may be very accustomed to getting these kind of warnings and then habituated to it. Some people will have nightmares for days if they watch a scary movie and other people could do it while they're doing math homework. So, there's such individual variation to it. And what's really important is that each individual knows themselves and does something that helps them cope optimally.
Because you're right, one of the things about the Gunderson residence is that it's fully supervised. And when I was running that program, I was actually literally chained to my cell phone. I could not go anywhere without it. I would answer it promptly whenever it was the ring of the counselors who were there every day because I did not want them to be stranded with a situation that was overwhelming with a patient or a group of patients that were at risk. So, it takes a lot of people to manage a setting where there's a lot of people who are vulnerable to being reactive, impulsive, and self-destructive. It's very hard work to run a residential treatment for patients who are self-destructive.
The idea behind not protecting people from triggers is that we saw that a lot of people who came to our program had been to all the other programs and their pattern was that they would get better and then go back into the real world and have the same problem again. And so we took the responsibility to be on call all the time and have it staffed so that we could take that risk to allow people to be triggered or overwhelmed or exposed to something that they didn't have the capacity or confidence to deal with. That's actually something we all face especially in the current reality. But people with BPD face it more frequently with less stressful events and they do more self-destructive things or aggressive things towards others in the face of those um triggers.
And in certain situations, avoiding triggers is the best someone can do. But obviously that's very limiting in life. If you have to organize yourself about avoiding things that could overwhelm you, that is actually the beginning of disability because it limits the things you're capable of exploring in the world. And really maturation, growth, development is all about that security to explore the world and all the dangerous things in it. The world is full of dangerous things and things that overwhelm us unexpectedly. Look at co and if we can't have the courage and the resilience to face it and try to figure it out, then we're not going to get past it. So, we had to do a lot of scary things like not go to school, work from home, transform everything we do, take vaccines that we didn't know could help or now now we know they do. But solving some of these problems required us to take risks, be triggered, face the things that scared us so that we can master them.
So that's actually a fundamental part of the attachment system that people don't pay attention to. But if a relationship is working like a treatment, it should encourage the patient to be able to face their fears. And some people aren't in a situation to do that and that's okay. I'm not judging that. But optimally, resilience is about managing all those things that we're not sure we can manage. You have to get to a certain point of discomfort, I guess, is what you're saying, to make to evolve or to adjust or to make changes. If you're too comfortable, what's the motivation to move your leg in a different way?
I think that's really the amazing thing about people is that there's a side of humanity that's incredibly resilient and innovative figuring things out that we don't know how to do and then there's a side of humanity that's really vulnerable and death can come on any of us rather unexpectedly. I think that's a tension we all have to manage somehow. And I think most of the dilemmas that people have that have personality disorders or psychiatric issues are human dilemmas. How do I manage my fears best so that I don't lose control and do something that's harmful to myself? maybe avoiding triggers is the only thing they've got and it keeps them alive but it keeps them in kind of a cave um and on the defensive.
So when we treat PTSD, for instance, we really tell people who have PTSD, your problem is not just that you're reexperiencing these cues and feelings and thoughts you had while you're in a life-threatening or overwhelmingly dangerous situation. But the problem is after that you develop all these ways of coping with that vulnerability of yours where you avoid things that could trigger you and then you escape situations that remind you of the past and that avoidance and escape actually cripples you so that your life is all about avoiding and escaping and not about your goals and values. And we all know as human beings that when we're not living by our goals and values, we feel a lack of meaning. We don't have sources of self-esteem. We worry more about our interactions with people. And we have less consistency in our lives because it's more about reacting to the things outside than guiding your life from the things that are important to you.
Would you say then to people who are sort of in the throws of doing that and let's say they don't have access to clinicians, what does someone do if they don't have someone who can help guide them through that space so they can get out of their prison. I think everyone has to make their own individual choice. For some people, they would rather stay in that kind of trap space. It's miserable and painful, but that's what they choose. Therapy is only one mode of healing. And I don't think it's personally the end all and be all. It's a tool that's a set of customs that are sanctioned by the scientific community and overseen by boards.
In the absence of that, for whatever reason, people need corrective experiences. So if the first time you go skiing, you break your leg. Mhm. The likelihood that you'll never go skiing again is high. But people who need to go skiing enough, like say your whole family goes skiing or you live in the Alps or something like that, you may have motivation to overcome this and try it again. And if you have an experience where you don't break your leg, then you will actually change your relationship to skiing. And the more you do it, if you've skied 10 times and only one time you broke your leg, then you can feel more certainty that this can be an event that you minimize the likelihood of in a variety of ways. But you can never make it completely safe for yourself no matter what. Skiing involves risk and things happen to people.