Religious Trauma and Broader Visions of Spirituality in Healthcare

Dr. Hilary Mcbride: [00:00:00] Doing this work myself as the patient has made me braver, has made me more fearless, has made me more relentless, more tenacious with the places of shame, terror, rage, fur, confusion, dissociation, because I have touched them inside of myself.

Margaret: Welcome back to How to Be Patient. Um, this is our first solo episode where, don't worry, Preston and I are not fighting, uh, but we are still in residency and so sometimes he's on nights I'm not. And we wanna be able to give you guys as many episodes week to week as we can. Um, today I am joined for my first ever solo episode with Dr.

Hillary McBride. Um, who's. Work we are gonna discuss throughout this episode, but personally, who I've been following for, I think since medical school for like maybe seven or eight years online. Yeah, I know. Deep Parasocial relationship. Uh, and we are gonna talk about [00:01:00] spirituality. Um, I. Positives and sometimes harmful parts of that.

For our listeners who are listening to this for their own mental health, for our listeners who work with people in the mental health field or healthcare in general and wanna have a more robust language around how to think about this as well as some in your work of embodiment and kind of the work you also do in having the podcast, other people's problems.

Um. And all the things, everything, all of that. Yeah. We could talk for hours. We won't, but we could. Um, we always start with a icebreaker question, even when it's just Preston and I. Um, and so today we are gonna start with one, um, and reading your book and in kind of again, knowing the background of your work.

The question I thought we would start with, you know, really easy, not at all deep question, but, uh. What are some ways that you found that sense of, I kind of think of it as just like bigness of like, oh wow, there's some depth here. [00:02:00] And there's some also sense of, some might call it the eternal, some might call it transcendence, some might call it just beauty.

Mm-hmm. Um, any small moments this week that you wouldn't mind sharing that have reminded you of these positive sides that we associate with spirituality sometimes. 

Dr. Hilary Mcbride: Mm-hmm. I mean so many, and it won't, won't be surprising to anyone familiar, familiar with my work to hear me say that the, the moments are often connected to the material, like the imminent of, of being embodied in, in the natural world.

I was thinking about, you know, when you post the question, this moment this week, I've got, um, of grief and tenderness in. Um, surge in different ways in different seasons. And earlier this week, I felt like it, it was so big inside of me, the ache, the heartache, the break was so big inside of me that it felt like I didn't know how to hold it even myself.

And I got in the [00:03:00] bathtub and I thought, okay, the wa you know, the water will hold me. And the bathtub wasn't big enough. And so I actually just went down to the ocean. We lived near the ocean and just got right in and it felt like. You know, laying there, letting my body float and undulate in the waves and feeling the way that the ocean was big enough to hold whatever was big inside of me felt like, oh yeah, it, the sense of being a part of and held.

I have that in very tangible, relational ways in, in lots of different context in my life. But there was something about knowing it did, it felt so wordless and so. So right sized to be laying with a heartbreak in, in the ocean, letting it hold me. And so that to me feels like the, the one that comes to mind the quickest in that question.

Yeah. 

Margaret: I recently was writing a lot about spending may with. The writing of Mary Oliver, [00:04:00] and one of the reasons I loved staying with it among many is this kind of like, can you expand your imagination to understand the way that the world holds you? Mm-hmm. Beyond just that which has like human language or human relationship.

And so your example is just another beautiful image of that, of the embodiment of being held in the water and mm-hmm. Connected and held by that without any kind of verbal explaining intellectualizing, but just the physical. Yeah, yeah, exactly. 

[music]: Yeah. 

Margaret: Well, well framed with our girl. Our best With our girl.

Yeah. With our girl. Yeah. Mary. Um, I'm trying to think of mine now. Yours is like, so beautiful. And I'm like, 

[music]: Hmm. 

Margaret: What? What was mine? Well, I recently finished yesterday. I finished my one year psychoanalytic, um, training. And I'm in Boston. Mm. Mm-hmm. And we had this clinical group that was the second half every Thursday night for a couple hours where we would unpack someone's case.

Mm. And I think it was the first time, [00:05:00] like this year, this experience of it, the first time of really being in a group of people who are spending extra money, spending extra time in addition to their work to do this, but to kind of go there as a group and really interrogate. In our bodies and in the emotions we bring in our cases together.

Like what happens. And at first that was terrifying and still is, but as we had our last session last night, kind of the feeling of like this knowing as a group what each other's kind of gives or approaches are and kind of saying like, I know you to be this way with patience. Hmm. And when you talk about the hurt this patient was talking about and how, what it evoked in you, you know, I'm reminded of this and how you are.

And it was just a really. Beautiful, and in some ways her me spiritual way of 

[music]: mm-hmm. Knowing 

Margaret: one another and that it was so, the lines between us have blurred in a way that I haven't necessarily experienced. Mm-hmm. But it was still very like a consensual blurring, but just a, we all show up to [00:06:00] this space once a week and are letting each other kind of know our way of feeling ourselves through the world, through this theory, but also kind of, I think more broadly just in this work and, mm-hmm.

Yeah, it felt connected in another, kind of like we had many words about it. Mm-hmm. But also in this like wordless way, um, that I've not really experienced other places. 

Dr. Hilary Mcbride: Mm mm Wow. That sounds so it, I'm noticing, sounding or feeling surprised, hearing you talk about it, like it kind of caught you mm-hmm. In some way.

This Yeah, yeah, 

yeah. 

Melding together. That's beautiful. Thank you for sharing. 

Yeah, of course. Of course. 

Margaret: So. I guess a few, a few things before we kind of go into the book. Um, I was wondering if you might share, I know you probably have to do this pretty frequently, but for those who aren't familiar with your work, if you might share a little bit of what you feel [00:07:00] like you were bringing into the moment before you.

Entered this part of your work that produced the first, the podcast for Holy Hurt and now the book. Mm-hmm. Um, what was your work looking like before you kind of embarked more concretely on creating these two things that you, that kind of precursor them? 

Dr. Hilary Mcbride: Well, they, it's kind of hard to describe a before because the threads of, of exploring spiritual trauma and holy.

Right back through to before I started publishing and talking about embodiment more. Mm-hmm. Like that. That actually is, is something that people are more familiar with in my work. And yet, spiritual trauma, religious trauma, religious abuse, abuse. And how that fragments us from ourselves is intimately connected to my work and embodiment.

In fact, I would say when I'm [00:08:00] sitting with patients this, there are people who come from a variety of of life experiences and backgrounds and context sociopolitically that have a hard time being in their body. And when we explore what it is that makes being in their body so unsafe, what it is that made them leave themselves.

Mm-hmm. There is the traumas that are acute and obvious. The things that we would all culturally agree on are horrific. Mm-hmm. And then there, there are the experiences that feel confusing because they were also. Part of, um, a sense of being right or righteous or good in the eyes of a community or a family that told them, your body is dangerous and sinful and needs to be disconnected.

Yeah. From the way you make decisions, from the way you trust, from the, from the way you feel in the [00:09:00] world, from who you are. Mm-hmm. So when I think about embodiment and spiritual trauma, this. You know, really the, it was, it's listening to patients often that connects me to the truths that are here, that feel, um, collective and even resonant inside of me.

And in hearing people talk about why their bodies felt so dangerous to them, it was surprising at first until I connected it into my own story as well. But hearing people say. My body is, is dangerous because I was told that it was, and it meant I was good if I believed that. 

[music]: Mm-hmm. 

Dr. Hilary Mcbride: So the, that is all interconnected.

Yeah. Right? Yeah. It's like I can't really separate out any of that work. And now I'm currently working on some research related to eating disorders and purity culture and mm-hmm. And just looking at the way that, you know, these systems that people think about as existing primarily within a religious [00:10:00] context, replicate.

Values and practices that we enact at in kind of our meta culture. And I think the idea that your body is bad and you can't trust yourself and it's a dangerous world and mm-hmm. You know, all sorts of things like that. And here are the things that you have to be to be good. Yeah. Those are themes that run through culture at large and these more microcultures of certain religious contexts.

Margaret: Yeah. I think, you know, in, in writing the outline, listeners, I, we write outlines for every episode in writing the outline for this episode, and even in talking with Preston and our producer about your work. I, I asked you that question as you were answering it. It just struck me that I, I'm trying to describe your work and how much it's resonated with me as a clinician and as just a human person in the world and trying to explain it and, and all the themes together, like it sounds like many different things and.[00:11:00] 

Trying to, but trying. But to me, I've had the same experience in consuming and reading your work over the years of like, no, there's a through line. It just like is in all of these things that if you mention like what clinical topics are you interested in? It's like this, this, this, and this. And it's like, well, how do we help people feel at home in themselves?

Mm-hmm. And feel at home enough in themselves to be able to make home with others. And 

Dr. Hilary Mcbride: yeah. 

Margaret: Maybe that's oversimplifying, but that's how your work has landed with me. 

Dr. Hilary Mcbride: No, that's exactly it. I think with the, probably the thrust, the primary thrust of my work is your body is safe. Mm-hmm. Your body can be trusted with your body as you, and then looking at all of the different things that make us question that or disbelieve that or put that in jeopardy in some way.

Yeah. And, and some religious context and trauma of, of most sorts will do that to us.

I I, well, we're gonna take a quick break, 

Margaret: but when we get back, [00:12:00] we're gonna talk a little bit more about this and some more specifics around the book itself. Different things talking about, especially for people who maybe don't identify or haven't had a, like what we think of when we think of religious or spiritual background.

And then I'm gonna ask you some questions that I've been thinking about after reading the book of. Ethos or kind of meaning making together and how that might apply in healthcare and mental health in terms of this idea of the, the body is good, the body is broken. How do we make sense of suffering and what does it mean if you're good at suffering and silence alone and these power dynamics, it it, we will get to that after this break.

Hey Preston, what does the sound remind you of? 

[music]: Oh God. It, it makes me think about being on call. It's the pager. 

Margaret: Okay, well it's not my pager, but it is equally stressful as the timer I use for studying. 

[music]: Oh, we got a Pomodoro queen over here. [00:13:00] 

Margaret: Do you know what is made studying Less stressful though. What Now?

You know, psych, you familiar? 

[music]: Am I familiar? I I use nine nosy for my in-training exams. Are, are we talking about the same thing? That excellent resource that has thousands of questions with associated flashcards, organized content in a user-friendly way. 

Margaret: You use it for pride. I'm using it for the board exams.

But yes, we are talking about the same resource. We, 

[music]: we can use it for both. Ao 

Margaret: Ready to take your exam prep to the next level? Go to now, you know, psych.com and enter the code. Be patient at checkout for 20% off. That's now you know psych com. 

[music]: Hey, so I wanna talk to you about this new podcast I think every clinician should be aware of.

It's the sepsis spectrum from Sepsis Alliance, and it's done by this great critical care nurse, Nicole Kubic. 

Margaret: You may be asking why are two psychiatrists talking about sepsis? But if you've spent any time, uh, in the hospital where psychiatrists or mental health practitioners go, you know that whenever someone's mental status is altered, we can be called and.

Not knowing the signs of sepsis, whether that's in the ICU, the ED or [00:14:00] other places in the hospital, can mean that we're missing things alongside the team for things that'll really impact our patients. 

[music]: Yeah, I mean, delirium comes on quick and fast and you have to keep it on your differential. It's hit me on the the inpatient psych floor and mm-hmm.

Even for nurses that work in mental health and don't think they're gonna come across this stuff, it's gonna come across you. So it, it's important just to, to keep it on your radar, and I think this is a great resource for it. So if you want, you can listen to the sepsis spectrum wherever you get your podcasts, or you can watch it on Sepsis Alliance's YouTube channel.

Margaret: To learn how you can earn free nursing CE credits just by listening, visit sepsis podcast.org. That's S-E-P-S-I-S podcast org for more information.

So one question I wanted to frame for our listeners with you is I think that at least I know you're based in Canada, I'm based in the us. Sometimes it can feel as someone who is just now finishing training and is, you know, maybe a younger [00:15:00] clinician that this question of. Unless someone is coming from a spiritual background themselves or a religious background themselves as someone working in mental health, it can kind of feel like overwhelming.

Or for some people it can be like, I don't really understand this world or this part of the world for my patient, 

[music]: I. And so 

Margaret: I wonder when you think about this book, you mentioned a few times in the book, maybe you're someone in a religious setting or you're someone who knows someone in a religious setting and you're reading this so you can understand and care for them better.

I wonder how you might posit that this book could help people working in mental health care, even if they're not someone who necessarily identifies with this idea of, they don't necessarily naturally find resonance with spirituality or spiritual trauma. 

Dr. Hilary Mcbride: Yeah. Yeah. Great question. So many, many ways, many things come to mind.

I think the first is that even if we don't resonate with being a spiritual person, I think our [00:16:00] definition of spirituality needs to be rehabilitated, such that we actually get access to even more of ourselves and then have points of entry for, for our patients and our clients. And the definitions of spirituality that I really like and I'll share like a, an aggregate version of that is.

Inborn human drive and desire to make meaning, to feel connected, to belong, to be a part of something bigger than ourselves to expand. And, and so if I would ask the question, you know, have you ever asked why are we here? Or Why did this happen? This is proof of your spirituality. If you've ever asked. What would it be like to not feel so alone in this?

Or if you've ever felt like there's something inside of me, I just have to get out and it feels like it's just humming through me, even though I, I don't really even understand it. It's not preplanned. It just feels like, you know, I'm getting this, this spark of something, or have felt resonant energy with even any [00:17:00] other form of aliveness, like mm-hmm.

If the, oh, the trees breathe. Has sparked a sense of communion with nature. Spiritual, so spirituality is, is written into us as people and. For those listeners who might think, well, I'm, maybe I'm not spiritual. Maybe what I'd say is I think that spirituality has often been conflated with the spiritual practices that people engage in to satisfy their spiritual longings.

Mm-hmm. Or has been conflated with the cultures of people who do that. And we would call religion cultures. It's a culture of people who answer spiritual questions in a similar way. It kind of satisfies their longing or, or maybe anesthetizes the spiritual pain or mm-hmm. Or questions that they have. So spirituality is in and through all of us.

And if we're not recognizing that, we're probably missing things in our patients in the questions we ask, and the way that we [00:18:00] understand how their pain lives in them, and we look at the legacy of the, the resources that they have as well as the, the wounds or injuries that they experience. But another piece of this too is that I would say that, you know, it's a pretty conservative opinion to suggest.

Trauma shatters something in the soul. Hmm. Trauma, whether it's, you know, a single incident trauma with an index event that's really neatly tidied into a before, during, and after. Right. Which like very easy to diagnose because it's so concrete and you know, objective as if it was all. All that way. We love to be objective, right?

Don't we? Yeah. Yeah. That like, even, even in those experiences, the thing that defines it as trauma is not that it was stressful, it's the, it's that it ruptured something inside of us in terms of being, um, fractured existentially and what I love, maybe I'll just kind of soapbox for one [00:19:00] second on this point.

Please do, please do what I love about. The history of traumatology and the resurgence of literature and, um, empirical research about trauma responses and symptomatology is that it has centered the body again in the conversation. So, because of trauma, I think we actually have more discourse in, um, in psychotherapy about the body.

The problem is that if we reduce trauma down to physiological symptoms, we miss the complexity of the absolute shattering of the self. Mm-hmm. That happens. Like to, to minimize trauma, to dissociation. Flashbacks, terror avoidance, mood changes, misses PCL five. Just, yeah, right. Exactly It. You miss the way that it is at the core of being human, completely altering the experience of being alive, [00:20:00] such that there is never any, going back to a before.

Yes. And this is first talked about in, I mean, Janae talks about it. Freud talks about it. We have more recent theorists who would talk about it. Mm-hmm. And just even thinking about like the theory that the Shattered Assumptions theory comes to mind, where like to describe the way that trauma shatters the entire worldview that we had that up until a certain point led us to believe we're safe.

There is no coming through trauma with, with your assumptions of the world and your self intact. So when we're talking about shattered assumptions, what we're talking about is the domain of the spiritual. Mm-hmm. Like what does it mean to be me in the world? Why do bad things happen? Where do I go with that?

So this is all just to make my my point and to drive the point home that if we're not thinking about any trauma through the [00:21:00] lens of spirituality, we're missing the way that it lands in people. We're missing the phenomenological, the qualitative, the lived experience of being powerless, terrorized.

Abandoned, neglected, and some, you know, some scholars would say something inside of you dies. Right? Something inside of you dies in trauma, so. Trauma is inherently spiritual. Mm-hmm. And then we also have this other kind of spiritual trauma that I'm talking about in the book. And I'll just give a, like a, a helpful series of definitions or axis axes through which we can relate to that when we, when it has just a little bit more of an affiliation with spiritual practices or religious context.

[music]: Mm-hmm. 

Dr. Hilary Mcbride: We'd say that spiritual trauma is any trauma caused by something that a person closely associates with religion or spirituality, and that could include clergy [00:22:00] abuse all the way to, I was in the middle of praying when a bad thing happened. Right? And because brains are association making organs, they're really good at pairing things together.

Spiritual trauma could also be inflicted by someone who's a standin for the divine. 

Yeah, 

and there are again, lots of scholars who would say, who are our first divine figures? Parents. Yeah. So we're like, oh shit. Okay. There is no getting away from this being all trauma being spiritual. Right. Like, okay, okay.

I get your point, but I'll go on. Uh, trauma that's justified by spiritual practices or beliefs. So public shaming, right? Because someone doesn't agree with, or steps outside of a boundary in a spiritual context ritual or a cultic abuse or occurs because of the religious or spiritual practice. Mm-hmm. I mean, there could be lots of different examples of that, but the point in all of those definitions is somehow to the person, spirituality and or [00:23:00] religion and whatever felt traumatic or was traumatic, become intertwined even if it doesn't happen within the walls of a a church.

[music]: Right. 

Dr. Hilary Mcbride: There's also two other pieces and this, you know, I'm pulling here from Michelle Hawk's work. She's a philosopher who's written about spiritual trauma. And probably has given the most useful definitions that I've found mm-hmm. In the, in the academic literature. But she also says that spiritual trauma includes the survivor, believing that spirituality or religion was somehow the cause.

And that post-trauma responses are connected to religion or spirituality or God in some way, which includes you. Think about this. This is where it starts to get a little murky and we can kind of feel like, oh, I'm pulling the thread and everything becomes unraveled. Is that which is, is what I love 

Margaret: in your work.

Great, great. Well then you sign, 

Dr. Hilary Mcbride: you signed up for it. I'm here. I'm like, yes. Is that if we think about spirituality. As also our inborn [00:24:00] meaning making drive and the way that we answer the meaning making questions we have inside of us. Mm-hmm. And then spiritual trauma being, you know, something that a survivor believes, like the trauma is something that the survivor believes is connected to spirituality in some way.

[music]: Mm-hmm. 

Dr. Hilary Mcbride: Essentially, there's no way for us to not have our meaning making systems affected, which again means all trauma. All trauma shatters something and what it, what is it shattering? I mean, we could look at fragmentation and subcortical, cortical structures and Right. We could look at changes in autonomic nervous system processes, but, but in terms of what it feels like to be human, usually it's this, like the ground underneath me is, is gone.

Right? 

Margaret: It makes me think of, I mean, grief is like a little bit, sometimes simpler, sometimes trauma. But the way that often people with grief talk about like, there's this before and there's an after. Mm-hmm. I think often that is, can be more quote unquote simple [00:25:00] loss, but the same feeling of the, the shattering, like who I was before this happened, I.

Is not the same person I am now. 

Dr. Hilary Mcbride: Yeah. 

Margaret: Even if we don't take that to a place where it's like, and I have secondary moral judgment or secondary emotions inhibiting that, or all these other things, like there is something significant that has happened here that has made me almost unrecognizable. Mm-hmm. To myself.

Dr. Hilary Mcbride: Mm-hmm. Yeah. Well said. I wonder, you know, I.

Margaret: Our saying with this is this like interconnection with meaning making spiritual systems, religious experiences, but also that like kind of thinking of how we now think about illness and psychiatry with more of like a circuit approach. And it's sort of like a circuit where it's like hit one of these things and the function that they all were connected to may become different, may become shattered.

Um. And I think you've also put [00:26:00] really well into words both here and in your book, how this impacts not just people who are thinking about the kind of, in some ways pop culture pithy thrown around. Like, this is what it mean. And I can say this is a Catholic, like, oh, that's Catholic guilt, that's da da dah.

Right? There's a way in which we understandably oversimplify some of these things in like the, in the culture. I, I wonder what your thoughts are in terms of, or maybe more than your thoughts, what's your experience been being someone writing about this, thinking about it, the thread always being there while yourself being a psychologist.

Mm-hmm. Like that there, at least in my experience in psychiatry, there is sometimes this still fall, somewhat held notion that these are separate things or that. There's this sort of view in the community of providers of religions over here. [00:27:00] Maybe it's also being on the East coast. Mm-hmm. Mm-hmm. Kind of like psychoanalysis is over here.

Mm-hmm. We can talk about their religion, but also we're gonna analyze their religion. We're gonna be distant from it. We're gonna put it into this box that is outside of the science and objective reality we're doing. And so I, I guess I wonder what your experience has been both being an academic and then doing this work that kind of pushes at the.

Maybe boundaries and walls that academia is comfortable exploring in terms of how it thinks about religion and mental health. 

Dr. Hilary Mcbride: Mm-hmm. You know, it doesn't actually seem surprising to me, and maybe that's because I carry contradictions inside of myself or complexity or haven't been able to bifurcate different like, um, qualities of my sense of identity or experience.

I just. It feels so impossible to separate any of the things, any of the facets of the human experience from the other that mm-hmm. Like I, [00:28:00] maybe the, maybe the angle that I come at it from might be a critical perspective to say. I think psychology has done a really bad job of, of honor. The inherently spiritual nature of our, of our beingness.

Mm-hmm. And thus has missed incredible opportunities to resource people. And subsequently we've missed the way that, like the inter cursory understanding of religion missed the way that religion and religious experiences can be harmful for people. That the assumption that when we do talk about religion often in kind of like mainstream.

Um, like I'm thinking about empirical research and like theory that's published. Like really, like if you, if you look at the research literature about spiritual trauma mm-hmm. Tell about. 15 years ago, 20 years ago. All you're seeing is that those two words, religion and trauma only go, go together when we're talking about post-traumatic growth.

Hmm. That [00:29:00] people would see trauma. That's interesting. Trauma. The religion could be an antidote. To trauma that it's part of, it's part of post-trauma meaning making experiences. Mm-hmm. And there is some really interesting research that says that people who have a particular kind of religious persuasion might, might fare better.

Right. Or have a different, we'll just say a different presentation of symptoms post-trauma than, or crisis than others, but. I think it's, it's interesting to say like, well, in, I think our strategy, particularly in counseling psychology or positive psychology to rehumanize and integrate religion as a potential resource and source for flourishing, we've missed the way that religious experiences and communities can also be part of doing harm.

So I think my, maybe my, my stance as a psychologist mm-hmm. Has. Also been informed by my, like you asked about experience, my experience of [00:30:00] feeling like my spirituality has been one of my greatest assets. Mm-hmm. And some spiritual experiences that I've had have directly. Causally impacted my own mental illness presentations.

Like I can't not know both of those are true. Yeah. I cannot see those in my, I'm living it. Yeah. Like, and it's like, you know, it is interesting. I have a, a colleague who, he's a theologian, Dr. Preston, Helen. He, when he talks about this, his, his argument is that there is some really good, when we're looking at the biblical.

Um, scriptures when we're looking at, you know, sacred texts from the Christian tradition, Uhhuh, that there's some really good arguments that the person of Jesus as written about in the scriptures makes that we can reason from our experience to know something about what is sacred, what is Hollywood is divine, that we can actually reason from psychology to better understand religion.

I don't know a lot of. Religious [00:31:00] traditions would, which might have said, you know, agreed with that or said that, that like, I think religion has done just as much to separate itself from psychology. And yet I would say, you know, maybe this is, this is coming back to the felt sense of embodied wisdom or sacred knowledge, or ancestral knowledge or de colonizing.

Mm-hmm. Decolonizing knowledge. But it feels like sometimes like truth is truth. Mm-hmm. And there are things that feel. Reliably. Human and essential. Mm-hmm. In what they reveal about who we are and what we need, including that we're all asking questions about meaning, and we all have like relational systems and minds and bodies and all of that is working together to shape what it feels like to be us.

So. Mm-hmm. I mean, it's like not very. Clear answer to your question, but I think didn't have you on here 

Margaret: because I liked, I wanted clear. Okay. I can read the dsm. These are like the, the musings that come to mind. Hey, when we posted that you were [00:32:00] coming on, we had a lot of messages that were like, this is my favorite overlap.

Like, I'm so excited for this. Um. I, I think one of the things that I have known from your prior work and from your, your book, the Wisdom of Your Body, which my eating disorder patients are sick of me, uh, quoting to them, I think at times. Um, and also not sick of it. They enjoy it. Mm-hmm. But one of the, I know one of your modalities or ways you've been trained as a therapist has been in.

A EDP. Mm-hmm. Which I think I'm gonna, I'm gonna misspeak about the, it's, is it accelerated experiential dynamic, dynamic psychotherapy? Is that right? 

Dr. Hilary Mcbride: Yeah. Think of like somatic growth-oriented, attachment based psychodynamic work. Okay. 

Margaret: Yeah. Is there. You mentioned this in this book as well in terms of understanding of, kind of integration of emotion, inhibition of that emotion, and then the core state.

Mm-hmm. I wonder just not, not everyone, uh, some, some of us are [00:33:00] psychiatrists on our way or med students. Mm-hmm. I, I don't know if that is the modality that you primarily now kind of view yourself as living in with probably eclectic things like all of us have from other parts. Um. I wonder though, if you could describe that modality, if it is the primary one you identify with and how you work with people.

Because I think it is beyond being in a chapter is so much of what we're talking about with this. Understanding of being experiential, embodied, and the emotional work. Mm-hmm. My understanding of you has been so much as informed by your own experience, but also your experience of learning from patients through this mode of therapy.

Dr. Hilary Mcbride: Mm-hmm. Yeah. So the question is like, if I could give like a brief summary of what it means to do that work or kind of the theory of change or theory of psychopathology or something like that. Just Yeah, I think Okay. 

Margaret: I, I know what it is and so sorry if I you in this box, but I like, I, I think learning about it [00:34:00] through you talking about it, um, I, myself am act and psychoanalytic at this point.

[music]: Mm-hmm. Mm-hmm. 

Margaret: I think. The description of it and what it means to enter into the emotion with people. How you de, you've described it in the books. Lisa has been something that made me start to think differently of how therapy is working. So maybe the theory of change in it, or like what's working mm-hmm.

Or happening when you're doing that therapy might be, yeah. A way to get at it, 

Dr. Hilary Mcbride: a central component to. To this kind of work is paying attention to what's happening somatically and effectively and what's happening relationally and interpersonally. And the reason for that is because humans like human systems, intra psychically learn about what to do with emotion.

Based on what's happening in interpersonal dynamics, we learn, and this would be probably in your theoretical frameworks, you, you use this language too, the language of defensive exclusion. That when, when life is really hard, like actually [00:35:00] human beings are wired to be able to face incredibly hard things.

We have, we come from. You know, ancestors who have, who have survived the unimaginable, and yet what it is, what is it that moves, what's unimaginably challenging into the realm of suffering, illness disorder, disability, when we're looking at it from that language, like a person becomes unable, like unable to live.

Mm-hmm. And we would say that there's this process that happens when, when these, and this, these are the words of Diana Fosia, who's one of the main developers of the theory. She would say that that in the face of overwhelming emotion, when we were alone with it in a way that was unwanted, like we have no other choice but to defensively exclude the truth and the reality of our knowing and of our pain.

Said another way in the face of unwanted and unwed [00:36:00] or un wielded and unwanted aloneness in the face of overwhelming emotion is the thing that drives us to, to exclude what we know to be true inside of ourselves. And so therein lies the kind of the crux of where so much of our distress comes from. That we have the, the pain, the pain of being human, which when we look at it in very.

Early developmental experiences can be. I don't want my mom to go to work. Mm-hmm. Or my brother took my truck, or I'm scared 'cause I don't know what's gonna happen next. Mm-hmm. But these experiences that feel huge and overwhelming for us, that we don't have meaning making structures for yet. We rely on other people around us to help us organize our experience, to tolerate the distress and to come through to the other side.

And if we don't have that, our body doesn't learn the maps of how to stay with. Distress. And so we have no choice given that distress is part of being human and [00:37:00] affect is part of being human. We have no choice but to, to find other kind of strategies, tactical defenses, relational process tact, you know, process defenses that mm-hmm.

Move us away from our distress. And that includes, you know, there's a whole other category of affect, which is suppressive. Mm-hmm. That we can, we can make use of other kinds of emotions to inhibit. The core emotions that are essential for our self knowing, survival, connection, and flourishing. And really I think the therapeutic process is about identifying what is no longer working that once worked.

Mm-hmm. And we would call those our defenses. Anything from avoiding to, um, blaming or. Violence or self-harm, or even I would include depression or dissociation as a defense. Again, not that it's intentional or cognitive, which is part of why this is a, um, a psychodynamic based model, right? That we're looking at these kind of unconscious [00:38:00] processes that are at play, but identifying what's no longer working and what it's working at, what it's working at, keeping us away from what it's inhibiting us or defending us from feeling, and when we can connect in with what's.

At the core of what's going on, of what's hard, and we have somebody with us who's not afraid, who's engaged, who's emotionally present, who's skilled. Who was unfazed mm-hmm. Who's entering into that process. With us, we can begin to complete the action tendency or the affect tendency, or the, the swell of energy that our body wants to release, which resolves to bringing us back to rest and calm, and the core of who we are, our creative, courageous, compassionate self.

I would say, you know, this model is. Can we be together with what's un been unbearable to be with? Mm-hmm. And when we can be together with what's been unbearable to be with it, all of a sudden [00:39:00] becomes bearable. And when it becomes bearable, you can organize it. You can resolve it, you can feel it, you can actually enter it, enter into it in a way that brings you more home to yourself.

With that, the connection to someone else, the ability 

Margaret: to let them not just into that or let the therapist or whoever's doing it into it, but to have also capacity to create a bi-directional way that now other people can also do that with you. Mm-hmm. 

Dr. Hilary Mcbride: Um, yeah. When I'm teaching about it, I like to say in therapy we're often creating relational imprints.

On the place that has been characterized by aloneness. So if you think about emotion, like terror or sadness as a place, mm-hmm. That's a place, it's like a world that likely nobody else has entered into. Not long enough to really explore it, check it out, understand it, get to know what it needs help to help to really like hear the message and work it through.

And so when we bring [00:40:00] presence into the place of affect, we leave the imprint of relationship, which allows a person to walk away from our work going, oh, people can exist here with me. 

[music]: Mm-hmm. And if people can exist 

Dr. Hilary Mcbride: here with me, then I can invite other people into this. And I can do that in a way that, you know, trusts that, okay, there'll be other people who will come and join me in this and I'll be able to talk about it and it will feel better on the other side and, and then I won't feel as stuck in the mismanagement right of the place that actually just needs to be felt in accompanied.

I'll have, 

Margaret: I mean, it's this, it's like the classic positive spiral as well. It's like, and then I notice I'm of use and I have these relationships that reaffirm and repeat this corrective emotional, you know, belonging or being with, and I. Feel more able to explore out in the world and Right. All these things happen.

Right. 

Dr. Hilary Mcbride: Or like, wow, I actually wanna enter into this with someone else. 'cause I have the capacity because I'm not afraid to touch in on that place inside of me. Like I think the, [00:41:00] the fallacy that psychotherapy creates more narcissistic, individualistic people mm-hmm. Is actually when we're using models of treatment that are non-relational.

Because relational work, when it meets. The needs that are inherently human like to connect and to be seen and to belong, and to know that we matter. Mm-hmm. Actually, it writes something inside of us that allows us to then say, I can now do this for other people. I will tell you unequivocally with. With absolute certainty that doing this work myself as the patient, mm-hmm, has made me braver, has made me more fearless, has made me more relentless, more tenacious with the places of shame.

Uh, terror, um, rage, fear, confusion, dissociation. Mm-hmm. Because I have touched them inside of myself. And what made it possible is people who said, I'm not afraid to go there inside of you, which [00:42:00] is immediately and directly transferred to my ability to say to someone else, I'm not afraid to go there. And you either 

Margaret: 1000%.

That has been my experience as someone who got very good. But very good, like relational therapy myself. The ability to be with patients is, I feel that every day, but like the pouring forth from the place where I was like poured into, and not, not in the religious way of like, you, you were given, this is not all religion.

There was in the religious circle. I was in kind of a, like, you have been given much by others and now you owe it to others. It's not the compulsive way as much as it's the Oh, or the obligation. Yeah. Something, something opened here. Mm-hmm. Um. I'm just, I'm struck by the feeling of just how beautiful it is to be in the space of being able to do that with people and being given the gift of like having someone show you that the things that you think are like monstrous or isolated islands within you are actually [00:43:00] like in them too.

And I, I don't know. There's um, there's a quote I think from Terrance who's like a Roman Greek philosopher who said like, nothing human is alien to me. And it just came to mind when. 

[music]: Mm-hmm. And you said 

Margaret: that of the like, yes, we can see it together. 

[music]: Mm-hmm. 

Margaret: And it's a little scary. It's a little scary, but that's okay.

We're here and we're doing it together. 

[music]: Mm-hmm. 

Margaret: Mm-hmm. When you were talking about that, it did bring me back kind of directly to the book and thinking about some of the ways that can be in a culture or religion or spiritual culture that. There. I, I wanna leave space that there can be ways religion can teach us to maybe respond in these ways to emotion or what wouldn't be called emotion in the religion, but like a rising of whether it's prayer, inspiration, connecting to God, connecting to others, but that there are a lot of ways that these religious cultures can make us [00:44:00] be more, much more phobic mm-hmm.

Of these scary places in ourselves. By giving it names of what it means in terms of our existential fate or mm-hmm. The kind of essence of what it means to be human. I wonder if there are things, this is a large question, this is basically the book, but kind of things that come up most frequently or in mind are top of mind to you of how maybe the lowercase t trauma, but the like formation or the water people swim in can make them more phobic of these emotions from a religious standpoint.

Or these kind of increase this terror of something is bad in me or something cannot be seen by others emotionally. 

Dr. Hilary Mcbride: Mm-hmm. And you're asking for examples or like just to say a little bit more about how that happens in religious context? 

Margaret: Yeah, I think, I think either examples or just, yeah, ways that that can come up for people.

For our listeners hearing this, that that [00:45:00] maybe is like, oh, okay. That's something that could be part of why this feels like such a strong belief that keeps coming up. And maybe as someone outside that circle, it kind of feels like, where is this like as the therapist? 

Dr. Hilary Mcbride: Yeah. Well, I think that. The important distinction here is that sin or the language of sin as a construct in many religious contexts is used as a brokering tool for control and fear, and ultimately, the language of sin is about defining separation from God.

Who, who is seen to be often, you know, outside of present moment, embodied experience, but somehow available. And that it's tenuous. It could be threatened, but, but it's eternal and it's the most important thing that matters. So for people, the language of sin is used in a very heavy handed way. To, as I mentioned, support, behavioral control, like threats of that being sinful, really evoke really strong fear [00:46:00] responses and, and one of the things that is often used or talked about as sin as as many different kinds of emotions or any kind of bodily knowing or wanting or desire, right?

Fear, often people are told fear is. Is proof that you're sinning because you're not trusting God enough or you, you, if you desire, right, just anything at all. And it isn't God, right? This is proof that your heart is evil and, and you are bad at your core. So there's these kind of like self-reinforcing loops that can happen where people are told this is proof that your body is bad and that you are bad.

And usually it comes down to wants and emotions. And when those things come up, those things may actually be like really, really normal human experiences. But because people aren't given skills and strategies and information and education and, and [00:47:00] resources around how to be with them, they can sometimes feel kind of unruly or scary or out of control.

Like they, they, they do kind of take over because there hasn't been any support around actually being with them. Mm-hmm. But then the, the scapegoating process. As happens where people see that, that the thing that shouldn't have happened happens, and it's proof that I'm bad and that I can't trust myself, which supports the, the, um, deferring of spiritual authority to another person.

Someone outside of me gets to decide what is right and true because I obviously can't trust myself. Myself. I can't do it. Yeah. I can't trust, yeah. I can't do it. And to consider that I could do it isn't itself pride. Right, exactly. I double need help now, right? Yeah, exactly. I'm really in trouble. Yeah, so there's that.

And then I think then there's the, the valorization of spiritual practices, which are used as bypassing techniques. So let's just say we've got this kind of two factor. Thing happening. We've got [00:48:00] people saying, I'm feeling something and I'm not supposed to be feeling it, and it feels kind of wild and I don't know what to do with it, and it's gonna lead me in the different direction than I, I'm told I should act or think or behave.

So here's this bad thing. Mm-hmm. And I'm being told it's bad, but then I'm also being praised for when I suppress that bad thing. Mm-hmm. For using any kind of spiritual strategy or language or words I've memorized mm-hmm. Or behavior in some way to suppress, oh, that feels really good. So there's like the being connected to myself feels bad and I'm told it's bad that getting away from it actually is rewarded socially.

Yeah. It creates, it doesn't take a lot to, to think about this to realize. This is creating experiences for people where they're profoundly separated from themselves and are led to believe that it's the best way that it's ideal. In fact, like I, when I'm writing about this and thinking about this, the language that I keep coming back to is the, [00:49:00] the moralization of the infantilization of the psychological self.

[music]: Yeah. 

Dr. Hilary Mcbride: That the person who is psychologically immature is seen as being more morally or spiritually immature, but they have no contact to themself. Terrifying inside. No awareness of how I actually think for myself, who I actually am for myself or connection to my body. But in this kind of really mysterious way, this is considered moral, morally superior.

Virtuous, right, ideal. It's just, it's like complicated mess for people who are navigating coming out of some of these religious contexts. 

I was gonna say again, 

yeah, it's not you. Not all religious practices or traditions are like this, but I think the ones that get the most airtime and have the most, um, evangelical flavor to them or mm-hmm.

Colonizing flavor to them mm-hmm. That kind of have this like mm-hmm. This reach or spread or are trying to, trying to bring people into this kind of [00:50:00] community. There, there are qualities of this that Yeah. Could be really damaging for people. 

Margaret: Well, and there's the way that it can pick up. Like the, the kind of, even people who are not raised in this setting that, but like, if you are feeling pain and you're feeling loneliness as so many people are in recent years, there is something intoxicating.

I think, and I say this as someone who's experienced it, I think at different points in my life from the being intoxicated by it, the fantasy that, and.

Your pain will finally go away. Mm-hmm. Will finally feel okay and belonging in the world if you just learn to deal with your emotions in this way, your internal state and how, I mean, I think a lot of times we talk about what makes someone more likely to like go into a high control group. People talk about this with like explicitly like cults and things like that.

Often the [00:51:00] people who are vulnerable to that. Like where is the robust experience of a different way of dealing with emotions that would let you know from experience that this, to reject it. Right. I don't, I, I can't, you can't think your, you can't read a book and be like, I'm now gonna understand how to do this.

I'm now gonna have the emotional kind of skill Rolodex to just see that this is. Not the right way to go about it. It's like you are in pain. You have been in pain often for a long time, and this group does seem happier. And more than that, the intoxicating part is they're letting you in and they're giving you an answer.

[music]: Hmm. 

Margaret: And I don't think that's just present in cults. I think there can be something in that. And this is, this is where I get controversial, uh, and even if you think about training and like working in mental health, like the idea of having an answer that will solve pain. Can be present in our field. Um, I think as someone who comes from a religious background and could kind of feel that transition of like black and [00:52:00] white thinking to them earlier, having like, oh, it's just black and white thinking with a different God.

Um, I, I, I wonder if there are times when we fall into this as someone who I think has fallen into this in the field of. Utilizing these control or these like high certainty, like we have the set of answers even in a field when we're supposed to be kind of helping people escape from this type of rigid way of thinking.

Dr. Hilary Mcbride: Mm-hmm. Yeah. Yeah. We could do the same thing just with different packaging.

Margaret: I am recognizing we're nearing the end of our hour together, um, which means, you know, that we covered everything that we could possibly cover. I'm just kidding. There's so much we could talk about. I'm, I'm wondering as we move to, you know, ending our time together, if there's someone who's hesitating to pick up your book, maybe they're nervous about it, maybe they feel it might apply to them.

[00:53:00] They're kind of looking at it and it makes their stomach drop. 

Dr. Hilary Mcbride: Mm-hmm. 

Margaret: I wonder what you might say to them. 

Dr. Hilary Mcbride: Mm-hmm. 

Me too. Fair. I start the book by saying, I don't think I wanted to write this. I didn't wanna write this. And I, I really avoided doing it for a long time because I know these places and so my, what I can promise the reader is me too, like an undoing of a aloneness by saying every question I ask, every place I went, I've gone to.

And so I can tell you. If you go there, you can find perhaps somewhere in the memory of your consciousness or awareness, the, the possibility that I know that place and that therefore it wouldn't have to be so alone. 

Yeah, that was, it was a very beautiful start to the book and 

Margaret: a start with also a lot of permission, which is, you know, important in all trauma work.

But I think especially when you're coming at this, and you might be someone with a religious or spiritual background where the urge towards. Conviction or confession or you [00:54:00] know, really performing the right emotions or beliefs. I think being able to be like, also, you could stop reading this and it's not a sin, or this doesn't feel so good, just take a sec.

Maybe just go on a walk instead. Come back if you want. Is. A beautiful, and you know, very trauma informed. Also very informed by all my understanding of your previous work way of beginning this book. You know, I was kind of scared to read it. I've been thinking about this stuff for years and you know, my own way and you know, like we started talking about with the episode, the threads go so deep and connect to everything and it, reading it and talking with you about it has been.

I think more so just a comforting and enlivening way of letting this in, in an, and thinking about, in a new way. Um, so I, for one, am very glad that you put yourself to the bank writing and discomfort. Thank you. Thank you. Of writing this book for the world. Me too. On the other side. I am too. [00:55:00] Um, if people would like to, obviously Holy Hurt is out now.

Have it here. Your other books are also out. Um. If people want to find other places where you are online mm-hmm. Where can they connect with you? Um, off the page? 

Dr. Hilary Mcbride: Yeah. Other people's problems. My podcast on CBC has just come out so that you can listen to me do some clinical work there. The, uh, on Instagram and most of the, you know, most of the social channels, Hillary Leanna McBride, my website, hillary l mcbride.com, and I post events.

I have a newsletter you can sign up for if you want to hear about events I'm doing and don't wanna. Don't wanna do the social media thing. Been to one of your, one of the virtual versions of your events. Mm-hmm. The 

Margaret: sacred feminine one. Yeah. It's so fun. It was great. They're great. Well, thank you 

Dr. Hilary Mcbride: so much for spending part of your Friday afternoon with us here.

My pleasure. Thank you for the conversation. It felt like such a sweet home to, to make with you here in in conversational territory.[00:56:00] 

Margaret: Thank you guys so much for listening to our first solo episode. Please be nice to me about it because I was scared to do it. But, um, we're hoping that this can allow us to have other conversations, allow flexibility for our guests and for us as trainees to make sure we continue to get. You guys content for your Monday morning commutes, rounding, or post nights.

As always, the reviews and how you interact with us on socials helps us to shape the podcast and to make it more applicable to what is the most interesting and helpful for people who leave us reviews, especially the Apple Podcast reviews. We read them, we try to integrate them. Um, shout out to one recently from Evergreen Alto.

I regularly tell my friends that I think that they'd make this podcast specifically for me. Every time a new episode comes out, the topic pleasantly surprises me. I could never be a medical doctor, but I've always been super interested in psych and I'm a scientist. So the focus on science research and clinical work is fascinating to me.

Preston and Margaret are so [00:57:00] funny. Thank you. They regularly make me laugh out loud, quickly, becoming one of my favorite podcasts. And then she has a little, they have a little heart at the end, so. If you're watching the video, it's here. Thank you for leaving that review, and thank you guys who help us to kind of get the podcast out there through reviews and shares on social.

Um, if you wanna talk to us more, come chat with us and everyone at our Human Content Podcast family. We're on Instagram and TikTok at Human Content Pods. Or you can contact us directly at How to be patient pod.com. You can see more from both Preston, who's not here, but from Preston and from me, either on the full episodes are on Preston's, YouTube.

Uh, you can follow him also on Instagram or TikTok. And I am on TikTok and Substack both as bad art every day and Instagram very occasionally. Um, as I said, full episodes are on YouTube under Preston's channel. I'm your host, Margaret Duncan and Preston, usually Roche. Um, our executive producers are Preston, Roche, Margaret Duncan, will Flannery, [00:58:00] Kristin Flannery, Aaron.

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As always, how to be patient is a human content production. Bye guys.

[music]: Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. [00:59:00] Lilac doesn't know what the internet is, but I swear they're there. They, they probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the background.