What is the meaning of suffering? Drawing on decades of research and industry experience, celebrity pain and mental health expert Dr. James Flowers, his lovely co-host Robin French, and trauma therapist Dr. Cesar Seveso discuss the ripple effects of trauma.
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Making Sense of Suffering, Resilience and the Ripple Effects of Trauma [Episode 46]
Welcome, everyone, to Understanding the Human Condition. I’m your host, Dr. James Flowers, and this is my lovely co-host, Robin French.
We have a special guest, our very own Dr. Cesar Seveso. How are you?
Thank you for having me here. Thank you for the invitation. Happy to be here.
Super glad that you had time to join us. I know you’re super busy at the office, and this was a great afternoon to do this, so thank you.
We really wanted to talk about the ripple effects of trauma, and you, being our very own trauma therapist, this would be a great time to share what everybody’s wanting to know more about.
Let’s do that.
Personal And Career Background
First, let’s talk about your accent, though. I want to buy your accent.
I’m originally from Argentina. I was born and raised in Argentina. I was joking earlier that I’ve been working on this accent for 40-something years.
How much is it? It’s a lot.
That’s where the accent comes from.
What brought you to Houston?
I initially came to Houston about ten years ago. There was an opportunity. I’m a clinical social worker, but before becoming a social worker, I was teaching. I have a PhD. I was doing research on political violence. I originally came to Houston because there was a teaching opportunity. That was in my previous life, a little bit of my previous life. I can tell you more about that, but that’s the reason why. Before coming to Houston, I lived in New York City. After that, I lived in Bloomington, Indiana. I’ve been in the States for 21 years already.
Let’s tell the audience about your education, a little bit about your background.
I’d love to talk about that. Originally, in Argentina, I was working as a reporter. I was working for a newspaper, working on political human rights issues. There was a point in time in Argentina, there was a dictatorship. I grew up during these seven-year-long dictatorships that ended in 1983. During the 1990s, there were human rights trials going on, and working for the newspaper, I got to cover that. As a result of my work as a reporter, I won a fellowship that brought me originally to New York City. I went to NYU, and I was living in New York City during 9-11. This is all related to trauma. That’s also why I’m saying this.
You were living in New York City during 9-11?
I was living in New York City during 9-11. That day, I was about to begin an internship with a newspaper. I was doing my master’s degree at NYU, and it was already planned. I remember walking back to the apartment, and I was living within walking distance of the Twin Towers. I remember seeing them on fire. I went to the newspaper. I went to a newsroom, and I said, “Can I go? I would like to go.” They said, “Yes, go, you can go.” I basically remember I had a notepad, and I was walking down Sixth Avenue, and I got really close to the Twin Towers. It was a very painful, surreal experience of people.
Sometimes, when we talked about trauma or when people used to talk about trauma, they used this idea of shell shock, the people who were coming from war. It was people in shock. I myself was also in shock. That was the beginning of my work on trauma. I became interested in how people can recover from this. Some of the survivors of human rights abuses that I met in Argentina, when I was working as a reporter, the people who died and the people who survived, how do they make sense of that? How do people make sense of the things that happened to them? The things that they’ve done to each other.
That took me to Bloomington, Indiana. I was writing a doctoral dissertation and doing qualitative research with survivors, people who had been detained in clandestine detention centers in Argentina, people who had been tortured, raped. That was the beginning of my approach to trauma, making sense of pain and how people can recover from pain, psychic pain, psychological pain, suffering, really.
How long was it between the time of the Twin Towers collapsing and the time you went back to do your social work degree?
I was doing my dissertation, about ten years. Ten years of doing research and interviewing people and writing, publishing some articles. It was a fulfilling experience, yet at some point, I wanted to do more. I think that as a historian, I got really close to pain, the experience of being with someone who is in pain. But also with that came the feeling of, how can I really help this person?
I’m going to write a book, I’m going to write an article, but how can I help this person who is crying in front of me, breaking down, not being able to make sense of what happened to them? There was a lot about this, I don’t have all the tools that I need. That took me to social work, University of Houston. Initially, I worked with homeless people who were diagnosed with HIV and AIDS. From that, I worked with people with advanced cancer, and then with young adults with personality disorders.
Trauma
With all of that background and your own trauma, experiencing trauma, even on 9-11, what work have you done, and what’s the importance of doing your own work for your own trauma and the effect of working and burnout?
That is very important. We talked about secondary traumatization. Anyone who comes into contact with trauma, whether you are a therapist or not, you’re going to see the ripple effect of trauma, really. Trauma, there are two things, whatever happened, and then how people are coping with that. Us seeing people who have experienced trauma, and some of them have experienced trauma for years, and some of them, they never talked about trauma, when all that comes up, it is difficult not to feel that pain.
It is a very important part of whoever works on trauma to be able to, a little bit, role model what you do, exactly what you tell your patient, your client, to do. It’s important for us also, supervision is very important, and self-care is really important, and being able to monitor ourselves. Some of the trauma that we see, or probably most, I would say, of the trauma that we see, happens in the context of interpersonal relationships. An important part of trauma work happens in the context of my relationship as a clinician, as a therapist, with the trauma survivor. It is important that I take care of me because, at some point, this relationship is going to play a very important role in someone else recovering from trauma.
Some of the trauma we see usually happens in the contact of interpersonal relationships.
Speaking of going from New York and talking about the 9-11 tragedy and the buildings, just a couple of weeks ago, the building collapsed in Florida. It was 1:30 in the morning, half of the building or more collapsed, and left part of it standing. There was trauma, obviously, from the people falling, the families around the world, they were traumatized, seeing it on the news over and over and over again, wondering if their loved ones were alive or dead. The second part of the building being demolished on July 4. People were even traumatized because their animals were in the building. They wouldn’t let them go in and get the animals out of the building. Talk about the trauma and the ripple effects from just that Florida incident that we’ve just experienced.
Part of it is really, there are a lot of reminders that we might have. I was talking about the Twin Towers before. Before that, the Oklahoma bombing, the idea that can happen, and we tend to make these associations. We have access because of media, Twitter, anything else. We can almost be there as things are happening. They’re quite new, or quite recent. Before, if someone else experienced something like this in Buenos Aires, I would find out, but I wouldn’t necessarily be able to see and follow that in real time. There is the experience of that.
With that, a major difference with most of the trauma that we see is that, particularly the one in Florida, it’s an impersonal trauma. You cannot blame someone else, particularly some other person, for what happened. I’m going to compare that to childhood trauma. If your father is sexually abusing you, that’s an interpersonal trauma, and there is an attachment bond that is real. The person who is supposed to take care of you is, at the same time, the person who is sexually or physically abusing you. What happened in Florida is different. It’s a different kind of trauma.
It is also important to say that some people are not necessarily going to develop a trauma disorder. In fact, many people can recover from trauma on their own. There is the other part, the people who are doing the work of rescuing, the reporters who are covering, the first responders, everybody else who is impacted. Even people from Argentina, I know that they are following the news because there were some Argentinians who were living, or who happened to be in this very same building at the time when it collapsed. There is a ripple effect of trauma. That is really what we are always looking into as clinicians. You see what happened and then the ripple effect of this trauma over time, to the person, to the family system. Intergenerational trauma is something that we talked about a lot.
Some people will not necessarily develop a trauma disorder. In fact, many people cannot recover from trauma on their own.
Four Signs Of Trauma
What should families look for in a loved one that may have experienced trauma in the past? What are signs of trauma? What should moms, dads, loved ones look for in family members?
That’s a very important question. There are four things that people should be paying attention to. Number one is people who are experiencing, or who have experienced, one or more traumatic events, and people who tend to develop what we call post-traumatic stress disorder. Number one, they are going to be reliving the memories of what happened to them. They’re going to keep coming up. Although they try to push them down anyway, they’re going to keep coming up.
That is number two, the pushing down anyway, the avoidance. Even sometimes it means avoidance of people and places that are going to remind you of the trauma that you experienced at a certain point in your life. The third one is more about behaviors. You’re going to see a lot of hypervigilance, a lot of anger that you don’t know necessarily where it might be coming from. There are triggers that some people are going to be able to see but may or may not be related to the trauma.
There is another one that is more about the thoughts. The person who has been traumatized, what they think about themselves. A lot of shame and guilt. “I am broken. This happened because somehow I deserve it. Maybe I have done something in the past.” All of these things that are coming up. What we are talking about here is a person for whom it’s going to be very difficult to feel that anything around them really matters. It’s going to be difficult for them to love and to be able to take care of others. It’s going to be difficult to get a sense of who they are and their identity, and to get into or develop relationships. I’m not talking about just romantic relationships, but the ability to develop friendships and be able to trust others.
When we are going through trauma, our brain is very sensitive. Our brain is going to adapt to that. This is a normal reaction. We’re going back to the idea that, when they are in certain situations, there is a fight, flight, or freeze. This is really how our brain is going to work, but for people who have been traumatized, the brain tends to get stuck in that. That’s the survival brain. The work of therapy is really, on the one hand, paying attention to the survival brain. Even in therapy, when I’m seeing a client, what is the body language? How is this person reacting to some of the things that I’m saying? The other part is really nurturing the other brain, the living brain, the brain that is still looking and hoping to find a connection, the resilient part of that person that has not been damaged by the trauma.
Do women react to trauma differently than men?
That’s a very interesting question. What we know is that women experience a different type of trauma. Not necessarily that they react differently. They tend to report the same symptoms. In DSM-5, the guidebook that we use in order to diagnose people with post-traumatic stress disorder, there are a certain number of symptoms that you have to meet. What we see is that women tend to experience what some people call high-impact trauma. This is the trauma of sexual abuse. Women are much more exposed than men to this type of trauma. For example, we know that 1 in 4 girls are going to be sexually abused before the age of seventeen. Men, it’s 1 in 20. That is something to really keep in mind. We also know that it’s important to pay attention to the trauma that happens during childhood. That is a trauma that is very likely going to have long-lasting consequences throughout the lifespan of this particular person, throughout their lives. That is a type of trauma that we need to pay attention to.
Also, we know that there are certain populations who are more likely to develop what we call complex trauma. This is ongoing, not part of the DSM-5 also. Which are the populations that we need to pay attention to? One is male survivors of sexual abuse. They are more likely to develop complex trauma. LGBTQI youth, homeless individuals, people who have experienced ongoing, repeated trauma. Sometimes we’re talking about trauma events, one thing happened. Florida, someone pointed a gun at me. These are one event. We’re talking about just one event. The type of complex trauma, the very significant trauma that we see many times, is the trauma that happens over time. Certain populations are more likely to be exposed to this type of violence, the fear of death.
How do children and adolescents react to trauma? Is it different than being an adult?
Yes, it is different. Children are severely impacted by trauma. That doesn’t have to be underestimated. I think when we think about trauma and trauma disorders, sometimes we think about people coming back from a war. This is really how we, in the 1970s, became aware that there was something that we call post-traumatic stress disorder.
A group of Vietnam veterans, at that point, it was called post-Vietnam syndrome. This is how it made it into the DSM-5 in 1980 as an official diagnosis, the diagnosis of post-traumatic stress disorder. What we see, and it is important to continue paying attention to that, is also the trauma that is happening to children. Child Protective Services is receiving about 3 million per year reports of childhood sexual abuse or neglect or any other form of severe abuse. Just imagine that, 3 million reports per year.
Awareness And Methods
Do you think that was happening all along and people just weren’t talking about it before? What’s your thoughts on that?
It’s hard to say. I think that people are becoming more and more aware that there is something called trauma, that it is important too, that it is not a sign of weakness if it happened to you, that it can happen to anyone, that probably we have more resources to be able to report when something like that happens. There is more awareness. Certainly, that might be part of the picture that we see. We have more ways to keep track of the trauma. Trauma has been around forever too. It’s only that we became aware of it.
Trauma is within yourself forever. You only become more aware of it.
We’re recognizing it more. What are some of the new trauma research findings that you’re seeing in research?
This would require another podcast in itself. It is a very exciting time for anyone working on trauma. It is very exciting. Probably, never before, have there been so many people working on trauma, but I would like to say 3, 4, or maybe 5 areas that we need to continue paying attention to, and these are the areas where we are going to see what people are doing research on at some point. It is going to impact the care that we provide. One, very exciting, brand new, is the use of psychedelics to treat trauma. This is one where even people like Van Der Kolk, who is one of the leading experts on trauma, have been working on that. The other one is neurobiological research. Really, what we are knowing more and more and more is how abuse and neglect impact our brain and how trauma therapy can help create new pathways and activate different areas of our brain.
Trauma therapy can help create new pathways and activate different areas of our brain.
Together with that, also, we’re paying a lot of attention to biology, and the brain is connected to our nervous system. We are looking more into people like Porges, the polyvagal system and theory, really going back to the flight or freeze, how that is. The other one is mindfulness. I’m thinking about Tai Chi, meditation, mindfulness, drumming. These are the ways in which people were taking care of their trauma when clinicians were not around. We’re paying a lot of attention to the connection between mind and body, brain and body. This is very exciting. The other part of going more into traditional therapies, couples therapy, intergenerational family system dynamics, really looking into how trauma is being reproduced across generations or in relationships. That also plays a very significant role in the work that we are doing.
Are you doing any EMDR work?
I’m not, but we do at J. Flowers. That has been one of the well-known interventions for trauma. It works.
Upcoming Project
Something you are doing is you have an upcoming project that you’re working on with leading trauma experts in the field of trauma. Tell everyone about that.
I’m very excited about it. I’m about to begin in a couple of weeks a seven-month-long training with some of the leading experts on trauma. It’s just a unique opportunity to work with the people who were at the very beginning of our understanding of trauma back to the early 1980s and the people who are today doing the research that is going to lead to new therapies. Just to be around these people and to get to talk with them, to get to see them, to get to learn from them. That’s great. It is a unique experience. I’m very excited about it.
You can tell. You’re doing it in person or Zoom?
It’s going to be Zoom. That’s another thing that you couldn’t probably get all of these people into the same room.
That’s true.
They’re very busy. They live not only here in the States. Some of them live abroad. Just to get them, all of them.
Trauma Evaluation
Is it possible that someone had trauma but didn’t realize that they had trauma and then it just bubbles up one day? I remember we had a patient that she just woke up one night with anxiety. Is it because she probably had trauma and it wasn’t addressed and it just bubbles up?
Yeah, that is possible.
I don’t remember the case, but it’s certainly possible.
It just happened out of the blue in your 50s.
I think probably, if that happened also, I would say that it is because that person was in an environment that allowed for that person to feel safe enough that then, not only that that person experienced that, but then came to the office and said, “This happened this morning. I woke up and I’m having all of these feelings that I was not aware of.” I think that part of it, again, is really what happens during the trauma and then what happens to people after the trauma and who are the people who are around that person. Sometimes, that makes a difference. I would say that person felt safe.
In trauma treatment, there are three stages. The first one is safety. The person has to feel safe, physically safe, emotionally safe. The person has to be able to trust. I’m not going to open up about my trauma if I feel that somehow I’m not safe here. I would say that there was safety in that person at that moment. Allowing that person to go to a therapist and say, “This is painful, and I want to talk to you about it.”
That’s the type of person that comes to J. Flowers. Maybe you can explain to the audience briefly, Dr. Flowers, about a comprehensive diagnostic evaluation and why someone would need that.
Human Condition
I think it’s important to mention that a part of our 360-degree comprehensive diagnostic evaluation, that a trauma evaluation is such an important component because not all of us realize that we have trauma or how trauma impacts our daily lives. We want that trauma evaluation to be a part of that comprehensive approach to look and have a better, clearer understanding of who we are and what our true experiences have been. Speaking of, what are your thoughts on this podcast title, Understanding the Human Condition? What does that mean to you?
It means a lot to me. I was reminded about the psychiatrist I really like. His name is Irvin Yalom. He wrote a book called Love’s Executioner. In that book, he talks about us therapists. He says we shouldn’t talk about our patients, them and their problems. This is about us and our problems. That’s the human condition, really, because all of us, whether I am a clinician or a patient or a client, we are dealing with love, sadness, anger, loss, freedom, fear. Those are known to me as much as they are known to you and to you. We are in this corner of the universe called Houston, doing this very intensive work with being able to develop a relationship that is going to allow a person to open up about being human, about curiosity, about connection, about understanding what I feel, about resilience.
This is truly what makes us human, the ability to relate to each other, to feel your pain, to be able to do something together, make sense, make meaning out of terrible experiences that many of our clients went through. I think that to work exactly in that corner of the universe where you are doing that very intensive work, that’s the privilege of being human.
What makes us human is our ability to relate and feel each other. This allows us to do something together to make meaning out of terrible experiences.
I think we should have him on every week.
Everyone who’s listening or watching, you can tell why we’re just so excited to have you with us. We know that you’re a man who had a lot of different choices as to where you wanted to work. The fact that you chose us says a lot.
I’m very excited to be here.
Episode Wrap-Up
Really happy to have you with us. If anyone wants to reach any of us at J. Flowers Health Institute, go to JFlowersHealth.com. You can also call us at 713-783-6655.
You’ll get to meet these two wonderful gentlemen.
We would love to visit with you.
I’d like to remind everyone watching or listening to us that there are numerous platforms to find our podcast, YouTube, Apple Podcasts, SoundCloud, Spotify, Stitcher, and iHeart Radio. Please share this episode on social media. Like it. Share it. Subscribe.
Thank you so much. Thank you for joining us.
Thank you so much. Thank you for having me here.
Thank you. We want to remind you, a clear diagnosis is the key to the most effective treatment possible. See you next week.
See you guys.
See you.
