Trust, Trauma, and Technology: An Intimate Chat with Emily Shaw, NP

How technology is infiltrating the mental health field

0:00

Want that human contact and I think that that human contact is what’s therapeutic. I don’t think it’ll be as therapeutic for people to interact with an AI

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0:14

Hi, I’m Kira Yakubov, Licensed Marriage and Family Therapist and founder of Heal Your Roots Wellness practice. Every episode, we talk with a professional from the mental health field to learn more about their approaches and specialties, and also their journey of becoming a therapist. In this podcast, we’ll uncover a deeper look at the world of therapy from new perspectives. You will meet the therapist of Heal Your Roots Wellness practice, and trusted colleagues from the community tackling mental well being. We’re your go to Network for practical and professional insight in mental health. Subscribe for new episode releases every other Wednesday.

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0:56

For today’s episode I’m welcoming back Emily Treadgold Shaw, Nurse Practitioner of Psychiatry, and she primarily works with children, adolescents and some adults. Emily,  thank you so much for coming back today.

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1:08

Thanks for having me back.

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1:09

Absolutely. So if anybody wants to listen in on Emily’s first episode, it’s in season one where she talks a lot more about how she became a therapist and the work that she does and what she specializes in. But for today, we’re going to shift gears a little bit, we’re going to talk a little bit about AI and some intergenerational trauma as well. So, Emily, what are your kind of general or broad Thoughts about AI and how that might cross over into the mental health world?

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1:38

So I’m kind of this weird luddite where I don’t, I sort of tried to minimize the presence of technology in my life anyway. So I knew, you know, it’s I feel like it’s all anybody’s been talking about the past couple of weeks. My husband is a software engineer; everybody at his job is talking about it. I spent the weekend with friends of ours. One of them’s in consulting, we talked about it with them. So it’s, you know, I have sort of had this like, here we go again, like, Yeah, I think so. I yeah, I mean, I think that, like, for me, personally, it’s something that I’m, you know, I think that child psychiatry is probably going to be one of the last fields that it infiltrates, primarily because it’s something that’s really sensitive, that people aren’t going to trust AI to be managing those kinds of decisions.

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2:30

I mean, I think that there are a lot of algorithms already that do like treatment recommendations, or medication recommendations for adult patients, in certain situations, like I had, I was discussing with somebody using an algorithm to make treatment decisions, you know, in a crisis situation, or like an areas that are like overwhelmed or, like slammed. And I think that child psychiatry is probably going to be one of the last areas where this creeps in, at least for me, like I see my patients, I try to see as many patients as I can in person that’s sort of minimal right now, because I have a six month old, and I’m trying to spend time with him. But I you know, I do go into the office one day a week, and with younger kids, there’s not really a substitute for like getting on the floor with them and like doing like play therapy and cracking out like the doll house or like the crayons or like, having them draw me a picture of their family.

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3:17

You know, it’s something that I’m much more concerned, you know, when I think of my adolescent patients, and I think of the impact on them, and I think of I mean, I think there’s already a lot of cheating school, I think there was already a lot of cheating with the pandemic and going to remote learning because kids are digital natives, like they know this stuff, so much better than older adults. And I think that there was a lot of stuff that, you know, teachers let slide during the pandemic, understandably. So I think about that. And I think about cheating. And I think that a lot of professors that I’ve talked to you or like that I’ve read articles about have said that they’re concerned about the impact on like, academic honesty. So I think about my adolescent patients, and I worry that the pressure on them to succeed is so high that they would turn to AI, like, out of desperation, this thing with anybody, like turns to like any kind of like academic dishonesty out of desperation. And I worry about the impact on them of that. And I also, you know, of course, like anytime you’re cheating, or anytime you’re having like an algorithm or you know, right now sometimes, you know, like, kids will pay another student to do stuff for them. And it’s like, if you have an algorithm do it for free. It’s like either way, like you’re not learning. So I think about that a lot. I also think about the impact on my patients’ parents livelihood and my adult patients’ livelihoods. So obviously, I think there are a lot of workers, even workers that weren’t concerned about being displaced by automation before, that are a lot more concerned about being displaced by this. And I think that the anxiety of that trickles down to kids.

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‍Stress and anxiety in young kids

4:52

And I think that also like obviously, if you’re losing your livelihood, like the anxiety that is triggered is going to trickle down to kids also, and like, there’s so much about even like really young kids, if you’re in an environment where like, all the adults are really stressed, and it’s like uncertain and there’s stuff happening. I mean, I think that has like a can have like really negative impact on brain development and on emotion regulation and all this stuff. So I think about that a lot too where I, you know, I wish I could be like, I’m sure everyone will be responsible with like adopting this new technology. But like, of course, that’s not true. I mean, I think that there are going to be like bad actors in any situation, they’re going to be people using it’s a tool, you know, they’re going to be people using it for good, and they’re going to be people using it for not so good.

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5:34

You know, I think that one of the things that apps do, and this is true of like any social media, it’s like Facebook, Instagram, Tik Tok, the point is to keep the user engaged and keep the user using the app. And I think that one of the things that drives that engagement is outrage. And, you know, I’m thinking primarily about adults here, but when I think about, like, how vulnerable like kids are, you know, and I’m sort of like, leaving all over the place.

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5:57

But, you know, there’s a lot of really negative messaging out there for adolescent boys. And I think that like adolescent boys, and you know, and adult men also, you know, I think are sort of in crisis and sort of struggling, and I think that, like, sometimes they’re vulnerable to, like, influenced by someone that speaks to that part of them, that’s really angry.

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6:15

And I think that, you know, I worry about AI being used, you know, because like AI has, especially with stuff like ChatGPT, that’s like a you know, it’s like a predictive language model. It’s like, trained on everything that’s already out there. But like, a lot of what’s already out there is not great, it’s like, the stuff  already out there is like, really, really toxic and like also like, again, like if the, if companies are trying to make money by keeping people engaged, and one of the ways to keep them engaged, is by making them angry, I worry about the implications where like AI could sort of like, pick up on and I mean, this, not even like a ChatGPT or anything like that. I do mean just like regular, like algorithms, like picking up on like, kids being depressed or angry or frustrated and like, sort of like having

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7:06

manipulating that information

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7:07

messaging tailored to them, that like, preys upon that.

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7:12

When they have done studies with, you know, using AI, like in a therapeutic context, like when people know that the, that it’s an AI, like, it’s not therapeutic, I think that one of the things that is therapeutic about therapy is like building a relationship with a human being that like cares about you. I was trained in like psychoanalytic psychotherapy, because I trained in New York City, and that’s sort of the thing that like they hammered into us was like, the therapeutic relationship, it’s about like building like, trust. And like, a safe space with like, another human being that you can then like, heal, like some of the time, you know, you can sort of like process some of the things in your life where like, during times that you weren’t as safe, in like a safe environment with like a human being that will like listen to you and like empathize with you and like understand what you’re going through and like validate your feelings. And like I think that with, this is why I think that it’s going to take a long time for AI to break through because like, I think that people want that human contact. And I think that that human contact is what’s therapeutic. I don’t think it’ll be as therapeutic for people to interact with an AI. And because AI is getting so good now, like I cannot even believe I’m like saying this sentence.

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How do you talk to kids about technology?

8:24

It kind of reminds me one of the very first chat bots is a long time ago, like decades ago, one of the very first chat bots, the person who did the man who developed it was having his assistant, converse with it. And she felt so deeply that it was relating to her she felt it was so deeply. Like, she felt like it was so deeply relatable that she asked him to leave the room. Eliza, I think was the name of the Chatbot this is again like a long time ago. Yeah. But you know, when it was just like a really basic kind of like mirroring, like what you’re saying, but like it sort of like got her to divulge things that like made her uncomfortable. And I think about that, and I think about Sydney and you know, I read that article that was in the New York Times where the journalist was testing Sydney who is like the Bing chatbot or it’s what the internal name for the Bing chatbot and they got to a point where the chat bot was saying things like no you know you you didn’t have a good time with your wife like you love me and like you want to be with me it was really crazy stuff. It was kind of reminded me of the movie Her. Yeah. Which I didn’t think we were so close to at the time I saw it in theaters. But again, I’m like, Oops, like here we are better think about this now. I’ve been sort of like pushing this away for a lot of the past couple years. Again, because like I try not to use the internet that much. I try to use it as little as possible. Like I feel like it’s had a really big negative impact on like my ability to focus and retain information and I’ve read a couple of books about it and sort of my suspicions were confirmed by like certain like books and articles that I’ve read that it really like decimates attention. And I’m not someone who has a huge amount of control over their level of attention anyway, under the best of circumstances. So I really try to minimize, like my phone use, I really tried to minimize my internet use, I really again, like I don’t do social media like so I’ve been like pushing this away for years. Like as this technology’s gotten closer and closer, I’ve been like, la, la, la, stick my head in the sand, not think about this, it’s not for me, which I think is how like some people have been, I mean, some people are really terrified.

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10:37

I’m not terrified. But I do have sort of a, I try to keep a very open mind about things that could happen. I try to really remind myself of all of the things that I don’t know, I really don’t know a lot about this technology. And I am open to being shown ways that it can be used for good. And I’m open to shown, being shown, like ways that it couldn’t be and I’ve been sort of pushing it away. And maybe in the past week or so the past week or two. I’ve been like, I can’t push this away anymore. Like it’s here. Like, it’s, it’s here.

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11:17

So I worry about the kids that I work with, they worry about their parents, I worry about my son, of course, because you know, when I worried about this before I knew I made a joke, the last time we were on the podcast about I was pregnant then so about no screens till you’re 40. Like, nobody can have, you can’t have an iPhone. But I you know, now I’m like, oh my god, this is so much more like, dangerous, right? And it’s like, how do you talk to kids about AI? I mean, this is like stuff that I’m going to like expect is going to come up. Like, soon for me, like how do you talk to kids about AI? And I mean, of course, like the kids that I work with, they’re like, way up more up on this than I am. And I mean, I’ve a couple of kids that I work with that have already mentioned Chat GPT and AI kind of stuff. Like, without me prompting them or anything like that. So I exactly it’s like, it’s it’s one of those things. It’s kind of like drugs where I’m like, don’t assume that your 14 year old isn’t using drugs, like you should ask them. Don’t assume that your 14 year old isn’t secretly communicating with ChatGPT, you should ask them. Yeah, because I, you know, I think that kids are always on the cutting edge of this stuff. And it’s also, you know, I’m 33. So I feel like all of a sudden, I went from someone that was adopting new technologies as they came out to now like, you know, when I started working with kids, I was 21 or 22, when I started working with kids, and I didn’t feel that at all, like I was behind or that I didn’t understand what they were saying. And now, you know, as I’m in my 30s, like, I, it’s funny, I was talking to one of my adolescent patients, and he was talking about other kids that have been like, messing with them. And I like, made an offhanded comment about how they were, like, trolling him. And he was like, yes, but no one says that anymore. It was just like, Wow, Okay. I, yeah, I’m getting old. And I have to, you know, sometimes agents will be like, Do you know who so and so is and I’m like, nope, and they’re like, it’s a YouTuber. Like, how could I not know, like, who this is? So, you know, kids are always like out there. And I mean, that’s part of why I like working with kids, because it keeps me on my toes like this. But I am like, Oh, my God, like, I’m old.

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13:21

We are the same age. We are not old. I think you because you work with teenagers it may seem that way.

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13:25

That’s true. I feel old. That’s true. We’re not old.

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13:30

Yeah.

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13:30

But I do. I do feel very old. Yeah, it’s funny with younger kids. You know, sometimes they’ll be like, are you 30?

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13:37

As if

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13:40

Like, do you remember the dinosaurs?

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13:42

Oh, my God.

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13:43

Yeah. So you know, I worry about them. You know, and I think that people were worried about us when stuff like the internet was first coming out. But I think that like, for all the worrying that they did, I mean, I remember adults being like, never give out your address. Never give out your phone number. I never did any of those things. But I think that there were like, other things that they didn’t know, were going to happen. That happened and that’s what I’m okay. That’s like, what I’m like the most afraid of is the stuff that like I can’t even anticipate, right. So it’s like, I hear stuff about you know, I like think sometimes about like toxic masculinity, like vulnerable young men like and I’m like, Oh, God, this would be so horrible. And I’m like, but that’s what I can imagine. And like, what can’t I imagine and not that there’s going to be this like horrible like doomsday scenario, I don’t think it’s going to be like that, but I believe it could and I also like, I’m sure that they’re like, it’s like the internet was positive too like, they were really like, pausing

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14:35

people like we’re able to connect you know, people with rare chronic illnesses, we’re able to connect with people, other people with that illness, or even like even see now it’s like, you know, people with there’s so many things about like ADHD and like anxiety and depression out there online that help people feel less alone. And I think that that’s like really wonderful. I mean, sometimes my patients will like show me memes that they see about ADHDH, especially about ADHD but sometimes about anxiety or even about psychotherapy, which is really funny. And I’m like, Oh, these, you know, it’s like the Same with me when I, you know, I’ll see something that really resonates with me too. And like, I feel less alone. So a lot of this is good. But like I just like I’m so you know, I want to be so cautious about this. And there’s this, like, there’s this sense that I have that like the horse has left the barn ages ago, all of a sudden, like this popped up. And we were like, so not ready for it. Like kind of like we were not ready for like a lot of other things that have happened. And I’m kind of like, I guess this is just how it goes with new technology. Sometimes we’re prepared, sometimes we’re not, but I just like I worry so much about the impact on kids, kind of like I worry about the impact of everything on kids. But I think that I talked for a long time about my broad thoughts. I rdidn’t ealize that I had so many thoughts until I like was talking

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Can a computer read body language?

15:51

I didn’t want to interrupt you because you were like on a flow

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15:53

I’m so sorry

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15:54

No

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15:54

Well, I just like I kept thinking of other things.

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15:57

Yeah. So it’s totally fine

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15:57

Yeah. I mean, I don’t know. Well and what I think also, because you work with couples, right?

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16:01

Yea

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16:01

So that’s another thing that it’s like, nobody is going to be able to replicate.

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16:05

Yeah, you touched on like a lot of good things in terms of like, the macro side of it all the way down to the micro. Right. So if we’re thinking about, like, from a therapist’s perspective, I think that the at least ChatGPT, I could see it being helpful in writing treatment plans, right? Like,

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16:22

Yes

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16:23

Use that as like a supplement to a therapist that will help us and in like the crisis situations that you’re talking about. Yeah. But like, I don’t think that it will take over the therapy world and replace a human the way you’re sharing, right? Because people, some people may want to talk to a computer to prompt them.

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16:42

That’s such a good point. But I think that some people feel safer with that than with a human,

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16:47

which I think is valid, right. And the whole point of the therapeutic experience is to be able to break through whether that’s those anxieties, those fear, or the trust issues with another human to build that trust again, and being vulnerable. There’s already prompts out there, right? Like, you get text messages, like how’d you feel today? What about this right? Or like if a therapist gives a journal prompt, right? Like, it’s a supplement, but it’s not. And maybe it will one day.

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17:16

Mhm

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17:16

Right? The only way I can imagine it taking over like a human therapist is that if there is like, human looking robot in front of you, that can read your body language, right? Because our intuition is so strong and our ability to do therapy and like, notice if someone is laughing while they’re telling the sad story, right? Or we know facts about their mom or dad that is slipping through the cracks a little bit that’s reminding us of this that

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17:43

yeah,

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17:44

without that context, I don’t think a computer AI can do that.

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17:49

Yeah, no, I think I think so too. That’s so interesting about reading body language, because I do think that there are probably AIs that can read body language now.

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17:57

Yeah.

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17:58

And that I mean, right. So much of therapy. This is why I like going to the office, even though you there’s a lot of nonverbal communication that you can see obviously on Zoom.

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18:06

Sure,

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18:06

but one of the reasons I like going to the office is like you can see somebody’s whole body, like you can see are their are their legs like jittery

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18:13

shaking,

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18:13

like, there’s so much that’s unsaid that I use that in that like, that’s all information that I use, and I like, but I do think that there are probably programs right now that can read body language who

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18:27

Yeah, like I’m sure, like for the government, NSA, right, all these things that they need.

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18:30

Yeah.

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18:31

It’s I don’t think that they care enough for our general mental health.

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18:36

No

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18:36

To have that taken over

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18:37

No, nope. Nope. Yeah.

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18:39

Not until it becomes profitable.

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18:41

No, exactly.

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18:42

Yeah

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18:42

That’s the thing. I also, you know, I think that there are, you know, there’s a huge gap in like, between, like, need, and, like, it’s a supply and demand thing, but there’s like a huge mental health need. And there’s just like, not enough, like trained mental health professionals like, oh, and it’s like, I do wonder, right, where I’m like, who’s gonna step in that gap and exploit it? I worry, a lot about that.

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19:06

There was a really good commercial, the one where it’s a guy and another guy, and one of them is like, what do you want, you know, and he starts sort of, like, the cameras sort of starts backing up, and he’s like, I want a job that I don’t hate. You know, I want to not feel like I’m constantly like, on the edge of, and then the other guy cuts in and he’s like, no, what do you want to eat?

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19:24

Oh, my bad.

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The importance of self-care as it relates to hustle culture

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19:25

And then it’s like, do you need to talk to someone? And I’m like, No, but like, that was like, I thought that was really funny. And I thought that was a great way to be like, Yeah, we all you know, a lot of us need to talk to somebody. And I feel like it’s also like, right, it’s that and then there was that big like hustle culture like thing. I feel like that that’s kind of like calming down now. And people it’s funny I keep like hearing people referring to productivity is like a dirty word. And I remember in my like, my early 20s Maybe when I was like, 24. I remember like listening to all these podcasts about productivity.

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19:52

How to be more productive. Yeah,

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19:54

yeah. But like that was really like important to me. And now, I think something I think the pandemic kind of broke me, I forget if I said this the last time that we talked on the podcast, but I think that I was really like, I need to take care of myself so that I can continue to take care of other people. And that was something that people had always said to me, like my mom, and other professionals before that, and I always just, like, brushed it off, I’d always been like, whatever like self care is for wusses like, I’m gonna, like push through this and like be a hero. And I’m like, That’s so not okay. Like, it’s not okay for anybody to think that. And I yeah, I was so glad to see that like, right women like a gen, not a whole generation younger than us. But even like maybe half a generation feeling empowered to be like no, like, my health and safety is more important than this. I just thought that was awesome.

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20:46

I think this is like a great segue into intergenerational trauma.

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20:51

Yeah.

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20:52

Because it makes me think about like, so we have the pandemic, we’re somewhere in the midst of towards the end to whatever we are in now. But that first year, especially, is we were all forced, just slow down. I don’t think there has been a global movement like that for everyone to have to sit and reflect about their life choices, what they’re going through if they want to continue it. And like having that hustle culture makes me think about how many generations of trauma had to endure, whether it’s oppression or survival mode, so that we are at a point where we feel guilty or ashamed or like a failure if we’re not constantly producing and having some value that’s like monetary.

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21:40

I know so many people, both like that I work with in my practice, but also people in my personal life that have expressed that like feeling guilty or feeling like feelings of worthlessness associated with like not producing enough or like not sort of like producing enough income or you know, I don’t know, yeah. How do you feel like that, like, plays with intergenerational trauma? Because you talked a little bit about, like, oppression and like feeling the need to like, be productive?

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22:06

Yeah. So I mean, I think like through traveling and being in different countries, I do think that American culture is very much the hustle culture.

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22:14

Yeah.

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22:15

But like, even coming from like, I was a refugee. My parents were refugees, like, even my husband’s parents came from a different country. Like, I think it was still instilled that they didn’t even have the opportunity to rest, right? Like, there was no space for them to relax. We’re gonna take time off or to think about joy or what they’re like what they want to do with their weekend too, right? Like,

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22:39

right, yea

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22:39

that’s was a silly thought it’s, we have to survive, but we have to go, go, go, go. And if you’re sitting down, that means either someone’s not getting fed, something’s not getting done. You might lose your job, your reputation’s on the line, which for like communism is huge, because what your neighbors think about you can literally can put you in jail

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22:58

It can literally kill you. Yeah,

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22:59

Yeah. So I think that like, and then coming to a country where like, okay, there’s not necessarily that happening, but there’s still this hustle culture. It’s kind of like natural for the next generation to feel like, I have to keep doing things like if I’m not busy.

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23:14

Yeah,

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23:14

I am a failure.

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23:16

Right. I’m worthless.

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23:16

I’m useless. I’m worthless. Yeah, well, but that’s how strong right like that this is passed down that these beliefs and the compulsions, and like our generation has, I don’t think we have more anxiety or depression, I think we’re allowed to have more of it. And it manifests in such a different way. Like, I talked to my parents, and they’re like, there is no such thing as anxiety or depression. Like, you’re just like, you’re not busy enough, you have too much time on your hands to think and feel about shit. And I’m like, okay, fair because they were in survival mode. They literally didn’t have the time to acknowledge it, but they still experienced it.

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23:54

Yeah.

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23:54

And so because they weren’t allowed to think about it or talk about it

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23:58

right, right.

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23:59

If I have it. I’m ungrateful. I don’t think about my privileges, right. And then so it creates this next generation of right of hyper anxiety, more depression, low self esteem, shame.

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24:12

Yeah.

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24:13

Right. And there’s not a space to talk about these things, because you have to kind of just push through and figure it out on your own.

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What is intergenerational trauma and why does it matter?

24:19

Yea. You’re right that like, right, it’s not like it didn’t exist, they just like nobody talked about it. So like my mom’s side of the family is like Irish Catholic. So like, nobody talks about any of that stuff. So my mom was really like, aware about a lot of that stuff. So she, you know, I remember once she was telling me that her grandmother had had, you know, may have had postpartum depression because like after her second child was born, she like, went away for a while. I’m using air quotes, if you’re like, not listening, if you’re just listening, you know, and I could see her kind of like, I could see the gears turning in her mind. She was talking about it what she was like, oh, like, that’s probably what they called it. When you were having a mental health problem that you just right like, nobody, it’s right. It’s like either Yeah, it’s like, you didn’t have postpartum depression. You went away for a while. They’re like, yeah, exactly. And it’s like, there was no like, space to talk about feelings. There was just like, yeah, exactly. You just had to survive.

25:11

For listeners, not knowing exactly what intergenerational trauma is, like, maybe we can kind of go over a little bit like what that means and like, how that comes up.

25:21

Yeah.

25:22

So I think a kind of a broad overview is, if prior generations, like our parents, our grandparents, great grandparents, ancestors, right have been through some kind of traumatic experience, whether that might be some kind of abuse, racial trauma, like being a refugee, like on a global scale, or direct, like something happening in your country, or even just like within the family and the culture, is that the way that people survive, they pass on these maladaptive behaviors on to the next generation. And then they live in a new environment. And they use these coping skills, which are also not very helpful. And they create more maladaptive mechanisms and continue passing this on until someone in the lineage goes to therapy breaks the cycle, right? Is aware of these things.

26:13

Yeah, yeah. I mean, obviously, like the one that comes to mind, like the maladaptive coping mechanism that comes to mind because I’m Irish American is alcoholism, just like sort of the one that like everybody would like, you know, it’s like the one that like, would come to mind for a lot of people, but it’s right. It’s like, it’s not talking about it, like not acknowledging it. It’s like denial, I guess, is like what the coping mechanism would be, or even maybe sublimation and that like, right, and then like self medicating with substance. So like, not speaking for any individual, but like, I think that, like the rates are higher in that population, or in certain, you know, in certain populations,

26:47

and I think the cultural context makes such a huge difference with the intergenerational trauma because, right, like if you are coming from a place where there’s war, right, like, right now, the war in Ukraine, like there’s gonna be a lot of this.

27:00

I know, I think about this all the time,

27:02

passed down to unfortunately, like people who are experiencing it now. And their children who are really young, and then their children that they’re going to have, right, like, it’s a ripple effect. And it’s part of it stays in our DNA as well.

‍

27:15

Yeah.

‍

27:15

Right. So

‍

27:15

it’s like epigenetics. It does, like literally change

‍

27:18

literally, absolutely. Right. And like,

‍

27:19

yeah,

‍

27:20

like, I’m Jewish, and, you know, in my ancestry, there was constantly genocides of wiping out Jewish people.

‍

27:26

Yeah.

‍

27:26

And, you know, sometimes there’s jokes that like, at least like with my family, like, Oh, they’re always complaining. They’re always asking questions. Everyone has IBS. Right. But like, thinking about how nervous and anxious and stressed you would have to be every day for your life, because you think that someone is going to kill you or torture you? Of course, your stomach is going to be turned inside out.

‍

27:47

Yeah.

‍

27:48

Right. It’s like these things kind of make sense. And then they’re passed on, because no one kind of addresses them, or they don’t know to address them, or it just becomes the norm of what happens.

‍

Relationship trauma and trust

‍

27:59

Yeah, I mean, I think that, right, and that’s the thing, it’s like, after a while, like, the thread of how it got to be that way is lost. And then it just, that’s the way it is. And I think that, you know, I think it can be that way with like family secrets as intergenerational trauma, where it’s like, you can feel you feel like something is off, but you can’t put your finger on it. But like, there’s no like space to ask about it, or like talk about it, or like anything like that. So you just kind of want like are going around like okay, like, I guess this is normal. You know, I think that that’s like, that’s been the case for like lots of people that I’ve worked with, or like, you know, feeling like something is normal. And then like realizing that it’s not like as you know, as you grow up and sort of, like meet other families and like, start to, like, realize that like, oh, like there are things that were tolerated, like in my family of origin that were like that would never have been tolerated, like in other families of origin. And you think that everything, you know, you sort of, like every family is like this. I mean, I know, my family of origin is like pretty conflict averse. So I’ve spent a lot of time around people whose families at origin were not as conflict averse, and who, you know, there was a lot of shouting and a lot of yelling, just like how they interacted with each other, now go over their houses, and the parents would be screaming at each other and like, screaming at the kids, and I would be like, Oh my god, this is like a war zone. And like, that was like Tuesday. And, and that’s the thing. It’s like, I don’t know, it’s that, you know, it’s like, the chaos of that has an impact to like, yeah, where it’s like, I feel like sometimes the chaos of that has an impact in a way that like people like some people feel like really comfortable with chaos and like when things are like too stable, they’ll like just like just mess it up. You know, just to like to like be so they can feel more comfortable.

‍

29:48

Yeah. So I see this a lot. It’s actually interesting, because doesn’t always have to be like a huge, traumatic thing. It could just go through the family. So I’ve had several couples who Were they were heterosexual couples and the female had severe jealousy and trust issues, okay, and the male partner has not necessarily done anything to warrant that, right? Outwardly. And then so we’re doing this family work, you know, as couples therapists, we take time to learn about each person’s family, like their family, their parents, and sometimes their grandparents. And, you know, we discovered that there was a lot of secrecy around affairs. And you know, this, yeah, this happens in any culture, any class status, right. But like, this particular couple was from an Italian heritage. And within that culture, sometimes there is like an understanding that there will be like a “Goomah”, right, like a mistress. It doesn’t mean that the wives are okay with it. But it is sometimes, like, ingrained in the culture. Yeah, it’s baked in. So imagine, you know, you have a grandfather, or you have like these uncles who you really admire and you love and they’re great family members. But then you see the other side of the female family members talking so negatively about not trusting men, they’re pigs, they’re dogs.

‍

31:10

Yeah,

‍

31:10

You know, they’re good for the family, but they’re not good partners. But you but you love them, and you have a partner anyway, right? So like, struggling with trust, or like, this level of vulnerability or intimacy within like, a romantic relationship, too, is that it’s trickled down,

‍

31:27

right

‍

31:28

through the generations too.

‍

31:29

Yeah. No, that’s such a good point that like, if in the environment where you grew up, just like nobody trusted men, and it was just this, like, not even an open secret, it was just like, out in the open that like, men are untrustworthy, they’re like, gonna, you know, they’re gonna betray you like, no matter what you do, like, you can’t escape it like, Yeah, I mean, like, who would trust somebody after that. Yeah.

‍

31:46

Yeah.

‍

31:47

Right. And so like, that’s traumatic to that’s like a relational trauma that is passed down until, you know, it takes a lot of work for that particular couple to work through building trust,

‍

31:57

Yea, I can imagine

‍

31:57

based on this relationship,

‍

31:59

because I think also that then that, like runs up against this, like, I feel like this ideal here that like, if your husband cheats on you, it’s your fault. Like, that’s because like you were found wanting, like you didn’t like satisfy his needs, like you weren’t like a patient enough or loving enough or sexy enough, or whatever it’s not. So that’s the thing. It’s also because it’s being like taken from this culture, where it’s like, you know, like, I don’t know that much about it. So I don’t want to, like make any generalizations. But it’s like, if it’s right, if you’re moving from a culture where like, this is a thing that happened a lot, then like, you know, everybody just understood that this was what men did, and that it had nothing to do with women. Like, and then it’s like, you’re moving it to this now this culture where it’s like, if this happens, it is your fault. Like, I feel like that, like is really destabilizing and like confusing.

‍

32:50

Absolutely.

‍

32:50

And ofcourse it’s like nobody’s fault

‍

32:51

The context changes.

‍

32:52

Yea

‍

32:52

Yeah.

‍

32:53

Yeah.

‍

32:54

And, you know, I, we were talking about this a little bit last night of thinking about whether you come from an individualistic versus collective culture.

‍

33:03

Yeah,

‍

33:04

right. And like how that also shows up in mental health and therapy, which I think is so important for therapists generally to be a lot more culturally competent, and like sensitive to cultural differences. Definitely. Because I find and like, I also don’t want to generalize, right, but like, in the Eastern European culture, at least from my personal experience,

‍

33:24

I feel like that’s not a generalization. Like, you’re, you’re from Eastern Europe.

‍

33:29

I know

‍

33:30

I feel like it’s okay.

‍

33:31

But like, not everybody, right?

‍

33:33

Like, No , I understand.

‍

Pathologizing immigrants in family dynamics

33:34

Not everyone’s gonna have the same experience. I have, like, within my own personal but also professional experiences, because I do work with a lot of clients who, whether they are born in Eastern Europe or they came here as children, yeah, is that a lot of the family dynamics are very enmeshed, which is, for people who don’t know, it’s basically like, kind of like a group think like, everyone’s in everyone’s business, everyone kind of believes the same thing. The ideals, the narratives, like it’s in line. So having someone do something or think differently, or want to be an individual is seen as a threat.

‍

34:13

Yeah.

‍

34:14

To the family unit.

‍

34:15

Yeah, that’s a really good point. Yeah. And I mean, we got we’re talking a little bit about this, because like, I like my parents were both born in the United States. So they were you know, and they grew up in like, the 70s. You know, it was very, like, you know, both sort of grew up in this very, like individualistic culture. So, like, I didn’t have any tension with that. They were like, You can be whatever you want to be and like you can, you should follow your dreams, go wherever you want. And, like, be whatever you want. And we would never try to stop you and like,

‍

34:42

yeah,

‍

34:42

you know, what, and when I was a kid, I would be like, well, you know, even like, when I would ask them, you know, sometimes I’d be like, Oh, do we have enough money for this? Or like, oh, like, you know, what are you going to do if this happens? They’d be like, don’t worry about it. Like, we’re the parents. You’re the child like, you don’t have to worry about that stuff.

‍

34:57

Oh, that sounds so healthy.

‍

34:58

I know. Oh, yeah. Yeah, yeah, I give my parents a lot of props. But I think that’s a privileged position to be in where I genuinely didn’t have to worry about it. Right. So like, I mean, it’s very easy to be like, Oh, that’s really healthy. But it’s like, that was the truth. Like, I didn’t have to worry about whatever it was, I mean, like, as long as they were all, like normal requests, or I didn’t have to worry about it. And I think that, that, you know, right, I bump up against my so my husband’s from Ukraine. And he came here when he was a kid with his parents. And I Yeah, it is like that, you know, just like, the way that we interact with, like, both of our sets of parents is like, really different. You know, I feel like he I remember the first time after, like, he spent time with my parents and me at my parents house, he was like, wow, like, he was a your parent, like, you and your parents are so like, close, like, you know, I felt like, I feel like he almost felt like, we were like, friends, like, he’s that just like, isn’t, you know, it’s like, the relationship that he has with his parents is really different. It’s like, there’s so much love there. But it’s like, not like, it’s not like this thing, where it’s like, you know, his parents have like, very specific ideas about like, what they want him to do and be, like, aren’t afraid to express them. And like, my parents would never, like, try to tell me what, how they thought that I should be. So it’s so funny. Because that was like, such a, like, you know, in a blows my mind, like, how different like, that has been. And it’s like, right, it’s not bad. It’s just like two different, like ways of like, two different sort of, like sets of expectations that come like it with like, sort of like the cultural context that like they haven’t that we have

‍

36:37

Absolutely and like not having that cultural context, right? It’s so easy for it’s so easy to pathologize foreigners or immigrants in their family dynamics. Because if we’re looking at it from an individualistic standpoint, these things are wildly unhealthy. And there’s like, emotional manipulation and guilt trips and enmeshment. And like, lack of boundaries, or like all these things that would be considered unhealthy and not a safe environment for somebody.

‍

37:10

Yeah,

‍

37:11

On paper. And for someone who doesn’t come from that lens, then when you look at it from the generational trauma and the things that they’ve been through, it’s actually like they needed to be this close to survive. And

‍

37:25

That’s such a good point.

‍

37:26

And they literally lived in the close quarters, like, yeah, I was born in Azerbaijan. And my parents told me like, there were no new developments there. They didn’t build new houses or residence, right? Like you lived in this apartment until someone died. And then you had a lottery to, like, get into that new apartment. But everybody lived in like a one to two bedroom apartment. I’m talking about grandparents, parents and their children.

‍

37:52

Yeah

‍

37:52

So you’re physically in a close quarters. And then emotionally, you know, everything about each other because,

‍

37:59

of course, because there’s no escaping it. It’s like, if you’re, you know, it’s like, it’s not like you’re gonna like go up to your room and like write in your diary, right? Like I did when I was a teenager.

‍

38:08

Yea

‍

38:08

Like, yeah, I mean, like, right, if you’re like, if you’re having like, a rough day, like everybody knows. Yeah.

‍

38:14

And everyone’s got thoughts on it. And yeah, because, and there’s also like, this really strong sense of what happens to the family stays in the family. Like, you can’t tell strangers you can’t tell your neighbors you can’t even tell your friends. Because there was such a fear and a lack of trust towards other people. Because yeah, it literally could harm you

‍

38:35

It could kill you.

‍

38:36

It could kill you

‍

38:37

Yeah.  no, I even it’s funny that you’re saying that now. Because like, even like after I was telling that story about how my great grandmother might have had postpartum depression, like maybe like, I just like I shouldn’t have said that on the podcast. Because that’s like, that’s the like, that’s

‍

38:53

Ingrained

‍

38:54

Yeah, it’s like, don’t talk about that’s no. That’s private. Like that’s not like, but this is also like, How is anybody going to ever talk about postpartum like, postpartum depression if like people aren’t willing to be like, I had postpartum depression or my mom had postpartum depression like,

‍

39:08

yeah,

‍

39:09

yeah, but I think that right I could sort of like almost like feel like the shame of like, I can’t believe you like talked about that. Like, and anybody could listen to it.

‍

39:21

Yeah, I know

‍

39:21

I’m getting like, I feel like I’m like sweating like thinking about it. Yeah, if you’re listening don’t tell my mom.

‍

39:32

That’s so funny. But like, right, we’re in a position now where that for the most part is not something that we have to worry about.

‍

39:39

Yeah,

‍

39:40

Right? Like we can openly share our opinions and thoughts online in this kind of way. And nothing really detrimental will happen to us.

‍

39:50

I don’t know. So like, I have like a fear I think it’s probably like a healthy fear but like I have a fear of part of the reason that I don’t do a lot of stuff online is like I have a fear of like making a mistake. And then it being there forever. So

‍

40:02

sure,

‍

40:02

but you’re right. It’s like, it’s not the consequences. You’re not going to be like your entire village shuns you. Right? The consequences are just probably I’m going to get like some kind of mean comment, right?

‍

40:11

Like mean comment

‍

40:11

Like, I’ll go about the rest of my day. Yeah, right.

‍

40:13

We feel will feel embarrassed. We might feel shame.

‍

40:15

Right, I’ll feel shame. Yeah.

‍

40:17

But everyone in our neighborhood probably is not going to know or come knocking on our door or call the police for something.

‍

40:23

Right. Exactly. Yeah,

‍

40:24

Unless we’re doing something crazy, right?

‍

40:25

Yeah. But even then,

‍

40:27

yeah,

‍

40:27

I feel like there’s like much more of like, a live and let live like situation, again, because like, it’s not like this life or death like thing where it’s like, if you didn’t like, you know, right. It’s not this like life or death situation where like, you have to, like rely on your family. And you have to, like, keep everything secret, because it’s like, if somebody finds out that, like, you’re like, I don’t know, like, not the religion that they thought or like, right, it’s like, then, you know, you could really, yeah, I mean, like, for years and years, you know, it’s like, if somebody found out that you were Catholic, like, in, you know, I mean, in a variety of places, you know, like consequences from that.

‍

41:01

I think it’s like, we can make the choice for ourselves. But it’s for other cultures, you making the choice for you reflects poorly on the whole family, and impacts the whole family.

‍

41:11

Yeah.

‍

41:12

And so I think it’s hard for a lot of generations, who went through the real, very real valid threats of that, passing that down on to their children now where that’s not as severe having a real struggle with like, figuring out that vulnerability and being able to balance like those boundaries, or like,

‍

41:32

yeah,

‍

41:32

giving unsolicited advice or like, allowing you to trust other people.

‍

41:38

Right? Yeah, definitely. Like, like, yeah, allowing you to trust other people’s a big one.

‍

41:43

Emily, thank you so much for coming back on. If anybody wants to hear more about the ins and outs of what Emily does, on a professional basis, you can check out an earlier episode from season one. But Emily, can you share where people can reach out to you or find you if they want to work with you.

‍

41:59

So right now Iwork at Integrative Psychiatry of Manhattan, so you can reach me at [email protected]. That’s my email address.

‍

42:13

Awesome, we’ll put that in the show notes for everybody to find you.

‍

42:16

Awesome

‍

42:17

So,  Emily, thank you so much for being on with us today.

‍

42:19

Of course, It was my pleasure. Thanks for having me back.

‍

42:21

Of course.

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