Podcast: Living a Life of Empathy and Experience

Episode Transcript

Trevor: Welcome to Mindful Things. Welcome new listeners. Welcome returning listeners. I am still sick, two weeks now, two weeks with this cold. It’s ridiculous. So, excuse the nasally grossness in my voice.

On today’s episode, I am interviewing Dr. Sophia Maurasse. She is the director of McLean Hospital’s 3East Girls Intensive and Step-Down Programs. We talk about young kids and teens struggling with borderline personality disorder, specifically with the girls program that she’s the medical director of.

Just found out and this is pretty amazing that Sophia was nominated for 2019’s Compassionate Caregiver Award from the Schwartz Center in Boston. The Schwartz Center connects and trains medical caregivers from around the world. It’s quite an organization, and it’s pretty big. Very proud of her. I hope you enjoy the interview. I really did. She’s a fascinating person with a really, really wild background. Really happy to have her here at the hospital and on the show.

Ah! I’m going to blow through this real quick because I feel really uncomfortable talking about it, but it’s been on my mind, and it’s been bothering me this much. It probably means I should say it. So, it really puzzles people, specifically my friends, when they hear me talk about myself in such a negative way. When they hear me say that I hate myself or that I’m useless, it puzzles them. Even the most open-minded person, you could see that they’re turned off by it or they invalidate it. They don’t think it’s real, that I’m probably saying it just to get attention.

I get that, I guess. It hurts when they don’t think I’m serious, but I can also see how hearing that can be difficult to handle, when hearing that somebody hates themselves and is so open about it, but it is true. I mean, that is how I feel about myself. I can give you a specific reason. I’ve realized that there’s something I need to work through, something that, for lack of a better word, I’m not trying to sound dramatic, but something that always haunts me.

So, to boil it down, and this is not at all an across-the-board description for borderline, I’m just saying, with me specifically, I just have too much emotion, just too much, just always feeling too much emotion at any time, and in a situation that would prompt a lot of emotion in anybody, it can render me useless.

Give you two examples. About 20 years ago, I was driving at night. I was in downtown Portsmouth, New Hampshire. I was at a stoplight. I’ll never forget it. There was an SUV coming the other way, and it was that night. So, you can’t really make out. You can make out the shape of the SUV, but you can’t really see the color or anything, but you can mostly see the headlights, the two beams.

I’ll never forget it. The beams were horizontal, one on the left, one on the right. Then all of a sudden, the beams went up in the air, and turned to the side, and came back down, and they were suddenly vertical, top to bottom. That had meant that the SUV had hit something and flipped up on its side and came down.

Seeing that freaked me out. Now, I was right there at the stoplight. I was the first person there going in the other direction. I was one of the closest people to that SUV. It was so overwhelming. I was so scared by what I saw that I froze, and I just sat there. I didn’t know what to do.

The next thing I noticed is that I see all these people running past my car from behind me. So, people who were behind me, they reacted. They jumped up. They got out of their cars. They ran over and find out it was a mother and two children in there, and I did nothing. I just sat there frozen.

Second one is that I live in this area right on a main road, and there’s another road perpendicular to it, and the road that’s perpendicular, when you reach the stoplight, you have three choices, you go left, right or just drive across the street into my little, little cul-de-sac street. You can barely see it. It looks like an alley. There’s a bunch of houses there, and my landlord owns all the houses on the cul-de-sac, and I have an apartment there, and we’re all one big family.

I lived there for nine years, moved to San Diego, and then when I moved back, I got an apartment right back there again because I really like the landlord, and the groundskeepers, and the building management there. Excellent. I love it there. That’s why I went back.

My first apartment was right there at the beginning of the road on the cul-de-sac, front door right on the main street. My living room faced Main Street. What would happen constantly is that drunk people or people falling asleep at the wheel, but mostly drunk people would not see the red light. They would come at the end of the perpendicular road, not go left, not go right, but go straight across the street onto our street, but it’s a little to the left.

So, basically, they would be coming straight for my window. The only thing that stops them is this stoplight. I can’t tell you how many times people have rammed into that light doing about 35 miles per hour, and it shakes the apartment. I mean, it just happened again about four months ago, and I felt, and my apartment is now back farther down on the cul-de-sac, and I felt it then. It’s crazy.

Well, one night it happened, and it jolted me up, and I went out, and I saw. The car was empty. The driver ran, and I froze. Two minutes later, my neighbor from upstairs comes running down, and he runs out, and he looks at me, and he looks at the car, and he goes, “Is there anybody in there?” I couldn’t even say a word.

He ran right into the car, ripped open the door, looked to see if there was a kid or something, and then got out in case there was going to be a fire or something. That will haunt me forever. I didn’t even think of that, that there might have been somebody else or a kid in that car. I was so, I don’t know. I don’t know if I was afraid. I don’t know, but whatever it was, I was just so overwhelmed that I froze.

This is why I think I’m useless is that when it comes to those moments, I don’t act. I know people have said you can’t weigh your entire life on what you would do in a specific scenario, but I don’t know. I don’t know. When push comes to shove, I just feel like, not I feel like, I know that I won’t be able to deliver in an extreme situation where you have mere moments or seconds to act.

Those two scenarios is why I hold myself in such low regard is that I just know that I won’t be able to act in those situations. Until I can learn how to handle an abundance of emotion or emotional distress in situations like that, which don’t happen often, so it’s not like I can practice, I’ll never feel like I could be a partner to someone or be a father to someone or anything like that. I just don’t think I could be of any use because my emotions have that much control over me. That’s one of the major reasons why I hate myself. So, there you go.

How do I transition from that? I don’t know. I got to work on it. I know. This happens all the time. How do I transition?

Coming up now is my interview with Dr. Sophia Maurasse. She is awesome. We had a really fun time. She grew up in Liberia during the civil war. It’s crazy. She’s here in Boston. She’s awesome. I tried to make that rhyme, but it didn’t really work. I enjoyed this interview. I hope you enjoy it as well.

You have this deer in headlight look You’re not looking forward to this, are you? I love it—

Sophia: It takes me a little while to warm up. I’m hoping I’ll warm up—

Trevor: Yeah. Yeah. You’re hoping you’ll warm up. I’m hoping you warm up. This is my job, Sophia. Okay?

Sophia: I will try.

Trevor: Yeah. The future of my employment is on the line here, Sophia—

Sophia: No pressure—

Trevor: No pressure, Sophia.

Sophia: This is my first time doing anything like this.

Trevor: Well, you were on New England Cable News.

Sophia: I was—

Trevor: It would have been better if you are on, for some reason, if you are on NESN, New England Sports News, instead. I don’t know what New England Cable News is. I was just like, “Is this the dumb little brother of New England Sports Network? What is this?”

Sophia: It was really interesting because I hadn’t heard about it before. Actually, it was my first time knowing about it. I remember my fiancé was so excited when I told him about it. He was like, “I’m going to record it.”

I’m like, “No, you’re not. It’s not even a thing.”

Then I come home and there’s a link to it to my phone.

Trevor: No. I watched it, and I’m not going to say names, but you heard me grumbling.

Sophia: It was an experience.

Trevor: Yeah.

Sophia: Yeah. It definitely was. It was live, which was terrifying.

Trevor: Yeah. You had some real geniuses on that board with you. There were some real bright experts.

Sophia: They were interesting.

Trevor: Yeah. That’s the kind way to put it. So, what happens in those kind of situations? Do you get the questions in advance?

Sophia: I get a general sense of it. I mean, that was my first time doing a live interview. So, it was just ... I got a call. It was from Laura. She just said, “Hey, they’re doing this interview. Here are some of the things that they’re thinking about covering. Would you be willing to talk about this?” Yeah. So, I don’t get the exact questions, but I get a general sense of where things are headed.

Trevor: Right. Do the press reach out to you a lot?

Sophia: No. I mean, I feel like it’s been creeping up a little bit.

Trevor: Yeah.

Sophia: Yeah.

Trevor: Making a name for yourself. Yeah. There you go—

Sophia: Something, something’s happening—

Trevor: Yeah. There we go. Then the rockstar story begins, the rise, the stardom, the cocaine addiction, the drinking, being mean to family—

Sophia: Oh, God! Yeah.

Trevor: A star is born.

Sophia: I will remember to be nice to people. Yeah.

Trevor: Yeah? That’s what they all say. They all say that.

Sophia: That’s what I’m working towards. Yeah.

Trevor: So, our pre-interview was interesting. This has happened a few times. It basically turned into a therapy session for me. It was pretty great. I had a really good time with it. Could have gone for probably another two or three hours, but I—

Sophia: Oh, yeah. It was a good conversation.

Trevor: It was pretty good.

Sophia: Yeah.

Trevor: We covered a lot.

Sophia: Yeah.

Trevor: Describe a bit about your role here at the 3East Program.

Sophia: Sure. So, I’m the medical director of the 3East Girls Intensive and Step-Down Programs. So, we’re a residential program for girls 13 to 20, who come in with a history of things like borderline personality disorder, depression, anxiety, PTSD, usually with a background where they’re engaging behaviors that include self-injury, disordered eating, all different ways of addressing their distress. Our goal is to give them the skills using dialectical behavioral therapy to cope in a much more adaptive way.

My specific role as the medical director is to work with the team, and also work with individual patients around addressing their medication needs, the medical assessment, and figuring out ways to make sure that while we’re addressing the medical stuff, not to interfere with what they’re currently in treatment for. So, making sure that we’re working with outside providers, let’s say if there’s a medical issue while they’re also attending to a pretty intensive program.

So, it’s partly sometimes some supervision. So, I do work with the nurses, and nurse practitioner, the postdoc fellow, and we also have a women’s mental health fellow who rotates through the various programs on campus, and I supervise that person when he or she is rotating with us.

I mean, I think what’s interesting about our program is that it has a very heavy didactic portion. So, basically, these kids are—

Trevor: What does that mean?

Sophia: So, teaching portion.

Trevor: Okay.

Sophia: So, basically, these kids are in class for a few hours in the beginning of the day, where we’re actively teaching them the skills. We’re actively giving them the vocabulary around how to express themselves, how to make use of the skills we’re teaching them. Then later in the afternoon, we have agenda-based groups where they can bring topics in the groups and say, “Here’s what I’m struggling with. How can I apply this what I’m learning to what I’m struggling with?”

So, there’s a teaching component for our patients, and then there’s also a teaching component for the parents. So, once a week, the parents come in, and they’re learning the skills just like the kids are learning the skills so that they can have a common vocabulary around their treatment.

So, that, I really like that aspect of it because it’s also reminding parents and kids that it’s a whole family that we’re looking at. We’re trying to really scale them up. That it’s not just the kid. We’re not having people to just drop their kids for us to fix, and then sending them back to the family, but it’s really helping the whole family.

Trevor: Nothing against parents, but aren’t there some parents that just want to drop them off and have them get fixed, and have them swap out a battery or tighten some screws, and then, “My kid will be okay once they’re out”?

Sophia: Well, I think it reflects sometimes an attempt to understand a really complicated situation that I think sometimes parents approach it like, “Well, if you just help my kid, everything’s going to be okay at home,” or “If you just help me,” because some parents sometimes look at it as the kid is struggling, and it’s the kid that needs to be fixed, and other times, some parents are like, “Well, if you just tell me what I did wrong, then I can fix it,” when it’s much more complicated than that.

So, I think it’s just one—

Trevor: Well, the kid doesn’t get fixed.

Sophia: Right. Exactly. Nobody really—

Trevor: The kid learns how to manage it because it’s going to be an ongoing thing.

Sophia: Absolutely, to some degree, yeah. So, we’re giving them ways of dealing with something that could be there for a while. Yeah. So, it’s a very simplistic, I think, explanation sometimes we all arrive, too. You and I talked about it in our pre-interview. Sometimes we want simple, concrete, certain answers to sometimes really complicated problems.

Trevor: Well, yeah. I mean, I think that is the essential core of education at youth. I mean, you’re taught numbers. These numbers add up to these answers. You’re taught letters. These letters when formed this way make these specific sounds, which form these specific words, and then these words put together form these certain ideas, throw in some grammar and stuff like that. A child’s educated mind is built on ... It’s concrete things. There’s no gray zone yet, and then they get thrown into the gray zone.

Sophia: Right. Now, our job is to help them sometimes find that gray zone, tolerate the gray zone because a lot—

Trevor: Wouldn’t they benefit from a class at school called the gray zone?

Sophia: Absolutely. I mean, part of what we’re hoping ... I mean, there are people who are actually actively working on bringing DBT to schools, at least some of the aspects of DBT.

Trevor: Right. Teach a kid that, “Hey, there’s going to be some kid that day that’s probably going to be mean to you.” Might not be because he or she is a jerk. It might be because mom or dad hit him really hard the night before, and they’re in a bad mood.

Sophia: Right. It might not have anything to do with you. Their distress might be their own.

Trevor: Whatever reason that is, you don’t have a right to know.

Sophia: Absolutely.

Trevor: Some people just have a bad day.

Sophia: Tolerating the stress that that might elicit for them and finding ways of dealing with it instead of trying to fix the other kid or address the other kid. So, yeah, I think a lot of times it’s helping parents and kids tolerate that uncertain area because a lot of times the distress comes from the nonacceptance potentially of not knowing, not being able to address something immediately in a really concrete way.

Trevor: Right. I was talking with somebody. It might have been on this podcast. We made the connection that I found that parents, when they’re teaching their kids morals or basic morality, and I’m talking outside of religion. I’m just talking the right thing to do, the wrong thing to do, and when they relate it to goodness, I find that’s the best way to go about morality.

Now, I, on the other hand, and I’m not blaming my parents because this is how they learned it, and that’s how their parents learned it, but I learned the wrong way to do things solely through consequence, okay? You do the wrong thing, you’re going to get hit, you’re going to get punished, you’re going to get grounded. You do the right thing, you’re going to get rewarded, or these things are coming to you. That’s just not how it works. You don’t agree.

Sophia: I would say that’s a tough one because to some degree we want people to recognize natural consequences, the natural consequence to not showing up for work repeatedly might be one loses their job, right?

Trevor: Right. There’s a consequence. The right thing is to show up to your job all the time.

Sophia: Right. Right. The other side of that, too, is when we think about what rewards the behavior, how do we keep reinforcing the behavior. If we keep doing this, good things are happening, right?

Trevor: Right, but what I’m saying is that if you always associate good or bad behavior with consequences, you’re chasing and avoiding consequences. You’re not being inherently good—

Sophia: Right. So, it’s more intrinsically motivated. Yes.

Trevor: Sure. Can you look up intrinsically for me real quick at the dictionary?

Sophia: So, I guess I get your point now that, in a way, the behavior then is being motivated more by the external factors, but it’s not somebody who is then motivated in and of themselves to pursue something that would be helpful—

Trevor: In the name of being good—

Sophia: Yeah. Absolutely—

Trevor: I feel that the children that learn that, they seem healthy. I mean, I don’t know. They just seem healthier.

Sophia: Absolutely. Yeah.

Trevor: Emotionally and mentally healthier, I mean.

Sophia: Well, it is helpful to do these things because we find them useful, and we find them helpful versus doing them just to please somebody else. I’m wondering if that’s what you’re getting at.

Trevor: Yeah. Sure. Sure. Karma. So many people have hung onto this concept of karma. Get out of here. What’s wrong with doing something good and just in the name of good?

Sophia: I see what you’re saying. That takes me back to one of the things we do in our program is when we admit kids, we actually have an interview, right? So, literally, every person on the team, so the therapist, psychiatrist, medical director, clinical director, the social worker, nursing team is actually there the first hour that the kid is there. We’re really assessing how motivated they are to do it. Back to what you’re saying, it’s not about, “Okay. I want to do this for my parents.” We really want to dig deep and find out, “How does this make sense for you? Why would you do this outside of these external factors?”

Trevor: Right. I feel like when you go at morals and, sure, this is a piece of it. I believe it’s a big piece of it, but, sure, it’s a piece of it. If you go at morals just in terms of consequence, treat your brother or sister right or you’re grounded or no dessert for you or something like that. Then you’re creating a child that just sees good or bad as a consequence game.

Now, I am not getting on parents because the other problem with this is that because you either got single parents or both parents have to work at this point. There’s not a lot of time for that. Consequences are usually the quickest way to discipline a child.

Sophia: It might be a starting point. So, we think about helping people we call—

Trevor: I guess I’m saying parents sometimes don’t have the time to sit down for 20 minutes and go through the fog of war that is morality.

Sophia: Right. Right. We have to think about where kids are developmentally. Kids very early on may be more concrete. It may be easier for them to do what we would think of as adaptive if they know these are the consequences they’re facing. One hopes that as a kid progresses and the parents progress through ... I mean, kids are growing up. The parents are also growing up in a way with the kids. Parenting a three-year-old is not the same thing as parenting a 13-year-old or a 20-year-old, right?

So, one hopes that it becomes much more motivated by their own desire than, “Oh, mom or dad is going to wag their finger at me.” It is a starting point. So, even in our program, we do have a level system where kids can accumulate more freedoms, more privileges if they continue to practice the skills, to ask for help, to do what’s required of them. Granted it’s still one of the main frameworks of they’re committed, not because of us or because of parents to do this for themselves, but there’s also that external concrete part. I agree 100% with you. It can’t be the whole of it, but there’s a slight role of it to help people along.

Trevor: Right. The point I’m ultimately circling around to is that I did DBT for a few years, and what I was told, not by the person who taught my DBT, is that the reason I need DBT, the reason I have borderline personality disorder is that there were certain things in my childhood that I just wasn’t taught. Okay? You would agree with that?

Sophia: In a way, it is, because we’re approaching it as there’s a skill. We see it as a skills deficit.

Trevor: So, what didn’t I learn?

Sophia: I mean, not you, specifically.

Trevor: Yeah.

Sophia: What’s missing for some of our kids is the capacity to tolerate the stress, to address emotional difficulties in a way that does incur negative consequences.

Trevor: So, how do you teach a kid that?

Sophia: Well, we also teach the kid first to identify what they’re feeling in the moment, right? To get back to you, what is this initial experience? What are you sitting with, and what can we do to best address it? Right?

Trevor: Right.

Sophia: So, if the kid is feeling say fear, but they can’t sit with their fear, they might potentially lead with anger, right? We think of that as the secondary emotion, right? So, instead of admitting, “I’m really terrified of going to school today,” they’re potentially kicking and screaming and hurling insults or doing something that’s really ineffective, right? So, what we’re trying to get them in touch with, “What are you initially feeling? What’s difficult right here? What’s getting in the way of you asking for help before this behavior gets out of control?”

So, a lot of the things we’re teaching comes intuitively to other people, right? So, we’re effectively saying if they had these skills that other people could intuit, they would be able to better manage it.

Trevor: Okay. So, where does biology and chemicals, brain chemicals come into it? Because there’s also a medicine component to this as well. Is there a group of medications that are in the DBT category or is it all over the place depending on—

Sophia: Yeah. So, there’s no medication, and I would say not even a specific combination of medications to target DBT—

Trevor: It’s different for everybody—

Sophia: I mean, I’m sorry, to target BPD, right? Partly because—

Trevor: I wish there’s medication that target DBT so I could get through it easier.

Sophia: Potentially, yeah, because it’s hard, right? We’re asking people to do very difficult things. As physicians—

Trevor: It’s the hardest thing I’ve ever done—

Sophia: I believe that because we’re—

Trevor: One of the hardest things I’ve ever done—

Sophia: We’re asking people, “Hey, these behaviors that have been able to work for you really quickly, we’re going to ask you to stop doing that.”

Trevor: Oh, no, no, no, no. They never worked. I’m not making a joke. These behaviors never worked, but I didn’t know any different. So, the only thing I was taught is that these behaviors were wrong, and I should be ashamed of them. So, then I learned ... No, and not just me. I could have asked anybody else in the group. They pretty much felt the same way, the way we react to things we’re wrong.

So, in a way, we were ... No, not the lucky ones, but we’re hiding in plain sight. Instead, we reverted to isolation. I mean, why talk with anybody or socialize with anybody if my approach to things are such a disaster. Well, how is it that when somebody says something that hurt my feelings, I somehow end up being in the wrong because of the way I reacted. So, that’s an uphill battle.

Sophia: It is. So, we try really hard not to be judgmental because the way we see it is it’s all behavior, right? These are attempts to address pain. These are attempts to get through a really difficult moment, right? So, we really believe if our patients had an alternative, they would have used it, but in the moment, they just don’t have anything else. This is what they have to get them through that really difficult moment, right?

So, during that interview process, we try to figure out, “Okay. How is what you’re doing, how does it make sense to you?” Because on some level, there’s some sense in it, and that’s why they keep going back to the behavior, right? Maybe incurring really awful consequences, right?

There’s something about it that shifts something enough that gets them to keep going back to the behavior, whether that behavior is self-injury, substance abuse, eating, what have you, but they’re all geared towards, “How do I make this pain stop right now?”

So, that’s how we approach it with them because they’ve been judged enough. By the time they come to us, they’ve been through so much already, right? They’re feeling intense, sometimes shame, guilt, fear about it. So, we really try to put that aside and say, “How is this not working for you? Here’s an alternative.”

The difficulty, though, is because they’ve been doing these things for so long as we’re saying, “Okay. Put that aside and have this leap of faith and try something different.” It won’t respond the way the other things you’ve tried before, but our hope is that if you keep practicing what we’re teaching you, you may get to the other side of it. You may find that this is helpful in getting you through those difficult spots without making the problem worse for you later on, right?

That’s really the central theme to it. Now, I’m noticing that I’m getting away from your initial question.

Trevor: I don’t even remember my initial question because I’m so sick. So, let’s just move on. So, let’s talk a bit about you and your background—

Sophia: Sure. Yeah. Oh, now I remember the question you’re asking about the medication piece because I think this is important that there’s no single medication, right? The reason—

Trevor: Well, somebody needs to work on that.

Sophia: I agree. I guess I would say that two things. We do end up using medications because there are a lot of instances where people don’t just have BPD. They have BPD and severe depression, BPD, and sometimes even bipolar disorder, BPD and PTSD—

Trevor: I think that was the case with a lot of the people that were in my group. It just wasn’t BPD. We all had two or three things. I mean, that’s certainly the case for me.

Sophia: It’s very common that there’s a lot of co-occurring disorders, right? So, sometimes when we’re treating somebody who has BPD as part of a group of other disorders, we end up having to treat that, and there are medications for these co-occurring disorders. So, we have to make sure we’re appropriately treating the whole patient. So, we’re addressing the BPD with DBT, and we’re also addressing the major depressive disorder or anxiety disorders with medications.

The other thing, too, is sometimes even without the co-occurring disorders, we end up using medications as a way to decrease intensity. Sometimes while people are learning the skills, their moods can be so disruptive. The intensity can be so high. They’re effectively using mood stabilizers at times to take down the intensity just to give them a little bit of space to do the work that they need to do using their skills.

So, we try as much, at least in our program, to use as little medication as possible, but we also don’t want people suffering unnecessarily if they can get some relief from them.

Trevor: So, I was on meds when I got diagnosed, but the fact that my meds needed to be changed, and there were specific meds I needed to take to address my BPD and stuff like that, that resulted in a BPD episode. Do you see that in the kids like, “Oh, now I’m on medication”? There’s a whole shame associated with medication. Medication has the worst PR person I’ve ever seen in my life. Those commercials are embarrassing. I can’t even look at them because they’re just so shameful. I mean, I’ll never forget one of them. It’s just that bouncy ball with the face that jumps across the thing.

I was like, “What? Did a puppet comedian write this?”

It’s embarrassing. I would have friends who knew. It’s like, “Oh, are you the bouncing ...”

I’d be like, “Come on, guys. It’s not funny.”

Sophia: No. That’s such an important one—

Trevor: You see young kids. Hey, now you got a bunch of meds that you got to go on. I mean, I’m sure that’s an episode all unto itself.

Sophia: It’s definitely distressing, and you think about what time this is occurring to someone’s life, right? So, I’m really interested in how people, not just what the medications do to them in terms of alleviating their symptoms, but also how they see medications, how they see the medications in the context of their overall treatment, but then also how they see it impacting them as people.

If you take that, and you put it in a developing person, that might impact how they see themselves, right? So, I’m always trying to be sensitive to not seeing this as like, “You’re broken. We need to fix you,” but more of this as a tool to help you address things differently.

So, I have these conversations with patients, “How do you feel about taking psychiatric drugs?” Because people have feelings about this, and I think if you don’t address it, and you’re like, “Okay. Just take this for that, take this,” you’re missing so much about how people relate to this. You’re right. Sometimes there can be so much shame that kids end up not taking them, not following on the directions you’re giving them.

Trevor: I didn’t go on them till my early 20s. So many side effects that caused embarrassment, shame, all on their own, and they were all physical, skin problems, erectile dysfunction, problems with going to the bathroom, all sorts of things. So, as an adult, that’s difficult. As a child, especially a teenager when they’re going through a period where their body is changing anyways, and then you’ve got to toss all of this on top of it.

Sophia: Sometimes, the other thing, too, we also see weight gain, right? I mean, that’s a whole other thing. You think about how it could impact—

Trevor: Oh, at least 15 of this. Lauren tells me to exercise. I told her, “Get out of here. Get me off these meds, and I’ll drop 15. Like It’s no problem.”

Sophia: I say that because there’s so many—

Trevor: Look at this. This is embarrassing.

Sophia: There are a lot of side effects. You’re so right about tossing all of that in a teenager who is developing emotionally and physically—

Trevor: It’s got to be a nightmare—

Sophia: It’s hard—

Trevor: I can’t imagine it. I feel for those kids. I really do. I shot a video promoting one of the programs in 3East, and the kids were lovely. They really were, but man, my heart went out to them because I knew. I knew when the night comes around, and the dark demons of your mind come out, when you’re left alone and trying to go to sleep, that’s when it’s brutal.

Sophia: Yeah. They definitely struggle more in the evening.

Trevor: Hell yeah.

Sophia: Yeah. For sure.

Trevor: Everybody struggles more in the evening because that’s when you’re on your own. Even if you got somebody next to you in bed, you’re on your own.

Sophia: Yeah. There is definitely less structure. There’s just more time and more space to struggle later in the day. I want to say that’s the side effects. That’s why we are so careful. I mean, during the admission process, we really figure out, “What’s your understanding of these medications. Does it make sense for you to stay on them? What are we actually targeting?”

A lot of times, if we’re not on the same page, I won’t prescribe something, right? I want to make sure we’re 100% on the same page as to what we’re looking for in the medication. If we’re not seeing that, then it’s not worth keeping because there’s a risk to treating. I mean, there’s also a risk to not treating, but because there’s nothing I could potentially prescribe that doesn’t carry a potential cause that way, we want to be 100% sure that it’s worth pursuing, especially for kids who are still developing.

Trevor: Right. So, how effective do you see the program?

Sophia: I think it’s quite effective. I mean, I’ve been there since 2013. I say that because now I’ve been there long enough that I get the benefit of having kids who’ve been through the program, who are coming back, who have—

Trevor: Wait. What?

Sophia: ... who are coming back to visit.

Trevor: Oh, yeah. You need to clarify things like that—

Sophia: I do need to clarify that. Yeah. So, who are coming back. So, I get to see them on the other side of sometimes ... Sometimes they’ll say to me, “I’m still having difficult times. I’m still noticing sometimes having suicidal thoughts, and I can manage them.” So, back to what you were saying initially, it’s about coping and working with this. It’s really encouraging.

Trevor: Yeah, Sophia, but this is where I get angry.

Sophia: Tell me.

Trevor: It’s because the issue, we need the suicidal ideation to go away, not manage them. This is, in my opinion, effective treatment, but it’s still, in my opinion, unacceptable. The goal ... Do you know a person in your life that doesn’t have suicidal ideation? Doesn’t? Yeah, right? Sure. Right? So, we know it’s possible.

Sophia: Yeah. Absolutely. Yeah. In a way, that’s—

Trevor: I’m sorry to take you to task, but suicidal ideation, as somebody who has it all the time—

Sophia: I agree. I agree—

Trevor: ... it sucks, it’s horrible, it’s torture, okay? To teach somebody to manage it is not, it’s great, but it’s still not enough—

Sophia: I agree. I agree. I agree. I think I’m there with you wholeheartedly, and that’s why I am committed to what I’m doing. We could say it’s not enough and walk away from it, and to me, that’s not acceptable.

Trevor: I’m not saying you do it, and I’m not saying it happened at McLean, but I’ve seen that. Once you managed it, you’ll be fine.

Sophia: No, no. The reason I said that is to be honest and transparent.

Trevor: You’ve been honest and transparent.

Sophia: Yeah. I want to make sure that we know as much as we can what our kids are up against. You know what I mean? I don’t want to say, “Oh, everything goes away once you do this treatment.” It doesn’t. I think part of why we’re in this field is to keep working on this. This is important.

Trevor: It absolutely is. In that interview on New England Cable Networks where you were clearly far and away more well-versed and far more professional than the other people on that panel, you talked about how the gap between teenage women and teenage men, when it comes to suicide, the gap is starting to narrow. I wanted to clarify something that the suicide for women, that they’re using more lethal methods. Could you explain specifically what lethal methods means?

Sophia: So, one thing that’s been coming up is we’re seeing girls are sometimes using more hanging. I’m just thinking back to my training in early days. Most of the time, you would see more attempts for via overdose, and that’s still pretty common, right? So, I think the hanging definitely increases the lethality that we’re seeing because the methods are changing, and you know that a lot of times with adolescent girls, there’s a lot of attempts.

So, you have a population where the rule used to be boys were more lethal, but girls had more instances of attempts. So, you already have a population where there’s this increase in frequency of attempts. Now, you’re combining it with lethal methods. So, that’s pretty scary.

Trevor: So, I want to break off from lethal. We’re going to go down a little dark path, but are you seeing methods grow that are more born out of self-hate? I’m talking like ... I won’t mention his name, but my sister and I, very big fans of this musician in the ‘90s and 2000s, and he killed himself by repeatedly stabbing a pitchfork into his chest.

Now, the level of self-hate to do that, because even physically, I would imagine the first time you do that, your body would react in such a shocking way that you would stop, but the level of self-hate that he had for himself made him able to keep going until he died. Are you seeing methods of suicide grow that way or are kids ...? I’m not trying to say one way is better than the other, but I do think how a child or how anybody, their method of suicide says a lot about where they were at that moment.

Sophia: Oh, it definitely could tell—

Trevor: Was it quick? Was it painless or was it filled with a lot of pain?

Sophia: So, when we’re trying to figure out—

Trevor: I’m on fire today, aren’t I? I need to do more interviews when I’m sick. I’m on fire.

Sophia: So, I’m going back to the admission interview when we’re first sitting with that kid with the whole team—

Trevor: Sure—

Sophia: So, we’re going to detail around like, “Take us through that day. What was going on? What were the events that all culminated to this behavior? How much of it was impulsive, out of nowhere? How much of it was planned? What were you researching? What was happening there?”

Trevor: These are kids that made suicide attempts?

Sophia: Yes.

Trevor: Okay.

Sophia: Yeah. So, what we try to figure out is, was the behavior with the intention of ending their lives? Was it in response to an immediate stressor? Was it in response to a cue in the environment? So, the day, for example, see a mechanism and think, “Oh, I’m going to use that,” versus they had a terrible fight with somebody, and then that sent them down the spiral, and they responded by wanting to escape or feel differently by engaging that behavior.

So, not just beyond the method, but also what’s leading up to it because we’re really trying to figure out what makes this person vulnerable to engage in this behavior. What are the places we can intervene before it’s too late?

So, the part of this self-hate piece, I think it’s worth exploring. A lot of times, we see sometimes a lot of self-loathing, a lot of self-judgments, a lot of criticism. Unfortunately, that can increase the risk if the patient feels like, well, they’re getting more and more distressed, but they’re thinking, “I’m not worth helping. I’m not worth asking for help,” right? So, we’re losing opportunities to intervene when they’re increasingly more self-critical that way, unfortunately.

Trevor: They’re putting that self-worth in the amount of pain their exit should be because what they’re saying is that, “I am only worthy of this ... I deserve this level of pain.” I know it’s a difficult thing to talk about, but I think people need to start talking about it not just suicide, but how did they do it. Isn’t the act of cutting more than just self-mutilation? I mean, there’s an emotional factor in cutting that says a lot and much more than I think just needing to release pain. You got to really feel that you deserve this scar. That’s got to be there forever.

Sophia: It varies. I mean, I think part of—

Trevor: You’re right. I’m sorry. It does vary. It does vary.

Sophia: Yeah, because a lot of times, back to what we were talking about with DBT and the skills, one of the things we really try to maintain as clinicians is that curiosity because I think a lot of things can really make sense from our perspective because what you said around that self-injury makes so much sense, but we can’t be so sure until we really investigate it with that specific patient because people do these things for a whole variety of reasons.

Everything from, like what you’re saying, deserving punishing as a way of inflicting pain on themselves because they feel they deserve it as a way of releasing pain, as a way of feeling something, if they’re feeling really empty and numb, as a way of validating that pain of saying, “My pain, I can’t verbally express it, but if I see it physically, then it’s real,” right?

So, until we really break it down with each person, it’s hard to fully appreciate the function of the behavior. It’s not just with self-injury, but it’s really even the suicide attempts like figuring out, “What was the function of this attempt or this behavior for that person?”

Trevor: The function?

Sophia: The function. So, specifically, understanding with our patient what they thought would happen, how they thought it would help them. So, it could be anything from, “I thought if I made this attempt, if I die, then I wouldn’t suffer as much, or I wouldn’t have to deal with X, Y, or Z.”

So, for each person, it has a different significance that we have to figure out. That’s so crucial because if we don’t understand that significance, then it’s really hard to be helpful like, “What are they trying to do in that moment that we might be missing out on?”

Trevor: Do they answer you?

Sophia: Sometimes they can initially at the start of treatment, and sometimes it does take a while because they may not have the vocabulary yet, or they may not have sat long enough without the stress before behaving to figure it out because sometimes they’re so quick to jump into a behavior that they haven’t sat down to figure out just on their own what’s happening.

Trevor: They may not have the vocabulary yet or they maybe were never given the opportunity to explain the stuff—

Sophia: Yes. Yes, especially if they’re potentially met by judgment, right? So, again, we were touching on this earlier. If people are constantly saying, “What you’re doing is bad, bad, bad. Don’t do it,” then we’re missing the opportunity to figure out, “Okay. Why are you doing this? What is it that you’re trying to address by engaging this behavior?”

Trevor: Right. Okay. Let’s talk about you.

Sophia: Oh, God! Okay.

Trevor: Let’s talk about you.

Sophia: Okay.

Trevor: You came to Boston from where?

Sophia: From Florida, Miami, Florida.

Trevor: From Miami, Florida, and you went from Miami to Boston.

Sophia: Yes.

Trevor: Yeah. Prior to Miami, from where?

Sophia: From Liberia.

Trevor: From Liberia. Okay. What year did you leave Liberia?

Sophia: I think it was 1991.

Trevor: 1991. What was going on in Liberia at that time?

Sophia: So, there was a civil war.

Trevor: Okay. Can you give me a little more detail on that civil war for our audience who doesn’t know?

Sophia: Sure. So, I was born and raised in Liberia. Both of my parents were from Haiti. So, my parents just went to Liberia to work, and they end up staying there until the civil war broke out.

Trevor: What kind of work do they do?

Sophia: So, my dad is an architect, and my mom is a secretary. Fresh out of school, he was offered this position to renovate some buildings, and he was like, “Sure. Why not?” He didn’t speak any English, which is problematic because Liberia is English-speaking, and he just went on this adventure. My mom followed. Instead of being there for a couple of years, they end up being there for well over 10 years.

Trevor: Did you go to Liberian schools, or did you have a special school for kids that ... I mean, a friend of mine who grew up in India, she ... Oh, no. I’m sorry, in Indonesia because her dad worked for Nike or something, she was educated with other kids whose parents worked for Nike.

Sophia: Right. So, it’s along those lines, but not exactly. So, I did go to school with other expats. So, I didn’t even go to an English-speaking school. I went to a French-speaking school that was run by the French embassy, and all of my classmates were European or from everywhere else but Liberia.

Trevor: So, you have Haitian parents. You’ve got French-speaking students, and then you’re in an English-speaking city in Liberia.

Sophia: Yes, pretty much.

Trevor: Okay. That—

Sophia: Makes no sense.

Trevor: Yeah. No. It’s not that it makes sense. I think it means that you’ve probably been exposed to the cultural gray zone very early—

Sophia: Yes.

Trevor: ... which I think puts you way ahead of the curve, in my opinion.

Sophia: Oh, yeah. It was an interesting experience because nowhere felt quite right because at home, I spoke French with my parents, but I spoke English—

Trevor: We’re going to get back to that nowhere felt quite right.

Sophia: So, I spoke ... I had a feeling. So, I spoke French with my parents, and I spoke English with my nanny, and then I spoke French in school, but then would sometimes speak English with my classmates, but that was against the rules. So, it’s me against—

Trevor: It was against the rules?

Sophia: Yeah. We’re not allowed to speak English on campus.

Trevor: Okay. So, what English names did you call your teachers to their face that they couldn’t understand? Because they didn’t have the internet.

Sophia: Yeah. I wish I had been creative enough to do that, but then my parents spoke Creole with each other because they’re Haitian. So, they insisted on sending me to this school because their family, my extended family is French-speaking. So, this was their way of making sure they had kids that could communicate with the rest of the family. The reality is that it meant I was living in an English-speaking country and didn’t know how to read and write English.

Trevor: Really?

Sophia: So, I could only kind of speak English, and it wasn’t English I’m currently speaking. So, it’s much closer to a dialect, if anything. We called it street English. So, it was definitely an interesting experience—

Trevor: I want to ask you to give me examples, but I’m not. I just say I want to, but I’m not.

Sophia: Okay. Yeah. So, it definitely was living in different worlds. In my neighborhood, my neighbor to the right was a Lebanese man married to an Egyptian woman. Then across from me was a Chinese family, and then on the other side was a Filipino family. So, it was interesting because most of my classmates, I was the only Haitian person I knew in school, right? I was also in most of my classes the only black person in my class just because of what was happening.

So, it was always this interesting experience of being the other constantly no matter where I found myself. It was something.

Trevor: Yeah, but you learned how to navigate it.

Sophia: I did.

Trevor: Okay.

Sophia: I did—

Trevor: How did you learn how to navigate it?

Sophia: I was very good at picking up the accent of whoever I was around the most. I think it helped me fit in wherever I was and adapt really quickly.

Trevor: Like Leonardo DiCaprio in The Departed. He hung out in the north shore, and then on the weekends, he dropped his “r’s” on the south shore, and fit right in, huh?

Sophia: Yeah.

Trevor: Yeah? We could send you undercover, can’t we?

Sophia: Definitely. Yeah. So, I think because I was used to being in different worlds constantly, there’s a world of at home with my parents, there’s a world with my nanny where I would speak English with her, and then there’s a world of being at school where I had to constantly speak French, but it all helped when I came to Miami because there is this whole other mixture of worlds there, too, but it was definitely an education in being Caribbean, in being Black, in being American. It was eye-opening to be in that situation because when I got plopped into a public school in Florida, the African-American kids were like, “You don’t sound like us.” They would call me all kinds of names. I mean, I was viciously bullied in middle school and high school.

Trevor: It sounds like to me, not even by choice inadvertently, it sounded like you were raised in the gray zone.

Sophia: Yes, 100%—

Trevor: That puts, I think, gave you a leg up on a lot of things, where it’s maybe when you are helping these kids, it’s not professional to give your background, okay—

Sophia: Right. Absolutely.

Trevor: You got to have the line—

Sophia: You do—

Trevor: You got to have the line. I’ve been in therapy long enough where I really respect the line. I really do.

Sophia: Yeah. Absolutely.

Trevor: I’m sure the kids can sense. I can sense it. We talked about this on the phone. I hadn’t even met you in person, but I could sense, I could feel that even if you didn’t know what I went through, you feel or felt what I feel, you just have the tools to navigate it, and I don’t. I’m not trying to say that ... Good for you for recognizing that and bringing your skills to other people who don’t because you could have gone in a completely self-serving direction. I’m sure, because you’re human, I’m sure there are times where you’re like, “What the hell am I doing? I could be a super-agent.”—

Sophia: Oh, my God!

Trevor: Yeah. “I could be ...” So—

Sophia: Especially with the accents, I mean, I could be—

Trevor: Yeah. How many languages can you speak? You told us so far three, and I’m talking—

Sophia: Three.

Trevor: Okay, but then there’s also some—

Sophia: Well, I speak Creole, Haitian Creole, and I speak French, and English, and I understand a fair amount of Spanish, partly because it’s close to French, but really because I lived in Miami for 12 years.

Trevor: Right.

Sophia: So, that definitely helps quite a bit. Yeah.

Trevor: So, Boston?

Sophia: Yes. Oh, my God!

Trevor: Of all places?

Sophia: Yes.

Trevor: This nightmare of a city, which I love. I’ve always complained about this city, but I keep coming back.

Sophia: Absolutely. Yeah—

Trevor: You like it.

Sophia: I love it. I do.

Trevor: That’s so crazy.

Sophia: Yeah. That’s what my mom says—

Trevor: I think you’re built for it.

Sophia: Yeah. I think so. Yeah.

Trevor: I mean, my situation a couple years ago in San Diego, I thought I was heading to paradise, and, really, it was not the case. I think a lot of people coming over here, “Oh, I’m going to the ground zero of intellectualism and art,” and stuff like that, and then they get here, and they realize that some of the most educated people that they meet, some people that they might assume to be the most open-minded person are also the same people that would probably be the most sexist, to most likely call them the N word, be racist because this is the most liberal racist town. This place is wild. It’s the Wild West when it comes to ideologies.

Sophia: It’s something.

Trevor: Yeah. There’s something in the water.

Sophia: It’s true.

Trevor: Yeah. I love you, Boston. I really do. It’s just this place is wild.

Sophia: Yeah. I’ve had some interesting experiences here.

Trevor: Sure you have. We all have.

Sophia: Yeah, and I still love it. Yeah.

Trevor: What did I say during the pre-interview? I said, “Well, you must have experienced the civil war if you can not only tolerate this but want to stay here.”

Sophia: Yeah. Absolutely.

Trevor: You actually didn’t disregard it. You were like, “Wait a minute. Yeah.”

Sophia: Maybe. Yeah.

Trevor: So, what did you see in that civil war?

Sophia: So, I mean, it was gradual initially. The way it started was we’d get newspaper. This is before social media and stuff. So, there were these articles of people running away from their villages. I lived in the capital, in Monrovia, but there’s increasing stories of people being harassed in their villages, of people being killed, and it felt far enough away. My dad was—

Trevor: How far away was it?

Sophia: It’s hard to say because I was 10 at the time, but it felt far enough away that it wasn’t impacting our daily life. So, my dad was like, “Oh, it’s fine. It’s going to blow over. It’s okay.” My mom was getting increasingly worried. So, we went from it feeling far away to one day we drove to school, and we got turned back. The school was closing. So, at this point, the French government was recalling their workers because they felt like the situation was unsafe. So, that was the second red flag like, “Wait a second.”

The third red flag was ... I’m sorry. That was the third flag. The second red flag was before school closing, my mom pulling my sister aside and me and saying, “Look, if you hear these noises, loud noises, I want you to get on the floor.” So, she was preparing us for if we’re caught in a crossfire, which was ... I think about that now, and I say why, but now, she was telling me, she was like, “Get really close to ground if you hear, essentially, gun fire.”

Then a few weeks later, the school closes down, and then—

Trevor: I love how we put education over child safety. It just blows my mind. It really does.

Sophia: It’s something.

Trevor: It really does.

Sophia: I mean, I think about that—

Trevor: School shooting is exactly where they keep sending their kids. There’s bombs going on, keep sending your kids to school.

Sophia: I think about that. Yeah.

Trevor: The girl from Sweden, Greta, what’s everybody? Go to school. You should be in school. This girl is out saving the world, but she should be in school.

Sophia: Yeah.

Trevor: It’s ridiculous.

Sophia: So, I mean, it’s something how on the one hand I think they’re trying ... The thing is I’m not in my parents’ head, but I think on the one hand, they’re trying to preserve some normalcy during that time, but then also trying to figure out how to be safe. So, my mom was simultaneously preparing us if something goes down. She was also conserving tons of food in the house. She went to the American embassy. She got us visas, a five-year visa if we needed to leave the country. This woman did everything in her power to get us out of that country.

My dad was like, “It’s fine. It’s going to blow over.”

Then next thing we know, we’re sitting at home on a weekend, and the government soldiers come and tell us to leave the house. They claimed that we’re hiding somebody in the house. This is the ruse—

Trevor: Were you?

Sophia: No. No. This is how—

Trevor: Not that I would judge.

Sophia: No, no, no, but this was their ruse of how to get into people’s homes, take their food, take their resources. So—

Trevor: Well, that’s terrible.

Sophia: They ended up kicking us out of the house, and then we ended up at my godmother’s house. From there, we get caught in a crossfire. So, for the next several months, there’s no running water and no electricity. We’re basically in a war zone at this point. Every day or so, my mom and my nanny would sneak off from where we’re living to go to our original house and gather food because my godmother didn’t have any food. So, for the next several months, all the food we’re living off of is the food that my mom had stored away.

It’s only in the middle of one of those days where they were shooting I think from 9:00 in the morning to 3:00 in the afternoon. At this point, the house was, there were bullet holes everywhere, and my dad looks at my mom, he’s like, “I think you should have taken the kids and left the country.” I think about him like, “Dude, it took you this much to happen before you realized we should have left.”

Next thing we know, we’re kicked out of the house, and we’re basically roaming the streets, and the streets were littered with shell casings, littered with bodies. The only other people who were there are the soldiers, who were manning these fake checkpoints along the way, but there’s nothing else. Imagine a ghost town. All you have are bodies, shells, soldiers along the way.

Trevor: So, when you see half the city having a nervous breakdown because Tom Brady got sacked in the game, it’s a little ridiculous to you, isn’t it, as, excuse me, Boston, it should be.

Sophia: I still love you, Boston.

Trevor: I still love you, Boston.

Sophia: Definitely, I mean, that’s where I saw quite a bit, that long walk of finding shelter because the curfew was happening. So, past a certain time, you couldn’t be outside, and we had nowhere to go. So, at this point, the firing had ceased a little bit, and we’re looking for shelter. That’s where I saw quite a bit.

We find shelter, and then we’re stuck there for a few weeks, caught in another crossfire, and that’s when my parents were like, “We need to leave. If we don’t, we’re either going to get killed in this, or we’re going to starve to death because we ran out of food.”

So, we walked several towns ahead to the American embassy. That’s where we evacuated. So, because we were foreign nationals, we weren’t Liberian citizens, so despite the fact that I was born in Liberia, but my parents are Haitian, we got rescued out of Monrovia. So, we got evacuated out of Monrovia, dropped into Sierra Leone, where we knew nobody, and then the Red Cross rescues us, and helps us connect with our family in—

Trevor: Hell of a story.

Sophia: It’s something.

Trevor: Hell of a story.

Sophia: Yeah. So—

Trevor: So, what I want to get to is let’s connect the dots here. That perspective, especially seeing that as a child, how do you bring that into your work?

Sophia: The first thought that came to my mind when you said that, it ebbs and flows in a sense that sometimes it’s more present than others. It allows me to really challenge myself because I have to be honest. When I first came to America, it was hard to relate to my peers because what you said about the Tom Brady thing, how do I connect with a 14-year-old when I’m 14, who is really struggling because their parent can’t buy a name-brand sneaker. Meanwhile, as a 14-year-old, I’m working really hard not to make my parents worry. I felt very responsible to not add to my parents’ worries during that time.

Trevor: I want to just interject. It took me a long time too. Not that I came from what you came from, but it took me a long time to realize that a child who’s having some sort of emotional breakdown or suicidal ideation because their parents can’t buy them the latest sneaker, I mean, I would resent them. Sometimes I still do in my contemporaries, but I had to realize that if you were raised in an environment where you feel it’s imperative to chase the next best thing, that does sound like hell.

Sophia: It does. It is hell. Yeah.

Trevor: Yeah. That does sound like hell.

Sophia: That’s one of the reasons—

Trevor: Then we have a media that glorifies that with Kylie and all this stuff.

Sophia: Yeah. It took me a little bit of time to ... and I think the difference between—

Trevor: Nothing against Kylie. It’s just—

Sophia: It taught me the difference between experience, education, and wisdom because I think I had experienced then because I had seen quite a bit of stuff that other people my age hadn’t seen, but I didn’t have the wisdom to understand that given that context, it makes sense that they would be struggling even at that point in my life I couldn’t relate to it.

So, I think in my work now, I think about maintaining that compassionate curiosity of saying, “Okay. Maybe if it feels really different from my experience, how does this impact that person’s capacity to feel like they can cope? How does it impact their level of suffering even if it’s in the context that’s really removed from my own?”

Sometimes it is helpful because I’ve definitely had kids who’ve experienced pretty traumatic things in the context of terrorist attacks at home and other countries, right? That’s allowed me to really be with them in a way that I don’t think I would have been able to if I hadn’t had this experience. So, I think that’s been really valuable to me that I can make use of something that was really painful for me, and be present with them, and really validate what does it feel like to be in a place and hear missiles going overhead, what does it feel like to go a whole night hearing gunfire, to have that sense of safety ripped away for weeks or months at a time, which allows me to do with some of my patients even if I don’t ever share my experience with them.

Trevor: Right. We interviewed an individual, an individual who is actually a friend of Lauren’s, who I wouldn’t say was raised in poverty, but was raised in a rough situation. I don’t know. Would we say poverty? Yeah, we would say poverty. He was street dealing at five.

Sophia: Wow!

Trevor: He was the only breadwinner in his family right here in Brockton.

Sophia: Wow!

Trevor: He would get paid out in hundreds, and he didn’t even know what he had in his hand. All he knew is that if he walked down the street and gave this person one of these hundreds, they would give a piece of pizza, and a bunch of change that didn’t mean anything and pocket it. Obviously, this child developed a lot of problems that he was lucky enough to find help and is now an outspoken advocate. He’s great.

There’s a hell of a lot more like him out there. What we’re finding out now is that it’s not just minorities of all kinds, it’s the financial shift as poverty grows. If anything, poverty is the great equalizer. I say that with sarcasm. How do we reach those kids that can’t get into these programs? I’m not accusing McLean, but there’s a whole lot of kids out there that are suffering probably from BPD. What do we do? Because the BPD numbers are growing, right?

Well, at the very least, a lot of—

Trevor: ... or among the demographics that we know of.

Sophia: Right. I mean, I think the level of distress is growing for our kids.

Trevor: The level of stress is growing.

Sophia: Yeah, and their distress overall is growing. I think we’re living in really uncertain times. I think there’s a lot of stressors. I mean, even without the uncertainty, I think being an adolescent now is just much more stressful.

Trevor: Hey, if I grew up knowing that the end of world was coming, I’m sure it would affect whether I was really excited to watch “Full House” on Friday night or not. I mean, it really would.

Sophia: The moments are harder. I mean, I think schools are much more competitive. There’s just so much that they have to juggle. I think—

Trevor: Right. At the end of the day, if you take stock in your life, “Why am I making all of this sacrifice? Why am I working this hard when this is going on?” Whether you believe ... I’m not trying to make a political issue. Whether you believe it or not, whatever, there’s some people that ... There’s people that believe it. I believe it. That’s got to be, if your child believes it, that’s got to be a monumental existential crisis.

Sophia: Yeah. There’s quite a bit of uncertainty, and I think, in a way, that feels different to me as a clinician in a sense that we’re sharing. I don’t feel like it’s just my patients dealing with that uncertainty. I think we’re all in this heightened state of worry in a way, regardless where you stand on the issue. There’s just a lot that needs to be resolved and figured out.

Trevor: Right, but we’ve been trained to still get up and go to work, and to pay our bills, which I’m starting to wonder if that might be part of the problem, but that’s a whole another five podcasts on its own. So, you got kids growing up in poverty, in neglect with rhetoric of the world crumbling around them. How do we reach those kids?

Sophia: My first thought in thinking about this question is this is where I think as clinicians our role increasingly isn’t just treating the kid in front of us, but it’s also becoming advocates in a way, speaking outside of our offices because those conditions aren’t just mental illnesses that exist in a vacuum outside of systems, right? How are we contributing to the school system? How are we contributing to things like after-school care? How are we contributing to the economic system?

I mean, I think these are, again, complicated problems that sometimes we have this desire for simple solutions, but there isn’t one. I think this is where clinicians, me included, could raise our voices and say, “As a clinician, this is how I know it’s going to impact the kid.” Not having free school lunch, not having access to basic things does impact our overall mental health.

So, I think it’s hard. I do work in a program where the reality is it’s not accessible to everyone. We work very hard to educate, to spread the word about DBT, and I think more could be done to advocate for everybody.

So, it’s not a satisfactory answer. It’s not one that I’m happy with, but I think we can do more outside of our individual offices. This is where I think some clinicians might veer into more advocacy or even politics, honestly, to impact policies and impact the system in a much larger way.

My work is intensive enough that I try to do the best I can within my little bubble, but I think speaking to you and speaking to others is my beginning of advocating and speaking outside of my office.

Trevor: Yeah. Again, I try and stay in the middle on this show, not in my life, on this show because I want, no matter what you believe, I want you to know if you’re suffering, we love you. That said, and I won’t say this person’s name, there’s a certain somebody in the political realm that you and I are a big champion of, and I haven’t heard rhetoric come from this person’s mouth regarding these topics or at least in this much detail, and I keep waiting and I keep waiting, and I’m getting frustrated, but then I realized, “Well, wait. Maybe it’s on me to reach out to this person and say, ‘Hey.’”

Sophia: Yeah, “This is important.”

Trevor: It’s not that they’re not listening. I’m sure there’s a million people hitting this person right now with all this stuff. It’s going to be my responsibility to keep hammering away, not hammering. Well, you know what I mean, to keep sending that letter, to keep sending that email, to keep making that phone call, and say, “Hey, this is big.”

Sophia: It is big. Part of the reason I went into psychiatry was because I feel like it touches everything. I mean, I think, and I’m biased, but I think psychiatry is the ultimate place, the biggest, most vulnerable place you can impact somebody’s life.

Trevor: Right. There’s this ... It’s a strange example to bring up because it was directed by a filmmaker, written and directed by a filmmaker who is reputably known for sexual assault, but there is a film by Roman Polanski called, it’s going to sound funny, but the proper pronunciation is “The Pianist.” It was about a piano player during the Holocaust who somehow made it out, and there is literally scenes where soldiers just missed him by inches all the time.

You start to realize that there is this, at least what the film is saying is that there’s this somebody, that’s just how the world works, is going to slip through the cracks and get out, and that was this person’s legacy was to slip through the cracks of all of this horror, and all of this genocide and get out.

Now, it’s the only example I can think of, but I think of your situation where you’ve been all over the place, with all these different factors, and it could have gone bad—

Sophia: Absolutely.

Trevor: ... in so many different ways—

Sophia: Absolutely.

Trevor: You were the factor that got out. Instead of, sorry if it’s a little hero worship, but instead of going and being self-serving, you went out, and you’re helping other people. Are you hearing me, people? I mean, this is important work that she’s doing. She’s coming from a place that isn’t self-serving. You’re making impact. So, is there anything you would like to add before we wrap up? You want to take a victory lap?

Sophia: Oh, my God!

Trevor: High-fives all around?

Sophia: No. I’m definitely grateful for the opportunity to talk about 3East.

Trevor: We’re grateful for having you here.

Sophia: Thank you. It’s an amazing place to be, and I think what we do want to keep working on is how do we make it better, how do we reach more people because it’s a hard thing. It’s really hard.

Trevor: Before we wrap up, I want to tell a little story about, and we only realized this. I actually met Sophia a few months ago. We did an episode with Blaise Aguirre regarding that absolutely reprehensible TV show, “13 Reasons Why.” There was a very nice retirement dinner, and I was there filming the dinner. I’m trying to do my job. Blaise, I’m walking by because I’m trying to ... I don’t know why. I’m trying to set up a microphone or something, and Blaise, “Trevor, Trevor. Stop, stop, stop, stop, stop, stop, stop.”

He’s like, “I need you to meet Sophia.”

You’re sitting next to him, and he’s like, “She’s brilliant. She’s one of the most brilliant people out there.”

You heard the words. He’s like, “She’s going to take this place.” We just looked at each other, and I’m like, “I got a job to do.” You’re looking me like, “This is embarrassing.”

Sophia: I know.

Trevor: I’m like, “Hi. Nice to meet you.” Now, you’re here. He’s right. He’s absolutely right—

Sophia: Thank you.

Trevor: Blaise, keep them coming, okay? With your recommendations, keep them coming. You’re sending us winners.

Sophia: Oh, thank you.

Trevor: Thank you so much for being on the show. Okay. Lovely to have you.

Sophia: Thank you.

Trevor: Thank you.

Sophia: Thank you.

Trevor: Okay. What did you think of that? She is a blast. She’s a lot of fun to talk to. Hey, if you’re listening, you used to be treated by Sophia, she’d love to hear from you. At the end of the interview, I really talked her up. There might have been a hero worship there, but it’s sincere.

Oh, no. When I go all hero worshippy on the guest we have on this show, I genuinely mean it. I hope it comes across as genuine. I really meant it. She could have done anything with her life, and she’s choosing to help. It’s amazing. I really admire that. She’s choosing, like I talked about earlier, that I’m forcing to comparison. It really doesn’t work, but she’s making the choice to help. She’s not overwhelmed by it.

She’s doing something about it. Whereas, me, I’m too overwhelmed to do anything about it. When am I going to give myself a break? Okay. I’m going to go and take some more cold medicine and sleep for another 12 hours and, hopefully, this wretched thing will go away. Fingers crossed. Two weeks, two weeks. You guys gonna come back in two weeks? I hope so. I miss you already. I miss you already. Come on back in two weeks. Remember to review us. We’re on that Pocket Casts app now. It’s pretty dope. We’re all over the place.

Leave a review. Tell us what you think. Send some feedback. We’re coming up on our one-year anniversary soon. So, one year might be a good time to shake things up. If you have any feedback, feel free to send it. Anyways, two weeks. Thank you for listening to Mindful Things, the official podcast of McLean Hospital. Please subscribe to us and rate us on iTunes or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

- - -

The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

© 2019 McLean Hospital. All Rights Reserved.