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Join us as we dive into a conversation with Christine Gibson, a family physician and trauma specialist. Christine shares her expertise on dissociation, trauma, and the profound impact they have on health care. Discover the importance of reconnecting with our humanity and the healing potential that lies within trauma recovery. Gain valuable insights into addressing dissociation, prioritizing self-care, and fostering interconnection in the medical field.
Christine Gibson is a family physician and trauma specialist.
She shares her story and discusses her KevinMD article, “Why doctors are experts at dissociating.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Christine Gibson. She’s a family physician and a trauma specialist. Her KevinMD article is titled “Why doctors are experts at dissociating.” Christine, welcome to the show.
Christine Gibson: Thank you, Kevin. It’s a pleasure to be here.
Kevin Pho: All right, so before we get into the article, just briefly share your story and journey to where you are today.
Christine Gibson: Yeah, I mean, it’s been tumultuous. We just discovered we have roots in Toronto. I did medical school there, graduated in 1999, and then moved to Calgary, which is in western Canada. So I’m a family physician in the truest sense of the word. I worked in the emergency room, I did 16 years as a hospitalist, so inpatient adult medicine, and I became the residency program director of the health equity residency during that time. I actually created it, and I did a master’s in medical education.
I moved into community practice only about six years ago. Because I’d run the residency in health equity, I had some understanding about the issues underlying equity, but it wasn’t until I moved into being a community family physician at specific community health centers that I understood the roots of everything I was seeing were deeply embedded in trauma. And I thought, one of the things that I think burns physicians out is when we feel hopeless about something, and because we don’t get a lot of training in how to manage trauma, I thought, “I’m mid-career. I can take a really deep dive.” So yeah, I became a trauma therapist. I took years and years and lots of certifications; we call it the alphabet soup. And so I’ve been working at our refugee clinic, in adult addictions, and with some of my previous family practice patients.
There’s a young person in my life, Aishwarya, and I’m actually here in Washington with her. She said, “You know, one of the things that you do really well, because of your background in education as well as mental health, is explain these complex subjects.” And so she convinced me to join TikTok in January 2021, and within six months it had blown up. I had about 60,000 followers then, and I started to get approached about writing a book. So now I’m at 130,000 followers, and my book came out two weeks ago, The Modern Trauma Toolkit. So that would be the quickest journey, the highlight reel.
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Kevin Pho: All right, well, congratulations on your book. I’d love to have you come back on again, and we’ll certainly talk about that. So talk about that intersection between TikTok, your background as a trauma specialist, and how that helps health inequalities. Give us a story or an example of how you move the needle there.
Christine Gibson: Well, I mean, when we’re in medicine, we get told that academic work and knowledge translation happen between us and the academy, and we publish in academic journals, interact with our colleagues, and give keynote speeches at conferences. I’m starting to recognize that a very important aspect of KT, knowledge translation, is how we disseminate information to community, and I think that’s an equity issue when it comes to knowledge. So TikTok is such an amazing way for us to do that. I mean, I also write Substack articles, and I used to do a podcast. There have been a lot of ways that I think we can engage community in the conversations that we’re having.
One thing that’s really been speaking to me recently, and I’m trying to figure this out in a doctoral program that I’m doing in autoethnography, so kind of like the study of my own public works, is: When do I show up as an expert, and when do I allow community to be the expert? And I think TikTok is such a perfect intersection for that. It’s just been a really good embodiment of community expertise. I’ve learned so much on there, and it’s just been a really great place of sharing. It’s also a place where there’s a lot of anti-oppressive dialogue, and I don’t really feel like that’s predominant in medical spaces, so I feel really comfortable there.
Kevin Pho: So give us an example. What do you mean by anti-oppressive dialogue? Give an example of what that is for those who aren’t familiar.
Christine Gibson: There’s just a lot of advocacy work on TikTok. I guess one example would be that there are a lot of people who are exposing child trafficking: how it happens, what it looks like, what grooming looks like, and what it looks like when people put their children on social media and all of a sudden they have tens of thousands of older male followers who make inappropriate comments on videos of the children. This isn’t something I had ever heard of before or been able to pinpoint, and now I can’t unsee it.
There’s one woman who’s called the White Woman Whisperer, and she tries to highlight when white women get it right. She’s a Black-identifying person, and she’s trying to say that white women often get it wrong, but we can also get it right, and she highlights what that looks like. There are a lot of people who are just showing us what’s happening in other parts of the world. I learned so much about the Iranian revolution there, and because it’s in video and because it’s in real time, it’s access, and an understanding, that I wouldn’t have had prior to joining that platform.
So yeah, I find it really fascinating, and I can see why they want to shut it down, because there is a subversive element to it. People are interested in deep systems transformation, which is something that I have also studied academically. I’ve done certification in social innovation and design thinking, but TikTok is an element of where that takes place.
Kevin Pho: All right, let’s move on to your KevinMD article. You talk about “Why doctors are experts at dissociating.” So tell us, how did your article come together?
Christine Gibson: I think it was when I was doing my reflection in my doctorate. I started to understand the traumatic experiences that we go through in training and clinical practice. When I was a hospitalist, I would work up to 100 hours a week pretty often; that was just the general expectation of the job when you included night shifts. And I started to dissociate from my own body messages telling me when I needed to eat or when I needed to sleep. I had to learn to suppress those messages.
When I started to do the doctorate, I realized that it wasn’t just physical suppression. There was also this psychological suppression. A patient dies and you don’t have any time to process. There’s no procedural processing. You literally have to go to the next room, because your metric is time: time to see patients, time to discharge, time to admit. You’re always running on this clock. And I thought, we think of ourselves as this expert, but in actuality we’re also experiencing a lot of physical and psychological harm that we don’t tend to talk about very often.
That conversation really interests me, with people who are willing to talk about it, because part of my purpose is systems change, and I also think that if we don’t acknowledge the systems that harm us, we continue to harm others. The more that we propagate these harmful practices as practitioners and as a self-regulating profession, the more that becomes the norm, and the more our profession becomes burned out, ill, and not equipped to handle major bumps in the system, things like a pandemic.
Kevin Pho: So you said that the systems that harm physicians also help harm patients as well. Tell us some stories or examples of how that could be.
Christine Gibson: Well, I think, and I’ve seen articles on KevinMD that highlight some of this, we become complicit in a system that can gaslight folks. So let’s just use long COVID as an example. We don’t understand the mechanisms well, and there are probably multifactorial physiologic processes behind long COVID, but because we haven’t elucidated that yet, it’s easier for us to turn the shame we feel, because we’re supposed to know things, about a presentation that has undifferentiated symptoms and reflect that back on the patient, making them feel ashamed for showing up with something we can’t define or manage.
I think that’s part of that dissociation: We need to manage our own shame, but we also need to manage our complicity. There’s deep systemic racism in medicine against many racialized communities, but there are also systems of repression baked in against folks who are just otherwise different, like neurodivergent folks. They’re constantly talking about the medical trauma that they’ve endured at the hands of physicians and care workers, and that’s a conversation I’m really grateful to be a part of on TikTok, because I learn a lot from it. And the more that I learn, the more that we can change systems, for those of us who have that leveraging privilege.
Kevin Pho: So this dissociation that you talk about, physically, mentally, and emotionally, how does that impact you yourself and other physicians who go through that?
Christine Gibson: I mean, I’m still really in a stage of self-reflection around that question. One of the things that I highlighted in the article was just that loss of our sense of interconnectedness and humanity. There is great suffering that we’re dealing with on a daily basis, and one of the ways that we often cope, as a survival strategy, is to not really feel like we’re enmeshed in the suffering of others. But we are still really dealing with it on a daily basis, and I think we need practices to release our sympathetic tone, because the stress of the job, not just the physiologic stress but the psychological stress, can throw us into a constant state of sympathetic nervous system overload. When that happens, we can get irritable, we can even get angry and resentful, and then that spills into our family, our community, and our teaching.
A lot of preceptors can really take that out on their residents when they’re stressed, and honestly, when I reflect, I know I did that. If I was working 100 hours a week, did I show up as a teacher with grace and with patience? Not every day. I mean, obviously I strived for that, but I wasn’t showing up as my best self, or as patient, for learners. And I really think the more that we allow ourselves to self-reflect on that, the more we can encourage systems transformation.
Kevin Pho: So let’s talk about next steps in terms of what physicians can do on their own and what type of systems transformation we need to help address dissociation.
Christine Gibson: Well, with a lot of my work in the world, I feel like I’m at the halfway mark in my career, and the doctorate was really a milestone where I would do that deep autoethnography and say, “Well, what are my next steps?” So what I’m trying to work on within the profession is a couple of things. The book that we mentioned, The Modern Trauma Toolkit, helps physicians understand the trauma response. We think we understand fight and flight, but there’s just so much more. I mean, I don’t know what year you graduated. I was ’99, so it was before we understood the implications of the ACE study, the adverse childhood experiences. We had no understanding of epigenetics. It threw everything I took in undergrad out the window. And with the way that people are more open about their differences, I think all of this gives us an opportunity to be a part of that conversation and change.
So my book really does highlight all of these areas. It’s a very deep understanding of toxic stress, but written in a very accessible way, so medical students could certainly appreciate it, and definitely patients.
The other thing I’m doing is starting a company called Safer Spaces Training. As a self-regulating profession, we’re not always showing up as trauma-informed in the spaces that we create and that we’re a part of, and we’re not always able to recognize the responses related to toxic stress in others. We always default to “What’s wrong with you?” instead of “What happened to you?” which is a more trauma-informed question. So this company that we’re co-founding is helping self-regulated professionals really understand what it’s like to have safer communication strategies, develop skills in psychological first aid, and be able to hold trauma-informed spaces, especially in DEI work. So that’s a company we’re getting off the ground too.
I really think we have this ability to leverage our privilege for systems transformation, for those of us who have the energy to do it, and I’m very driven in that direction. So I’m trying to think, “Well, what does KT look like? What does professional regulation look like? And what does it look like to bring these ideas into systems change?”
Kevin Pho: So short of reading your book and taking the course, give us some specific ways that physicians can effect change.
Christine Gibson: I’ll give you a really specific example. When I was working at the community health center, one of the things that I did was create a patient advisory council, and they created their charter of expectations, kind of like a charter of constitutional rights for the clinic. They just said, “This is the way that we would like you to show up. This is the way that we would expect to be held accountable.” And they created this at a very grassroots level.
I also created a social innovation lab, where I would bring in people with a lived experience, say chronic pain or mobility challenges; trauma was one of the labs we ran. We ran a social innovation lab in the clinic, and people looked at their biggest obstacles, their biggest barriers to health, and we troubleshot those from multiple system levels. We applied for grants to get things funded and off the ground, just in ways of thinking about the true biopsychosocial nature of health and the holistic, comprehensive context where health takes place. Patients have that lived experience and understanding, so there are lots of ways to bring them into dialogue. So my book isn’t just about how you regulate your own nervous system. It’s also about what you can do at a community level, and there’s so much we can do.
Kevin Pho: We’re talking to Christine Gibson. She’s a family physician and a trauma specialist. Her KevinMD article is titled “Why doctors are experts at dissociating.” Christine, tell us some next steps in terms of what you’re doing to help with this issue of dissociation and trauma-informed care.
Christine Gibson: Well, I’m trying to speak to more and more physicians. I really think that the more that we learn our own interoceptive strategies, like what are the signals we’re still listening to and paying attention to, and what are we doing to self-regulate, the better we’re going to be able to cope with the job that we do. Our job is hard, and I say all of this with a deep amount of compassion and self-compassion. We develop these survival strategies and coping mechanisms in order to do the job that we do. So how can we transform the job, and how can we learn ways to shift the way that we show up in the job? A lot of what I’m trying to do is to have conversations in MD spaces around what it looks like to show up with that compassion for yourself, but with a lot more awareness of how you’re showing up, what messages you’re still paying attention to, and what you can do, both within yourself and your community, to effect change.
I personally believe that we’re in for dramatic amounts of change in our lifetime with regard to the climate collapse, and I think if we don’t get self-regulation practices out to the public in the next 10 to 20 years, it’s going to hit us a lot harder. So I think dissociating is a good skill to have. I mean, we all do it. I use TikTok to dissociate. Sometimes I’ll just doomscroll and watch random pottery classes or something. That’s a great way to turn my brain off when I’m feeling overwhelmed. But if we dissociate, then we allow the climate emergency to keep happening; that’s also a dissociative response. And I think the more that we recognize these things as dissociative, and then try to show up when we can and really just wake up to the consequences, the cause-and-effect reality of it, the more that we can become a part of the world we’d rather be in.
Kevin Pho: So give us a hypothetical scenario for physicians of this ideal situation happening. What exactly would that look like? Paint us a picture.
Christine Gibson: Well, I mean, I think a lot of people envision it like, “Oh, we’d have breaks in our day to do yoga or meditation.” And I think part of it is for us to build the structures into our day so that we can actually come out of sympathetic and into a parasympathetic state. I think we’re just not really well balanced for the most part. I mean, some are better than others. I look at my dermatologist, and he doesn’t seem super fazed. But for anyone who’s doing hospital-based practice, anyone who’s feeling the pinch of, understandably, certainly the nursing shortages, and for helping those of us who are in a sympathetic state when we’re working, what are those micro moments in the day where we can actually take that time?
So I really think this is skills-based, and it’s why I called my book the toolbox, or toolkit, because I think we all need to develop our own personalized toolkit. So I could say to you, “Oh, you’re going to love this ASMR video and just listening to these soft sounds,” or, “You should do a music-based practice where you sing and let go of your stress and release your vagus nerve.” There are specific skills around tapping, tremoring, and havening, very, very easy somatic skills that anyone could learn, but it’s not always going to be the best fit for a person’s toolkit.
To me, I would love to see all practitioners, and certainly public-facing professionals, develop their own toolkit to manage their own regulation, and to develop an understanding, and systems change at the community level, around the fact that disconnecting from each other and disconnecting from ourselves is really the root of a lot of the harms that we’re seeing. And it doesn’t have to be that way.
Kevin Pho: My final question, Christine: Tell us some of your take-home messages that you want to leave with the KevinMD audience.
Christine Gibson: I think I reflected on it a little bit, but the place to start is just compassion: compassion for others and compassion for self. I think that’s a really big part of it. And then I think the second one might be the concept of interbeing, that sense of interconnectedness. We do suffer as a profession, and we engage in a lot of the suffering of others, and there is great suffering around the world. It’s one of those things that connects us. It’s a part of the human experience and journey, and we can’t turn away from it, because it’s literally our jobs. But there’s a way to approach it with deep awe and respect and a sense of interconnectivity and reverence. And I think if we dissociate less and just be in that moment, really acknowledging how special it is, I don’t know, I find our job can just be so awe-striking, awesome in the deepest sense of that word.
Kevin Pho: Christine, thank you so much for sharing your time and insight, and thanks again for being on the show.
Christine Gibson: Absolutely. Thank you, Kevin.
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