Understanding the Fawn Response With Doctors (Episode 360)

Full Transcript: Episode 360

This is the Fertility Friday Podcast, episode number 360.

Welcome to the Fertility Friday Podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery charting journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with us today.

Lisa: I hope that you enjoyed my conversation with Kimberly today. I feel like we covered a lot of ground and I gained quite a bit of insight into how we cope with traumatic and stressful situations. And it was really interesting to learn that women respond differently to traumatic situations, which I think we know. I think if you actually think about people in your life who’ve experienced different traumatic experiences and things like that, I think at least for me I know it rings true that women tend to respond differently in certain situations. And so I think what I really appreciated about this perspective was that even though we’re not responding necessarily in the kind of affirmative, combative ways that we would see in the movies, right, when someone’s standing up for themselves, they’re valiantly unafraid and standing up to authority and being a thorn in their side and those types of things, I think what was really interesting to learn is that the tendency to appease and kind of just agree, be agreeable in those types of situations, can be the thing that you need to keep yourself calm and also to kind of just leave the situation with the least bit of strife possible, with the options — as Kimberly was mentioning — of, you know, if you end up booking an appointment that you didn’t want to go to. And I know personally I’ve had that experience as well, where there’s been a few times where I’ve had an issue, I go to the doctor hoping for some insight, and instead I end up with a prescription for something that I don’t want. And I’ve had a number of prescriptions — some that I just didn’t fill, so I didn’t even go to the pharmacy to get them filled, and others that I actually did fill and didn’t take. So I really resonated with those things. So without further ado, let’s go ahead and jump into today’s episode with Kimberly Ann Johnson.

Lisa: Well, I’m really excited to have you back on the show. Welcome back, Kimberly.

Kimberly: Thank you, Lisa.

Lisa: Well, congratulations on the release of your new book, “Call of the Wild.” I’ve had you on the show a couple of times. The most recent was with Keli Garza, and we were talking about the postpartum vaginal steam study. And I mean, I could go on about that all the time. Obviously today we’re talking about — I would say something, they’re all serious, but I would say this is a bit serious in a different way — in terms of how we process trauma and how that affects our lives and how it affects our nervous system. And so the first place I’d love to start is, why this book and why now? What is it that inspires you to focus on the nervous system and how does that relate to your work in the world?

Kimberly: So it might seem like it’s separate from the other work, but in fact, I’ve always been working with the question of authority. Who has authority? How do we confer it? How do we know our own inner authority, and how is that authority received externally? And I’m a female, and I identify as a woman, and my whole life has been marked by my relationship to male authority, at least at the big turning point moments. So it is a serious topic, but on the flip side of trauma is play and resilience and pleasure — so those are the things I’m interested in — but just because we’re human, if we’re in a human body, then we’ve experienced trauma. So that’s part of the point of the book: to demystify the word and to offer up some practical ways that we can learn to understand what of our past we’re bringing into the present that’s not allowing us to be fully available to our power in the present moment. And as you know with your work, you work with a lot of women who have gotten all kinds of advice, right? And so have I. And some of it’s really hard to sift through, some of it’s mind-boggling, but because we’ve been taught that a doctor is an authority and knows more about our body than we do — and in many ways, we should be able to trust doctors, because if you’re going to get surgery, you need someone who knows more about your body than you do — but we haven’t really been taught about this gradation of when is it time to insource our authority, and when is it time to outsource our authority. That’s something I’ve been talking about since I had a public platform, and even before that, because it’s very much how our culture looks at this whole conversation.

Lisa: So for any woman who’s been in a doctor’s office and had an issue that’s related to her female body — if she has an issue with her menstrual cycle, if she’s pregnant, if she’s in the process of birth — I mean, we could talk about all these different aspects, but there’s always this conflict, it seems, between what the authority is telling us and sometimes what our lived experience is. And so I mean, there’s so many places that we could go, but I feel like one question I’d like to ask is about trauma and this concept of authority, and I would just love to hear your thoughts on how that interplays into our reactions when we’re in these kinds of situations with these authorities that supposedly know more about our bodies than we do.

Kimberly: Yes, so one thing that’s new about my book from the earlier trauma literature — you know, the earlier seminal trauma works are “Waking the Tiger” by Peter Levine, and “The Body Keeps the Score” by Bessel van der Kolk — because they’re male authorities coming from a male perspective, there’s still this default of women being, to me it feels like, the identified patients. So if we’re talking about sexuality, or we’re talking about birth, and then we’re talking about abuse, it’s still coming from someone who has structural power. And if we’re going to look at numbers, probably — and I’m not calling these people perpetrators, because for me it’s actually about taking the stigma out of perpetrator and victim and looking at the nervous system underpinnings for how that gets set in place. So the book has a jaguar on the cover — that’s because all of my work is about helping women come out of freeze and flight responses, or fawning and fitting-in responses, into a healthy fight response. A healthy fight response is when you know your own power, you have self-protective instincts, and you’re able to mobilize them when you need to. In the social nervous system, which was put forth by polyvagal theory in the mid-90s — most of us, when we learned about the autonomic nervous system in middle school or high school, learned that sympathetic is fight or flight, and parasympathetic is rest and digest. But that’s a mixed metaphor. The sympathetic nervous system under stress is a fight-or-flight response, and the parasympathetic system in safety has a rest-and-digest response. But if we expand it out, which is now what we know, there’s a whole other branch called the social nervous system. What hasn’t really been elaborated much is that it disproportionately impacts women, because the social nervous system evolved for maternal bonding. It evolved so that we have a complex, interconnected mechanism through our orienting apparatus for attunement and mirroring — so that we will take care of babies that require us for so long compared to other mammals, and that we will continue to protect and attune to them. So it’s our superpower, in some ways, that we have estrogen, which is a bonding hormone that makes us very aware of how people around us feel. We care for the group, for the family, the unit. On the flip side of that, because we’re disproportionately impacted by that, we’re also disproportionately impacted by what happens when we don’t feel safe in the social nervous system, which are two responses called fawning and fitting in. Fitting in is something that I added; fawning is something that’s already been in the literature. These responses are contested — they’re not fully accepted — but I believe that’s because it’s people who have had less structural power who are most familiar with those responses, and they’re not normally the ones chosen in the canon of the literature. Because we can see that anyone with less structural power — whether that’s racially, or sex or gender-wise — if you feel threatened, then you approximate the threat. So this is where we see women being really nice to doctors during labor. Maybe they feel totally scared, totally threatened, the plans have changed, it’s not what they asked for — but they know if they disagree, they depend on this person for their safety. And that’s true, that’s not imagined, that’s not an emotional trip — you do depend on this person, who could be a surgeon, who could decide the health of you and your child. So for you to be nicer is a strategy that you’re not rationally choosing — now, we can rationally choose that, and also manipulate — but our physiology is choosing it. And we see that with animals: two dogs come up to each other, decide who is dominant, and the less dominant one submits, lays down, shrinks, rolls over. So it’s not just a human behavior, but it’s more elaborate in the human space. It’s part of why the whole MeToo movement — if you watch the movie “Bombshell,” you see the variety of ways that when someone has power and someone doesn’t, how we respond to that. And it’s why it’s so confusing, because the person who has the power is saying, “But you agreed to that, what do you mean? We talked about it, you agreed to it, I don’t understand” — and it’s because we don’t have an elaborate way to even look at it. So what I’m trying to do in my work is tease that apart — number one, so that we stop blaming ourselves, because we ask ourselves those things. How many times have I worked with a woman who basically sleepwalked her way into a cesarean — meaning she just went along with the program, was kind of wide-eyed, thought that’s what had to happen — then afterwards realized, you know what, that wasn’t necessary, I didn’t need that — and then finds herself choosing the same doctor and doing the same thing? Why? Well, number one, it’s a fawning gesture. Number two, you’re still in a bit of a freeze cycle, because that first trauma hasn’t been resolved, and the way our system works is that we repeat things so that we can cycle up and repair. That can feel to a lot of people like punishment — “oh my god, am I dating another narcissist, oh my god, another situation” — but it’s our nervous system that’s actually procuring this similar resonance so that we can repair it and have access to more life-force energy. And people could listen and be like, well, I don’t know about that — it is a bit of a framework, like I’m a Rolfer, so I come from a place of how our nervous system and fascia relate to gravity. And the belief system behind that is that in our structure, we always want to align with gravity, which could also be nature, which could also be unconditional love — because we’re living in this field and we don’t even realize it. So if someone is prone to fawning or fitting in — fitting in is camouflaging, don’t stand out, just do what everyone else around you is doing because it’s safer to not stand out than to stand for what you really want — these are the dynamics that come into play all the time and get exaggerated the more threat we feel. So doctors are famous for saying, “you could put your baby at risk” — you escalate the threat, and then we go to our default responses. It’s going to be harder to activate our healthy fight, which is “this is what I stand for, this is what I want, this is what I know about myself,” because those threat mechanisms start to escalate.

Lisa: Well, this is really interesting, and I think a lot of women listening, if they think back to their various experiences — I mean, I’ve had many, how much time do you have — many experiences in doctor’s offices over the years that just were not pleasant. And so I suppose a lot of what you said really rang true, and it’s making me think: so our nervous system is designed in such a way that we respond in a certain way — I’ll just break it down — from what you said, it sounds as though women, female bodies, are designed in a certain way, obviously because of the things that have to happen with the raising of children. So there’s a certain tendency towards certain responses in situations where you feel under threat, particularly if there’s an authority who you also depend on for your care. And I think that’s really interesting, because that’s reflected in so many of the conversations I have with women about all kinds of topics — whether it’s something like birth control, where obviously the threat is that you’re going to have an unplanned pregnancy and this person is an authority telling you that you need to do this, whatever that thing is, that can range from taking a pill to literally getting an IUD inserted that day. I’ve spoken to a number of women who go to a doctor and potentially get a diagnosis for something — let’s say they get a diagnosis for abnormal cervical cells, that’s something I hear a lot — and again, the doctor doesn’t present the full picture, because they only have five minutes. So often the conversation goes something like: “You have abnormal cells, we need to do this procedure, we’ll schedule you for Thursday” — and it’s Tuesday. And they say okay, and then they go and have the procedure done, only to discover later that potentially it wasn’t so urgent that they couldn’t have waited a week. I’m famous for saying things like there’s nothing so urgent that can’t wait a week — get a second opinion. So maybe you could talk a little bit about that, because I feel like what you described plays out in our lives, and we then, looking back, are going to beat ourselves up and think, well, why didn’t I ask, why didn’t I do this. And potentially women like you and myself, who talk about this a lot, are giving women permission to actually say things like — even if you’re not comfortable challenging — “I’m just going to go home and talk to my partner about this, I’m not going to make a decision today, but thank you so much.” So we’re still being nice, we’re still doing the things that are comfortable within our nervous system, but literally giving ourselves a minute.

Kimberly: No, totally. I mean, trauma — one definition of it — is too much, too fast, too soon. So the flip side of that is slower, less, and in its own time. So when we feel — and it’s normal, right, if someone’s telling you even the word “abnormal cells,” that feels scary, and we don’t know how bad that is — but what I always tell people with cesareans also is, there are so many deliveries I’ve been in, and I’m a birth doula, where the doctor comes in with the pad to sign for the cesarean, and then we wait for hours and hours. And that tells you: if a cesarean is an emergency and truly necessary, they’re wheeling you out and you’re signing at the same time, it’s happening that minute because you’re hemorrhaging or because there’s something that’s really necessary. The other thing, as I was hearing you talking — fawning or appeasing would be like making the appointment, but then you don’t have to go to the appointment. So fawning is super effective, and that’s why it’s a strategy, and that’s why we do it. And I want people to know it’s not a call-out, it’s not saying these people are weak — if you are in a body dealing with wide authority, assimilation and code-switching are part of survival. It’s not a moral value judgment on someone; it’s just noticing when you’re in that situation.

Lisa: I love what you’re saying, like having pre-prepared language. I think for me, I have a tendency towards a freeze response — for me the challenge is, can I just tell someone, “I notice I’m in a freeze response right now, I don’t think the answer I’m going to give you right now might be my final answer, because I just feel confused right now.”

Kimberly: Right, a low-level freeze response is confusion and disorientation — it’s like a haziness, nothing’s really making sense, we don’t really know what we want, so we’re just kind of like, okay, well I guess I don’t feel like I even have a choice in this situation anyway, so okay, I’ll go along with it — but the truth is we do always have a choice, and it is, it never stops being our body. We’re the ones who are going to deal with the consequences of the choices that we make — the doctor’s not going to deal with the consequences. So it’s absolutely necessary that we have that language: “I need a little more time for this.” And oftentimes, when I’m doing trauma repair with people — because I specialize in healing birth trauma, gynecological trauma, and sexual boundary violations — the repair is, “I need some time to think about this.” People think the repair is going to be telling the doctor to back off, or doing something dramatic — no, it’s just, “I just need more time.”

Lisa: This is really interesting, because as we’re breaking this down, I feel like on the one hand, someone could be listening to this conversation and thinking, it’s like we’re equating going to the doctor with something like being blown up in a building — because of course you may need to correct my assessment here, but you’re so traumatized in a way by this experience — so whatever it is, if you’re in the middle of birth, your doctor is telling you your baby’s going to die unless you do this procedure right now — if you’re in the office and the doctor’s telling you a bad thing is going to happen unless you take their advice at this moment — so it’s like we’re equating going to the doctor to something highly traumatic, because it seems as though that’s how our body is responding.

Kimberly: That’s literally the system, you’re totally right, and what you’re pointing out is really important — trauma is never a thing, trauma is how our body processes that thing, how we digest it. So for some people, going to the doctor or the hospital actually isn’t a big deal, and it’s fine for them, and they’re able to have a conversation and say, “you know what, I’m not up for this today, but I’ll make an appointment for another day,” or “I thought I wanted this but now I don’t, so I’m going to go home and come back another time.” As you were talking, what I remembered is — because I really have a huge resistance against going to the doctor, and sometimes I question myself, well why is that — and as you were talking, I had an image flash in my head, which is the first time I was at the pediatrician as a kid and they checked my genitals, and I had a male doctor, and it was just creepy — I don’t know if he was creepy, I have no idea, but my feeling about it was that it was creepy, and when I look back I think, why does a seven-year-old need their genitals checked?

Lisa: Obviously many of us were wondering the same thing quietly. Yeah, but probably it’s part of a routine — check the orifices, I have no idea. Can I share something? I had an experience, and I don’t remember how old I was — probably around 10, though I wasn’t menstruating yet — and I had signs of a potential yeast infection, so I had some discharge and things like that. So in my case, when the doctor assessed my genitalia, there was a reason — so just to compare that, because there actually was a reason. And so what happened — I think my mom was in the room — and he did a swab, and I remember feeling like, this is a stranger looking at my genitalia, that has never happened before, and a swab right in the vagina area, and I just remember feeling really disgusting, and there was a reason why it was happening in my case.

Kimberly: Yeah, so I just want to take a second, because I think probably people listening are also having some images and memories, and again it’s because we just normalize these things — like we have to get through it — there’s stuff that lives on in our system because of that, and that’s the residue of trauma. So trauma doesn’t have to be this big thing — and for many people listening they do have a big thing, they did have something in their childhood or their family, a bigger “capital T” experience — but oftentimes it’s these little things that leave impressions we carry with us, and then at a later time we have such a strong reaction, and we don’t know why we’re having a strong reaction, because our body is still holding on to whatever it was at that time. And a lot of what I do, because I do hands-on work, is — there’s really no reason in a situation like you’re talking about, because the genitals are so charged, it’s so separate everywhere — that when medical professionals are doing exams, they don’t want to do anything that might be conceived as arousal-provoking, and so they’ll just do a swab and get out. But to a female body, that feels so invasive, and what we need is some contact first, some safe porting — “here’s what I’m going to do, here’s what’s going to happen, do you feel ready for that, this is probably going to be a little weird for you, maybe no one’s ever been in this situation, how are you noticing, would you rather your mom do this, where would it feel comfortable for you to have your mom with you in this room” — something that’s actually giving you words for what you’re feeling inside, because as an adult we can imagine what a 10-year-old would feel with that. It’s not hard to imagine — this is really strange, how do you feel about it. And you know, it’s like what happens in birth too — all of a sudden, okay, take off your clothes and put on this gown and do all these things — and each of those things requires its own timing, and that timing is what allows us to repair. So I like to help women have positive, reparative experiences, because sometimes it just feels really daunting, especially since a lot of women have had stacked trauma — maybe they had a miscarriage, and then the miscarriage wasn’t complete, and then they had to get another procedure, and another procedure, and they didn’t really have time to catch up and let their system settle before something else happened. This is really common, and as we’re talking about it, it’s like — you and I hear these stories all the time because this is our work, but people who are just out there living their lives — I’ve had friends who’ve had abortions on a Friday and gone to work on a Monday, because it’s like their system wants to just keep going, because there’s so much happening inside that they don’t want to settle into it, it’s easier to just trip over it and keep going. But those are the things that later become panic attacks, or other symptoms or syndromes, that we’re trying to deal with when it’s something earlier that set that cascade in motion. But in the present moment, there are two things — one of them is that what you do is help people get out of immediate urgency, because to track your own fertility means that you’re playing the long game, right — you can’t just do it for one month, you can’t just do it for two days, you have to have a commitment to longevity, a long-term relationship with yourself, and that’s something our culture doesn’t totally get — it’s like, this is about not just solving what’s happening right now, right now, right now — it’s like, hold on, let’s take a minute. I just was working with someone last week who said, “well, the doctor said I need to come in right now,” and it’s like, well, do you feel you need to go in right now? “No, I feel like I could wait.” Okay, so we’re skating between what the expert says and what your intuition is telling you, and probably there’s something in between, but we always have that thing pending, because now with everything it’s like, well you better get a mammogram every year, you’ve got to do all these things preventatively — but that only works if you feel that it’s preventative and you feel that it’s what you need. So we need to give ourselves permission to slow down, and then in real time practice — so if you do need a pap smear, or you do need some kind of birth control, or some kind of procedure — when you go, put in place what you need to have a voice. We’re so hard on ourselves, we think we should be able to do it — okay, “should” is fine, but if you can’t do it, then what do you need? Do you need someone to go with you, do you need two people to go with you? We think we need to do it ourselves, and so we go, and then we suffer through it, and then we just get it over with. People dread pap smears, they dread the dentist — it’s like, we don’t have to force ourselves into it. We had a COVID test in our family, and my daughter, the first time she went, was jerking her head away, and the nurse was like, “you have to do it,” she was really nice, but I was sitting there and I said, “well, can she hold it herself, because she could put it up her own nose, why does someone else have to be putting it up” — or I said, “could she put her hand on yours while you’re doing it?” And they were like, no, no, no — and it was like 45 minutes later, after the jerking and the fighting and the negotiation, and then the clinic was going to close, so they just gave her the thing and let her do it. And I’m like, okay, so she could do that, but that wasn’t what you wanted to happen, but then at the end that’s what happened anyway. So it’s like, we have to listen to our bodies, they’re telling us something, and overriding that is just setting in motion a pattern of “I’m just going to override and override and override what my physiology is telling me.”

Lisa: When you said something earlier — a little while ago — to the effect that we’re scared of these horrible things that would happen if we don’t do exactly as we’re told, and certainly I’ve been thinking a lot about that lately, about how our world has created — especially as it pertains to women and going to doctors — we’re just really told that we need to listen to them, that they’re the experts and the authorities, and we’re trained to defer to them, even if our experience is directly opposed to what they say and recommend. And so the example that you’re giving — going to the doctor for a procedure, especially as a child — I had a similar experience with needles. I don’t really know the answer, they used to say I had thin veins or something, and it was hard to tell — I think that I had darker skin in a predominantly white area, and they literally couldn’t figure out how to take my blood. In retrospect, I’m not a particularly small person, I’m just an average-size human, so I don’t know, but my point is that there was an experience similar to your daughter’s, where this nurse did something wrong and blood literally spurted everywhere, and that freaked me out because I was a child, and you might be in a situation where they say, “well, we have to do this today, so you’re just going to have to put on your big-girl panties” — and no, my mom was like, “we’re done, we’re not doing this today,” and I literally, a week later, went to a different, well-experienced, older nurse, and she was completely fine and everything was fine. So back to my initial question — I feel like in these types of situations where we’re told, “no, it has to go down this way, it has to be done now, no, you need to come back next week, we’re going to schedule you an appointment for Thursday” — I feel like maybe we over-exaggerate what would happen if we just said no, and, like you said, sometimes we make the appointment but then we can call and cancel, or we just don’t show up. I’ve recently had conversations like this with family members and friends in a variety of different situations, where an appointment was scheduled and I was saying something like, “well, what if you were to get a second opinion, you don’t need to go to that appointment, what if you just rescheduled it,” and it was like, “I can’t, what if — the doctor told me I need to do this right now.” And so there’s a lot to unpack here — I’m hanging out here because this kind of thing has been showing up in my life and my client work recently, quite a bit, with a number of different health conditions.

Kimberly: What you’re saying — the word that’s coming to mind is obedience. And if we’re obedient, that means we’re good. I lived in Brazil for a long time, and there — like in every country — there’s a whole relationship to the earth, the plants, the herbal medicine, the medicine that we have around us, but industrialized medicine came later for Brazil than it did here, so they’re almost a generation behind in how they deal with medical care. There, they get the leftover flu vaccines from here, so they get the flu vaccine a year late, and then the government gives them out for free and brags about how good they are about vaccinating so many people — and I don’t want to get into a vaccine debate, but what I was noticing is that there’s this displacement about what love and care means, and that interfaces with authority — people who’ve gotten used to feeling like, well, the government is giving it to us, so that means they’re loving us or caring about us, so I’m going to go get it. And I saw this with my in-laws, who come from a place where — my mother-in-law has so much wisdom about herbs and medicine, and yet she takes so many medications that the government gives her for free, because to her that’s like she’s being taken care of and given something. And I’ve talked with people who are very educated — and this is the other thing, it doesn’t really have to do with our politics or our education, because the women I work with, some of them are very educated and have very progressive politics, so they’d say, “I’m a feminist, my body’s my own, my body my choice” — but then when the stakes escalate a little bit, they find themselves doing things that later they’re like, “I don’t know why I did that, I don’t know why I followed that piece of advice, why I did this.” And it’s because these earlier programs are operating, so we have to become a little bit tolerant and uncouple this idea that being obedient is good and therefore safe.

Lisa: Well, and if I use birth control pills as an example — it’s kind of easier to stick with what I often talk about — but if I give that as an example, kind of as a metaphor for the experience we often have with our medical system, we’re talking about some of the inherent limitations. When you described what would have made that procedure I had done more tolerable, and potentially wouldn’t have left that bad taste in my mouth, what it felt like is that you were humanizing me — so all of a sudden I wasn’t just a body part that needed to be swabbed, but a person, and my feelings mattered. And anyone with common sense can see a 10-year-old who’s nervous and would notice that and acknowledge it, but it’s not how we’re taught. And so with the example of birth control, I think the other thing is that we’re not presented with options — it’s kind of like, this is the only thing that’s going to help you, and you need to do it now. So what I’d like to ask, to shift to the good news here, is — you mentioned it before, but some of the things — I think we’ve talked about a few of them — but ways that we can prepare. I think it’s really underestimated, the importance of preparing for these types of interactions, to the best of your ability. Obviously you can’t predict the future, you can’t know if there’s going to be an unexpected issue that you didn’t anticipate, but ultimately I talk about this a lot with my clients, and I can just imagine the work you do with your clients as a doula — of course I’m not preparing my clients for birth, I’m literally preparing them to go to the doctor and talk about different things, but ultimately there’s still a lot of prep that goes into that. I’ve been known to tell my clients things like, if your doctor isn’t open or isn’t respectful, you can find another one, and in addition to your doctor you can find other advocates in the health field who can support you, so the doctor doesn’t have to be the only person on your team. And literally just having these conversations and empowering women with strategies for how to handle things, and putting them all on the table — up to and including getting the prescription, making the appointment, but knowing you could cancel it later. It’s unfortunate, but it’s kind of like these medical professions are super pushy, and we need to find ways to navigate those stressful situations. And I’d love to hear — I think we’ve talked about a lot of them — but that validation of, we can actually prepare for these situations, and even if we get flustered, even if we get in that freeze response, or the fawning, or the fitting-in, we can still be empowered to make the best choices for ourselves.

Kimberly: Yeah, I think when I talk about a healthy fight response, people think I’m talking about being an aggressive, alpha female who’s negative with everyone — and in fact I’m really about creating a situation where everyone is respected. So when we’re having these conversations about medical professionals, I actually think most doctors are doing the best they can — doctors have a lot of their own trauma, medical school is traumatizing, they have no training about self-care for themselves, the same with police — it’s crazy, the jobs that police do without any kind of trauma repair for them, which of course makes all of their responses exaggerated. So we’re at this interesting crux in history where we’re kind of in purgatory, because we have an oppositional gaze towards authority and yet we still find ourselves in the system, and the system just doesn’t work all that great — short appointments, a doctor who has to give short appointments because they’re rushing to get to other appointments so that they can even make a living, because they’re billing insurance. But the thing is, most women are conditioned to take the point of view of the other person, and so we’re always giving them the benefit of the doubt, and in this case, to our own detriment. So when we prepare, we have to be prepared that doctors are trying to help us find a solution, and the degree to which we’re desperate is the degree to which they’re going to try to find a faster solution, even if that’s not a good long-term solution. So we also have to present ourselves with, “here’s how I usually view my health, here’s what I feel okay with.” It’s hard, when you and I are talking, not to go to the level of absurdity — the latest one I heard was a girl who’s 16 or 17, who’s gay, who went to the doctor with painful periods and was offered birth control — offering birth control to someone who doesn’t even have reproductive sex is kind of like — I give up, I mean, how someone even hears those words and thinks that’s a good idea is directly proportionate to what they feel the options are that are available to them. So you and I both know, we’re both working at a system-wide level to change that, to offer more solutions. In the meantime, we can be prepared without demonizing the other person — it’s the same thing with sex, we can be prepared to have a difficult conversation without thinking the other person is automatically wrong or bad. And the way to do that is to start getting some tolerance for sympathetic charge — getting tolerance for conflict, getting tolerance for, it’s okay if I disagree, can I just sit here in that disagreement, I don’t have to make it better. If it’s true that this is your doctor, some people are afraid they’re never going to get care again, or they’re going to get bad care — it’s not a simple answer, because developing this level of self-trust and autonomy happens over time, with small steps. But in the present moment, I think that we mistake dependence — which is basically what we’re saying is, we become dependent on “father doctor god” to heal us and give us our solution — we confuse that with asking for help. Those are two different things. Asking your friend to go with you, or your mom to go with you, or your partner to go with you — that’s actually not dependence, that’s autonomy. That’s knowing who you are and how you respond. Most of my trauma teachers, I was really surprised to find out — instead of being more independent and more tolerant of difficult situations, they just know what support to elicit. Like one of my teachers said, “I never go to the dentist or the doctor alone,” and I was like, at first I thought, that’s weird, how much healing work have you done if you can’t do that by yourself — but then I thought, oh, that’s just knowing your own system, and that’s all of our responsibilities as incarnate humans: know yourself. I particularly know that I cry really easily — has that changed over my life? Yeah, and I don’t cry in the same situations all the time, but I do cry easily, and if I’m moved or emotional I’m likely to cry, so then I have to give the other person information about it — I call it giving my code. It’s different than dumping your trauma on someone — it’s different to say, “hey, I’ve had a lot of difficult experiences with my pelvis and my cycle, so I really need to know a lot about what’s going on for me to feel comfortable with this,” than to say, “I don’t trust you, I don’t know where you’re coming from.” There’s a difference between being in your center and having an out-of-proportion trauma response. We need doctors to be informed, but we also need to understand the context that we’re operating in. So how do we prepare? We prepare incrementally, little by little, by doing this work on our system — that’s what the whole book is about, and that’s what all my work is about. But we have to have the skills to know what’s happening — I think that’s the most important thing: know what response you’re in, know what that feels like in your body, and then have a couple of go-to things that could help you. So I think role-playing is really helpful — like, you be the doctor and I be me, and then you say some possible things, and I see what my responses could be, so I’ve already practiced hearing myself say things like, “okay, Lisa, tell me I need a procedure right now.”

Lisa: We found abnormal cells, Kimberly, and we’re going to schedule you on Friday to come in and have that colposcopy procedure done right away.

Kimberly: Oh wow, that sounds really scary.

Lisa: If you don’t come — I mean, this is really important that you come on Friday, and we actually have an opening.

Kimberly: Okay, I don’t really know what to do right now, because I feel scared about that, but I don’t really know what that means, and I don’t know what could possibly happen after I do — do we need to do anything right away, this procedure?

Lisa: I mean, we could just go ahead and schedule the appointment.

Kimberly: Okay, well, you can schedule it — but can I call later if I need to change it?

Lisa: Oh yeah, of course you can, if something comes up, for sure.

Kimberly: Okay, so I think that’s a good plan for me — we’ll schedule it, but can you tell me a little bit about what are some possible contraindications to the procedure?

Lisa: I mean, it’s a fairly benign procedure, I’ve done hundreds of them in the office, so certainly there’s nothing really I’m concerned about.

Kimberly: I’m sorry, I’m breaking our thing here — the reason I said that is because that’s kind of what a lot of women face, where — yeah, I’m not a doctor, so I can’t honestly answer the question of what they would say — but I would imagine it would be, “well, there could be a little bit of mild discomfort for a couple of days, there might be a little bit of bleeding, a little bit of spotting, but ultimately it’s a pretty routine procedure.” And so what you’re not going to hear is that when you cut off a piece of the cervix, it can have implications on sexual function, for example, on your ability to orgasm — things like that — because many doctors don’t believe the cervix even has nerve endings. So there’s a lot of information you wouldn’t necessarily hear.

Lisa: Definitely, yeah. And so in that case — I always think, if people are listening to the podcast, they already know you and they already have lots of information about everything you offer, but I think especially with white conditioning, we’re conditioned as white women to believe that we’re going to be taken care of, and that we can have kind of a learned helplessness — that’s why there’s the stereotype of the white woman collapsing and crying — and we’re conditioned to think that the world has our best interests at heart, and that we can trust that. And so we have to develop a bit of an oppositional mentality when it comes to healthcare, because healthcare comes out of a very specific way of looking at, especially, a female body — which circles way back to the beginning of the conversation.

Kimberly: I wrote this book because all my yoga teachers were men, and most of the students were women. Trauma school — mostly male teachers talking about female patterning, and mostly female students. Sexological bodywork school — mixed gender-wise, but focusing mostly on the anus because it was founded by a gay man. And in 10 days of trauma school, one day was for people with vulvas, in a room full of mostly women who have had babies, all of them with a birth injury, totally untreated — so they’re completely, totally awake erotically, doing sexual healing work, but never address their births. So there’s just this default of male body, male body, male body everywhere — nutrition, everything — and I’m like, okay, well what about the fact that we’re defining complex PTSD, and periods and birth don’t factor in, which are the things that set in motion so much disempowerment for so many women? That’s why I wrote the book — because we can’t just assume that the way everything is, is to our benefit. We can’t walk around assuming that. And for some people who are in less structural power, that’s obvious to them, they were raised that way, knowing the world’s not out here for their best interests. But for whatever reason, as females, because we have this estrogen, because we’re so concerned with the good of the whole, we’re not as practiced at tolerating conflict in order to protect ourselves and our own children.

Lisa: This is so interesting — now I’m contemplating if there’s a reason why I’ve had a bit of an oppositional stance from a young age, and certainly it goes back to a lot of the experiences I’ve had, but when you said what you said about white women — I mean, I’ve never been a white woman, so I never thought about that, believing that of course everything is, you are going to be taken care of — that’s something I’ve never heard before, but that is a really interesting thought and concept, something like a structural luxury, right — if you feel like, well, this system was made for me, and people who look like me — and it’s not like we’re having that conscious thought, but I feel like that’s why so much is happening in the racial dialogue.

Kimberly: As you saw in the book, each of these nervous system states has correlating emotions, and for most in white-over culture, we permit men to be irritated, frustrated, angry, and enraged, and we permit women to have worry, anxiety, panic, or confusion and disorientation — but we don’t like the reverse. We don’t like men displaying worry, panic, or confusion and disorientation, and we don’t like women displaying anger and rage. But then if you lay a racial template on it, the stereotype is the angry Black woman, and most Black women haven’t been permitted to be able to do the collapse, and most white women don’t feel comfortable in the anger and rage — and so then it gets polarized, of like, this is who you are, this is an okay way to behave, and when you behave that way repetitively, that creates nervous system grooves which predispose us to certain responses. My work is really — because the more sympathetic someone gets, the more angry activation — when you played the doctor, you brought a lot of sympathetic energy, and if I’m not used to that, then I’m going to start to shrink back. So if you’re being the bulldog, then I’m starting to be the rabbit, and it’s like, okay, I need to get more peacock, so that maybe your bulldog will settle down. And so we have to witness ourselves in this, day to day, so that we can strengthen these responses — they’re the hardest when we’re the most activated. It’s not even fair to require this of women in birth, and when I say fair, I just mean organic and physiological — we shouldn’t be in a situation where somebody who’s in the most vulnerable state — which is also a very powerful state — a birthing person needs to be protected, that space needs to be protected. That’s why animals go to be by themselves in the dark, away from everything else. We shouldn’t have to protect ourselves and do the birth at the same time, but that’s where we find ourselves. So — best choice — choose something that is physiological for you. And this oppositional gaze is actually — I mean, I think that’s why Black women really are the reason feminism is what it is, because there’s been so much disenfranchisement, so much abuse, that it’s like the response to that is, what do I have to lose, this is how it is, this is what’s going on.

Lisa: Well, in response to what you said, I’m still percolating on it, so I’ll probably be thinking about that for a while — but you could argue that someone like me, I’ve never had the luxury of assuming the system was made for me, it would never occur to me, this is not something I’m thinking of consciously — but when you said that, I was like, well, an argument could be made for that, and maybe that’s why I’m more likely to want to get the actual facts instead of what someone says, maybe that’s why I’m less likely to trust the words of an authority over the data, or my own body and how I feel. And certainly, something you said — we were talking — I feel like this conversation has even helped me to better understand how women, as a concept, respond to these types of situations, because I feel like I’ve been in so many situations where I’ve had to advocate for myself — it’s never been fun, it’s always horrible, I’ve cried in many doctor’s offices, this is not a cakewalk — but I’ve also supported countless friends and clients after having horrific experiences, and I sometimes find myself, because I’m a human being, thinking, “why didn’t you — how could you let that happen” — of course I’m not saying that, but thinking it in my mind. It’s really hard, but what you described really — I think this episode is one that we all needed to hear — this is how we respond, and this is how we can work in that framework, and we don’t have to feel any kind of way about it, because when we feel threatened, we actually have these fantastic mechanisms to help us get out of the situation safely. And even though it doesn’t look like always fighting back and being aggressive — ultimately that’s not safe anyway — because what you said at the very beginning, it might not always be correct, but sometimes that is a real threat — sometimes when you’re concerned that if you argue with the doctor or the authority, or you push back, sometimes it is a real threat. Sometimes you’ve built up a relationship with this person for years and years, and if you sour the pot, it could literally have a negative impact on the relationship and change it forever. So I feel like this was really helpful to ground it into what really is happening, and how we really respond, but how we can work within that framework to empower ourselves more.

Kimberly: Yeah, and it’s understanding that whatever we’ve done until now was the best that we could do with our physiology — we did survive, because if you’re listening, you survived, and you did it in the way that your organism could sustain. What you know now might be different, and you could be experiencing frustration because you know something different now that you didn’t know before, or who you are now would have responded differently — but we can’t go back and change those things. We can change them in our imagination, which actually does help some of the time, if we get into the right space — maybe we did a little repair, you and I, today, just talking through how your visit could have gone when you were 10. Sometimes just hearing those words, and hearing them spoken by someone else, is a mini repair. But we can locate ourselves right now, and move forward knowing what we know now, and we don’t have to sleepwalk into the same dynamic with the same practitioner, or a different practitioner, or a different partner offering the same dynamic — but it does take some work and renegotiation. It doesn’t mean you have to do a retrospective of all the traumas of your past — who would want to do that, that’s actually not a good idea — but it means that in present time, you learn how to track your own experience, you learn how to communicate, because even communicating is a movement out of freeze or fawning a lot of the time, and you really get to be a part of building this world that we all want to belong to, where every voice matters.

Lisa: Well, I mean, I could talk to you all day, but we should probably wrap up. Can you tell us — first of all, any last comments if you want to tie anything up with our audience today — but also tell us about your book, and how it can help us to work through these challenges, and where we can get it, and I know you also have your programs to help women address these issues.

Kimberly: Yes, so I want to say a couple of things — we talked a bit about race today, and none of us are robots, none of us fit every pattern. So when we talked about, in your case, Lisa, thinking that maybe it’s because you always have known the system doesn’t work for you, that you’ve been able to activate a healthy fight response to do something — sometimes the opposite happens, and people become completely immobilized, they’re like, this doesn’t work for me, but just, this is the best I have, and they find themselves just going along with things anyway. Again, it’s not a value judgment — functionally, with life-force energy, it’s helpful to get into “I can do, my voice matters,” but sometimes we have to be with people in those immobilization responses to be able to get to that. Again, it’s not a value judgment, there’s not something moral about it, and there are lots of people in all different kinds of bodies, with all different kinds of cultures and religious backgrounds, where they might be feeling themselves in certain places and not others — so I just want to make that clear. But I do feel it’s important that we begin — especially someone like me, who’s white — to bring race into conversation in a way that isn’t just a race talk, but that we’re talking about how this influences care specifically, because if you’re in a Black body, where the statistics about gynecological health are a lot darker, meaning the consequences are more dire, then you might be using these strategies more, because you do need those strategies more. And repair is always possible — that’s really important to say — no matter what’s happened to you in your life, no matter how you relate to the strategies that your system chose in the past, and whatever your particular soul journey in this life — in nervous system language, it’s your original blueprint — you can always start where you are, and your body has all the information that you need in order to heal. There’s no situation that’s not repairable. Our job is to integrate it — not to make it go away, not to imagine those things didn’t happen, but to integrate them into our system, to give them a place to live, a home inside of us, so that we’re not only relating to that, or against that, all the time. You can read the first chapter of the book for free at kimberlyannjohnson.com — that chapter has the most graphic content, I know, we’re going to give that away — but you know, my job is really to get as many people this information as possible, so that on all sides of the equation we have the language that we want, so that in this age where so many power dynamics are shifting — in parenting, school, work, medical care, sexuality — we have a common language where we can work through some of these power dynamics together. And then I have the Jaguar class, which is where I really help people do this work — kimberlyannjohnson.com/jaguar — and I’m on Instagram also, at Kimberly Ann Johnson.

Lisa: Awesome. Well, thank you so much for being here, and for having this conversation. I feel like, over the years, so many clients — this conversation is one that so many women need to hear, just about navigating these things, because I feel like this is really the nitty-gritty, day-to-day — I mean, it just ended up that this is where we ended up taking our conversation today, but this really feels like those interactions that are so challenging in so many ways. So I really hope, and I’m excited for how this conversation will impact those interactions for everyone who listens. So thanks so much.

Kimberly: Thank you.

Lisa: Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/360. I hope that you enjoyed today’s episode with Kimberly — I really appreciated this conversation for a number of reasons. I think one of the things that really stood out to me was having that perspective of why we respond the way that we do as women, and to have that kind of context of how we respond to trauma, and why that may be different than men, for example, in those types of situations. And so what I really appreciated about what Kimberly was talking about is that, over the years, I myself have responded in a variety of different ways in stressful situations, and also my clients and my friends. So there are times when you might be very assertive — “nope, I’m not going to do that,” and so on — but a lot of the time we find ourselves being very agreeable, not really wanting to stir the pot, and kind of just wanting to leave unscathed, to just not really challenge the authority. And so I can think of a number of situations where the doctor’s giving me a prescription for a different medication, and there have been many times where I’ve taken that prescription and not filled it, in a case where I wasn’t really sure that was the approach I wanted to take. There have been situations where I actually filled the prescription and never took any of it. There have been situations where appointments have been scheduled and they were canceled. And so a lot of that really rang true for me, and I would imagine that if you listened to the whole episode and you’re still with me, that you may have also had an experience like that yourself, or know someone who has, where you really felt a bit pressured to say yes to something, but then later — you kind of did it just to make the situation go away, but then later on you didn’t follow through, or, as Kimberly said, you don’t even have to cancel the appointment, you could just not show up. I thought this was really interesting, because she wasn’t demonizing the response, she wasn’t saying that if you don’t respond in an assertive way, you’re wrong — and that’s kind of how our society tells us, if you don’t stand up for yourself in this way, then that’s wrong. It’s more so understanding how we do respond, and then looking at how we can create a safer environment, or how you can create a situation where you feel safer, and how you can better handle those responses, even if your natural tendency is not to be assertive. And so I love the recommendation to consider bringing someone with you — if you know that these types of situations make you feel uncomfortable, is it an option to have someone come with you, is it an option to actually plan ahead and do the role-playing? This is something I naturally do with clients — we have these kinds of conversations, we always talk about choosing a practitioner, understanding that it’s not always easy, especially if what you want to do is different from the standard recommendations. So even something like, you know, birth control — not wanting to opt for a hormonal method — and having to prepare yourself for the conversation if you’re thinking of using fertility awareness — actually role-playing, sometimes your practitioner will be very supportive, or just not really care, they’re kind of like, “oh, I’ve heard about that,” whatever — but sometimes you can get a combative response, “oh, that doesn’t work, that’s not scientific” — and so if you get that kind of response, have you thought about how you would respond, or even role-played what you would say? These are really important conversations to have, because for better or for worse, when you find yourself in a healthcare practitioner’s office, sometimes those experiences are really pleasant and friendly, but sometimes you find yourself in a high-pressure situation — if there’s something wrong, if you did a test or something and they find it, it can very quickly turn into, “okay, we found this thing, so we’re going to give you this medication, or we’re going to do this testing, or we’re going to do this procedure, we’re going to do it on Tuesday” — and you could just come back, and it’s kind of like this whole story is laid out for you of what you’re going to do, and you’re not even consulted in the process — it’s just, “this is what we’re going to do, this is what we always do, and you’re just going to come back next week and we’re going to do the thing, and that’s how it’s going to be.” Knowing that, and thinking through how you can respond, even having a few canned responses in situations like that — whether it’s a medication, a procedure, a certain type of testing — what I always say is that, unless you’re bleeding out on the table, there is nothing that has to be done today, there’s nothing that can’t wait a week. Of course there are some situations where things are really pressing, but other than that, there’s never a situation so serious that you can’t wait a week, or use the “phone a friend” option. So this is your friendly reminder that you can have in your mind a few canned responses — for me, if I was in a situation like that, one of the responses I would probably practice and role-play would be, “okay, well, before I make any decisions, I’m going to talk to my husband about it,” or “I’m going to run this past my partner,” or “I’m going to run this past my best friend,” or “my sister’s a doctor, so I’m going to talk to my sister” — whatever — think of a few of these canned responses. All that’s really doing is giving you the time — it doesn’t mean you’re not going to do the procedure, this is not the point of what I’m saying, it doesn’t mean you’re not going to take the medication — but it means you’re going to give yourself time, so that if you decide to do it, it’s going to be your decision, not just because you were told to do it. Similarly, if there’s a test or procedure or medication being recommended to you, you always have the right to ask for and get a second opinion. These are really basic things, but you and I both know that most of us don’t necessarily do that. If you think about it, throughout the course of your life, if you’ve been prescribed medications, how many times did you actually type in the medication name — the brand name and the medication name — and search it for side effects? This obviously applies to birth control — I don’t really know that many women I’ve talked to over the years who, when they were prescribed a birth control, actually typed in the name of it, or the medical name, or the brand name, and searched to see if there were any side effects associated with it. When was the last time you were recommended to get a procedure or some sort of testing done, where you actually said, “okay, well, I really appreciate you going through this with me, I’d like a copy of all of my test results, etc., for my own personal files” — because you always have the right to do that, and should consider doing that — “I’m going to go get a second opinion from another practitioner.” So we kind of know these things, but we don’t necessarily do them. And so if you needed permission — I officially give you and grant you permission to always give yourself a week to make a decision about anything, to just do a quick search online — we don’t really have an excuse anymore, since we all have computers in our pockets — so do a little search if there’s a medication being presented to you, to see if there are any side effects associated with it, as in the case of birth control, and also, if there’s a procedure or anything being recommended to you, you also always have the right to get a second opinion. And if you give yourself that little bit of buffer and space, ultimately it is you who’s making that decision — the decision isn’t being made for you, and you’re not simply a passive participant in this process. So lots to think about — I wanted to share just my thoughts on some of those things, because in the work that I do, this is something I see all the time. And what we don’t always consider is, even if something’s routine for the doctor, it’s not necessarily routine for you. Going back to the example that Kimberly and I talked about in the interview, which was cervical dysplasia — it’s routine for the doctor to do the colposcopy, LEEP procedure, etc. — but for you, if you didn’t research it, and depending on the procedure and the severity and all of those things, it could be a decision that’s really quick and easy and routine for the doctor, but could have effects on your sexual function for years to come. So it’s in our best interest to give ourselves just a little buffer, and it’s hard, because these situations often bring up a lot of trauma, a lot of emotions and feelings and fear, and it just doesn’t feel good when you’re being pushed into doing things that you don’t fully understand. So with that said, I hope you have a wonderful week or weekend, whenever you are tuning into the episode, and of course, as always, until next time — be well and happy charting.