Ep. 146 - Understanding Others’ Minds: The Science of Mind-Reading in Borderline Personality Disorder
What happens when you can't understand what others are thinking or feeling? Why do some people constantly misinterpret your intentions? The answers lie in a fascinating psychological process called mentalization.
Mentalization—our ability to understand the thoughts, feelings, and intentions of others and ourselves—forms the foundation of healthy relationships. When this process goes awry, as it often does in Borderline Personality Disorder (BPD), relationships become minefields of misunderstandings, hurt feelings, and confusion.
In this episode, we delve into DOCTOR Jacqueline's dissertation topic of how mentalization can go awry with deep shame and personality pathology. Shame emerges as the critical factor that disrupts mentalization. Those with BPD often carry core beliefs about being defective or unlovable, coloring how they interpret others' thoughts about them. If you believe you're worthless, you'll likely assume others see you that way too, regardless of evidence. This creates patterns of negative assumptions without sufficient proof that can become self-fulfilling prophecies as relationships deteriorate.
The social media landscape introduces new challenges, bombarding us with inconsistent feedback that mirrors the chaotic responses some experienced in childhood. When hundreds love you and hundreds hate you simultaneously, how do you form a coherent sense of self?
Ready to learn more? Our community and group course launches July 14th—visit KulaMind.com to join the waitlist and gain the skills to navigate relationships with loved ones facing mental health challenges.
If you have a loved one with mental or emotional problems, join KulaMind, our community and support platform. In KulaMind, work one on one with Dr. Kibby on learning how to set healthy boundaries, advocate for yourself, and support your loved one. *We only have a few spots left, so apply here if you're interested.
Follow @kulamind on Instagram for podcast updates and science-backed insights on staying sane while loving someone emotionally explosive.
For more info about this podcast, check out: www.alittlehelpforourfriends.com
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Dr. Jacqueline Trumbull: 0:00
Hey guys, welcome to A Little Help for Our Friends, a podcast for people with loved ones struggling with mental health. Hey, little helpers, today we're going to talk about my dissertation, but I promise I will not drag you through a boring description of my methods and results. We're just going to be focusing on the topic itself, which, for me, was something called mentalization and I was looking specifically in borderline personality disorder, was something called mentalization and I was looking specifically in borderline personality disorder. But to not confuse you further, I'll say that mentalization is kind of like when we think about what is in another person's mind or what's in our own mind. So I'm looking at Kibbe here. If I'm mentalizing, I'm kind of like trying to figure out what it is that she's thinking or feeling, or maybe what she believes about herself or the world, and I'm using clues like conversations we've had in the past or the facial expressions she's making right now or how I feel in her company, which is just gross and and off-putting and frightening.
Dr. Kibby McMahon: 1:02
Excuse me.
Dr. Jacqueline Trumbull: 1:12
No, which is lovely and light and fulfilled, and I'm making inferences about who she is because of that. But I could also be doing the same thing with myself. What am I thinking Based on these physical sensations I'm having? What emotion could this be? What might I think about a future situation If you told me to go jump off a rocky cliff into the azure waters below? How might I feel about that when the time comes? So it's this really, really broad term, and there are a couple of terms that we use more frequently, like empathy, and that gets at a lot of mentalization, but I think mostly we'll be using the term mentalizing now. Is that fair? I can add a lot more to that definition, but I don't want to bore people.
Dr. Kibby McMahon: 1:58
Yeah, I think it's all of these different. The big category is social cognition, right, and it's like what do we think, what are our thoughts doing in social situations and mentalization, specifically like my thought process around what you're thinking or what I'm thinking. So, yeah, Cool. Well, I'm going to get good at taking as another piece, but you know, yeah.
Dr. Jacqueline Trumbull: 2:22
Yeah, taking empathy, like all of these words we use to describe just figuring out how another person thinks and feels. That's mentalizing. What can cool in mind, help us or tell us about mentalizing?
Dr. Kibby McMahon: 2:37
Well, we got some really exciting stuff coming up. Um, we're not I'm not officially supposed to be announcing it yet but our group is starting. Yeah, our community group is starting in July, so it opens up at July 14th. I'll be spreading the word until then. So, basically, it's KulaMind.
Dr. Kibby McMahon: 2:56
is our platform and community for learning all the skills that we talk about here about how to navigate the mental illness, personality disorders, addiction of the people in our lives, boundary setting, how to recognize when a relationship is getting abusive and how to set those boundaries. And how to take care of yourself and how to support your loved ones when they're struggling, Because I know there's so many pieces to supporting a loved one with mental illness in your life. So, um, based on what people were saying, I mean we were doing one-on-one coaching, but we're also now launching a group so that more people can join, because we're running out of spaces. So, um, if you're interested and want to learn more, go to the link in the show notes or go to Kulamind K-U-L-A-M-I-N-Dcom. There actually is a place where you could put your name on the wait list for the group.
Dr. Kibby McMahon: 3:50
So, if you're interested, just check out the website. You know, ask me, reach out. You could book a free call and we could talk about it. Yeah, I'm really, really excited for this topic because I know that we love this topic so much. It has everything empathy and shame and personality disorder, and how does one get so messed up when it comes to reading someone else's emotions? It's like such a interesting topic for me.
Dr. Jacqueline Trumbull: 4:16
Yeah, I mean it's hyper relevant to Cool the Mind because you're working with like how to help people be more interpersonally effective and like care for themselves and others when, especially when they have like dysregulated loved ones, and we really really need mentalization to be able to do those things.
Dr. Kibby McMahon: 4:35
Yeah, it's one of those things where I mean you feel it, we, you when you have a loved one who cannot mentalize, who just doesn't have empathy, who doesn't take your perspective. It's maddening, right. It's like this, this feeling that you're, you don't matter or you know, you're just like an observer watching this person in their own head, and it doesn't feel like a back and forth. So mentalization, or all these skills that we talk about, are just so subtle but so important.
Dr. Jacqueline Trumbull: 5:03
Yeah Well, you did your dissertation on empathy, I did mine on mentalization. I actually, when I first applied to the lab and interviewed with Zach, I was talking about my interests. He was like, yeah, I'm not really that interested in that stuff, but Kimmy is oh, okay, so yeah.
Dr. Kibby McMahon: 5:24
Why would he be taking us? But yeah, what tell me? I mean, if, if you could summarize your dissertation question like what you studied in a question, and how did you get interested in this? Actually, I don't even know.
Dr. Jacqueline Trumbull: 5:41
Okay, how would I sum it up in a sentence? Um, I was basically wondering if people with borderline personality disorder are better at mentalizing about other people that are unrelated to them than they are when they are themselves in an interaction. If I were to mentalize about you and Caitlin hanging out and thinking about how you two might have felt in each other's company and what kinds of things you might've talked about and thought about, I might be better. If I have BPD, I'd make better at doing that than I would be if I were mentalizing about us hanging out, you and me hanging out and like wondering what kinds of things you're thinking about me and wondering what kinds of things you might believe about me and how you might feel. And the reason for that is because I previously studied for my thesis.
Dr. Jacqueline Trumbull: 6:34
I studied the role of shame in borderline personality disorder, and the existing research suggests that shame is super duper important in BPD and that it's not just that they feel shame frequently, but that the core schemas, the kind of core beliefs they have about themselves, others in the world, are really impacted by shame. So I don't think it would come as a surprise to anybody with BPD, but a lot of core schemas around worthlessness, defectiveness. I am broken. There's something wrong with me, I am abandonable. People don't love me. There's you know I'm, I'm defective. And if you think that you are defective and worthless, then if you are in interaction with somebody else, wouldn't you expect to see that that would color how they feel about you?
Dr. Kibby McMahon: 7:27
And how they understand how that other person's thinking, feeling in your presence.
Dr. Jacqueline Trumbull: 7:30
Yeah, Like, if I think I'm a piece of shit, then I probably think you think I'm a piece of shit, but that doesn't mean that I think you think Caitlin's a piece of shit because I don't think Caitlin has defective or worthless Right. So that was kind of my hypothesis and spoiler alert it was null, but I still think it's correct. It was just the way I, the way I measured it.
Dr. Kibby McMahon: 7:56
How did you get interested in that? Like what what about either borderline personality disorder or mentalization or shame caught your attention. What do you think is so interesting about it?
Dr. Jacqueline Trumbull: 8:09
Uh, I think I have the conscious reasons and then the subconscious reasons, the me search reasons. Research is me search. Yeah, I think the conscious reasons were I dated, um, uh, a terrible person but he was really exciting and interesting and I thought that he was histrionic person. I thought that he had histrionic PD, so I was like PDs, and then I decided no, he's a narcissist. So I was still like PDs, but nobody studies those two disorders. So I found a BPD lab and that was a population that was much softer in a way than narcissism, more vulnerable, more lovable, more I don't know. It pulled me in in a way, but I like how activated, I like activated people a lot of the time, um, and so I. I just there was something about a like a good personality disorder that was just like interesting, activated, dynamic, um, chaotic, right, like there's like it's just a lot to, there's a lot to wrangle with and um, I've also loved interpersonal relationships.
Dr. Jacqueline Trumbull: 9:26
I'm really interested in how people get along and how they fall in love and, um, how they protect themselves and defend themselves from relationships, but also how they've, you know, fall into them and surrender to them. So how we understand what's in another person's mind is a really crucial skill for that. Um and shame is just the worst, you know. I mean, no one likes to feel that one. That's the point of shame and it's a it's it's an interpersonal emotion. So all of these things just kind of fit together and, of course, like, yeah, I can see where shame influences my behavior and my reading of how other people see me, the subconscious pathways. I think that I have a particular person in my life with BPD who I think set me up to welcome in more people in my life with BPD and I wound up with a lot of people in my life who have BPD and their ways of relating are just fascinating.
Dr. Kibby McMahon: 10:31
Yeah, it makes sense. How do you think shame affects the way you mentalize?
Dr. Jacqueline Trumbull: 10:38
I mean, I think that you know, shame can be a little bit interesting to peel apart when we're talking about schemas, because we all know what like the state, like state shame is like. Like shame in the moment when we talk about beliefs that we have about ourselves. We're talking about insecurities. It's like is that shame if I, if I have an insecurity right, like if I think that I'm not good at something, does that mean I think I'm defective? Probably we wouldn't say that, unless it feels like I myself am defective. But what if it's just like I myself am defective at being a leader? Would we say that that is a shameful self schema? If I think that there's something about my personality that doesn't bode well towards something else, is that truly shame or is that something else that's yeah.
Dr. Kibby McMahon: 11:31
I don't know yeah, I would say that if we're talking about shame, the emotion that comes up when we feel like we are something or have a quality that would get rejected from the group right, or get ostracized or kicked out of the social group, then when you have these schemas, in other words for core beliefs, when you have these beliefs about yourself that are so ingrained, that are about I am broken, I'm a bad leader. I have this quality, I believe I have this quality. Bad leader, I I have this quality, I believe I have this quality. But then when that belief is attached to and then people won't like me, people will judge me, people will reject me. Right, like I believe that I am not a prima ballerina. Like I truly believe that I don't think I ever will, I don't even know that score belief but like, but I don't feel like yeah.
Dr. Kibby McMahon: 12:28
I definitely believe I'm not a prima ballerina, but I don't have any shame around it because there's no one Unless like for some weird reason, someone you know forces me to get on the stage and try a couple of standing on my toes, that it doesn't affect my life, it doesn't lead to any feelings that I have been cut out or rejected by the people I care about, right.
Dr. Kibby McMahon: 12:50
But other qualities, yes, right, like we talked about my anger or my, you know, like different, different mechanisms I have, I have more shame around those core beliefs because it's like, oh, I have this quality, therefore I'm bad and people will reject me.
Dr. Jacqueline Trumbull: 13:05
Yeah.
Dr. Kibby McMahon: 13:05
That's what I assume, right. Yeah, what does that quality lead to?
Dr. Jacqueline Trumbull: 13:11
Right Does it lead to rejection.
Dr. Jacqueline Trumbull: 13:12
I mean, I think if you have like a pervasive shame schema, then we're talking something that's closer to self-loathing, where you just really believe that you yourself are just not lovable. I wouldn't say that I suffer from that yourself are just not lovable. I wouldn't say that I suffer from that. I would say that I have insecurities and when those insecurities are spotlighted then I feel shame. So, for instance, I was talking to my supervisor today and she was like she gave me some really nice compliments. She said she's like you're better at CPT than almost any intern I've ever seen and I think your clinical insights are excellent. I've seen some phenomenal sessions. This was bleed into her compliment sandwich.
Dr. Jacqueline Trumbull: 13:55
Um, the anti-compliment was you don't bring enough structure to sessions and something's keeping you from doing that. And that's true, like that's definitely true. I've gotten that feedback before. And she's like what do you think that is? And I was like I think that when I'm in session I find it really difficult to take command.
Dr. Jacqueline Trumbull: 14:15
Sometimes I feel like if a person doesn't take the homework seriously, then that might mean they don't take me seriously and they don't think I'm helping them. And then I get insecure about, like you know, leading them and being like no, you've got to do these Right. So that would be an example of like my insecurity, kind of bringing up shame in myself and changing how I believe my patients are mentalizing about me Right, where I'm like, or that changes how I mentalize about my patients where I kind of like in, I mean maybe I'm correct, but we'll say incorrectly, mind read, that they don't take me seriously and that I think I'm they, they think I'm useless. So we see that like our insecurities often drive the way that we think other people experience us. Yeah.
Dr. Kibby McMahon: 15:06
And we've gotten in.
Dr. Jacqueline Trumbull: 15:08
yeah, we've gotten in tussles right when, like you'll, like, I was like late to a recording session, and then you said something to me that made me upset. But part of why it made me upset was because, like, I feel insecure about being a responsible, incompetent adult. So right.
Dr. Jacqueline Trumbull: 15:23
So then, like being a responsible, incompetent adult, so right. So then, like my, that's my, that's my portion of the of of the thing you know. It's like, how does my shame then? Then it comes up and it's like Kibbe thinks that I'm all the time an irresponsible child because that's who I am, that you know. Like it overtakes and it changes what we think. Shame often prevents us from saying, well, she was annoyed with me in that moment. We'll be fine in five minutes, right. Instead, it creates this like existential crisis.
Dr. Kibby McMahon: 15:53
Yeah, yeah, that's. That's interesting. I know that shame for you like we've talked about this, where shame is one of the hot emotions I don't know for a lot of people, but you've expressed that when you feel shame and you have this weird shame experience where, like you've been internet trolled before being on the you know there there's like this whole level of like online bullying that you've experienced, that like adds to the shame piece where, when you feel shame, I've seen you the most shut down, like different emotions You're able to like kind of stay in the moment, but shame is one where you really go inward.
Dr. Kibby McMahon: 16:28
and yeah, I mean shame and empathy is really just an interesting topic, because if you feel shame in that moment, I get it like it makes total sense that that's a blocker of being able to empathize and attune to someone else's emotions, because you're, like in a time where you probably should, right, it's like in that moment you think that person hates me, that person's going to reject me, um, and then you have all these defenses around it, whether it's like an anger of like fine, I don't need that person. They're, they're terrible anyway, I don't need them. Cut them out, yeah, I'll reject you before you reject me. Or you're just shame can like pull you inwards. All you're doing is thinking about yourself, which means that you're not there with that other person, right?
Dr. Kibby McMahon: 17:17
So it really is like it's a. It's a. It's an emotion that's supposed to keep you in the group, right, like keep you with the caveman pack, but when it gets so dysregulated and high, it it makes you actually sometimes act in ways that lead to rejection. We'll talk about this where it's like, you know, when people like it feels so ashamed, that they tend to lie right or they tend to get angry and mean to the other person, which then does lead to the rejection, right. So it's just such an interesting navigating, you know. The kind of the interpersonal effects are just really interesting.
Dr. Kibby McMahon: 17:57
You're smiling Go for it.
Dr. Jacqueline Trumbull: 17:59
Well, it's just always like these emotions. Are these like evolutionary tools that were given to us? Like these emotions, are these like evolutionary tools that were given to us, these sort of, you know, primitive little systems, but they go so haywire so quickly. I mean, yeah, shame is supposed to keep us in a group. It's supposed to tell us shut the fuck up and go hide and stop doing what you're doing.
Dr. Jacqueline Trumbull: 18:21
Like let people forget about you for a while and then you can kind of creep out and rejoin society. But all it has to do is be turned up a little too loud and it turns into anger and aggression and all sorts of behaviors that are likely to get you rejected. And that's what people with BPD find. They're getting rejected all the time. Their shame is so high. It's not, you can't hold it, and I can talk about why that is.
Dr. Kibby McMahon: 18:42
Yeah, I want to hear that. I just just having a thought about how much this whole thing of shame and lack of empathy might be such a driver of what's going on globally and socially, right, I mean, it's just like, if you think about there's so much of like I'm forgotten, like my group is forgotten by the government. My group is, is or I'm not seen publicly, I'm not represented. I, whether you're from you know, like a conservative middle of the country or from a different, you know, minority group, right. Like we're all angry that we feel so rejected and dismissed that it's just shutting off all of our empathy towards anyone else who's different than us. So just, I was just thinking about how like relevant this topic actually is right now.
Dr. Jacqueline Trumbull: 19:32
Yeah, I mean, in my opinion, this is what the dumbest thing the Democrats did was they shamed the majority class yeah, majority and the most powerful ones. Like what were you thinking? Don't kick out men, so anyways. But yeah, I mean, we see a loneliness epidemic and a crisis of purpose and an opiate opium addiction. It's like opiates addiction that is probably embedded in. Like who am I? Is there any point to me? Nobody cares about me, no one's sticking up for me. Like fuck me then, so fuck you too.
Dr. Kibby McMahon: 20:06
Um yeah, yeah, lack of shutdown of empathy all around. So what did you? Okay, wait. First I want to hear how you actually like studied this, because you did actually like a really good job. You don't have to go deep into the hairy methods that you don't want to, but you did a really cool study.
Dr. Jacqueline Trumbull: 20:28
Well, thank you. So when you do research, you don't want to reinvent the wheel. So I went and looked at mentalization measures that have already been used a lot and I found one that had been used a lot in BPD research and then one that had been used in psychosis research that I used as well. So basically what I was saying is, all the existing measures were asking people to mentalize about other unrelated people, and I'm not the only person who has proposed turning this around and making it what we call self-referential. So I am now mentalizing about Kibbe and me. That's self-referential. It references the self versus other referential meaning. I'm talking about Kibbe and Caitlin. So I took an existing measure and then copied it but changed it into self-referential, so it was like Tom and Vicky. Now it's Tom and you. Ooh, like very simple switch.
Dr. Kibby McMahon: 21:25
What were the tasks? What did they ask people to do?
Dr. Jacqueline Trumbull: 21:30
The social faux pas task is like Helen is at her friend Sarah's house, she spills coffee on her dress and says Oops, I was going to wear this to your party on Saturday, but it was a surprise party. Did Helen say something she shouldn't have or something that was awkward? And then it's like why do you think Helen said it? What do you think she was feeling when she's? It's like that kind of you know. So they ask you about like a social faux pas, and then, like you have to mentalize about why this may have happened and like was it intentional, right?
Dr. Jacqueline Trumbull: 22:06
Um, and the hinting task is the one from psychosis research. They had made a self-referential one, so that's why I took it, and then I made an other referential one that could be used for online purposes. But it's the same concept. It's a vignette and one character gives the other one a hint. Like Tom goes over to Jack's house to study. When he gets there he says bird's cold outside. What could he mean by this? And the hint is basically supposed to be like I'd like to warm up before we start studying, or like can you hand me that? I?
Dr. Kibby McMahon: 22:36
was like sounds pretty clear to me. I don't know.
Dr. Jacqueline Trumbull: 22:45
When I looked at the hinting task I was like, uh, I might get results suggesting that I under mentalize, because I tend to take people at their word. Once you get the gist of the task, you can keep going with it. But I mean, this is the thing, right, these like measures aren't amazing and yet it's what the research relies on and that's what you find in research a lot. This is why when people say like I believe science, like that's fantastic, but you have to understand that science itself, like like my study, is going to say there's no difference between other and self-referential, because they got the null hypothesis. But that doesn't mean it's true. It means that the measures I used, that the rest of the literature has been using for so long, might have some flaws in them.
Dr. Kibby McMahon: 23:28
And they might not like pick up things. That's an aside, Right, it's, it's really it's. It's really tough to capture everything, all your social skills, by like reading that description online and then for you to answer the question of, like what could Tom be thinking, but was there? Were there right answers or was it just? Was it just about seeing how you answered? Like how, how does one do well on those tests? There's a right answer.
Dr. Jacqueline Trumbull: 23:47
Multiple choice.
Dr. Kibby McMahon: 23:48
Yeah.
Dr. Jacqueline Trumbull: 23:50
Yeah, all right, yeah, so that's whatever. But we found that shame was important and that shame explains some group differences. We found that people with BPD are worse at mentalizing overall, even worse than people with just like general high psychopathology, so people who are depressed or anxious, you know, or have some other disorder. We found that, like, if you have BPD you've got even greater deficits and that state shame. So the shame you feel in the moment can collapse those group differences. So suddenly it's shame that explains things, not diagnosis.
Dr. Kibby McMahon: 24:26
So what do you make of those findings?
Dr. Jacqueline Trumbull: 24:29
What do they mean? I think that we need different paradigms and ways of measuring the question, but it means that the way you feel in the moment, if you're super ashamed, right, like, of course that's going to give you deficits it's going to do the same thing we were just talking about. I think that there are reasons I would like to do. Well, I would like somebody else to do analyses that show whether that like shame process is specific to BPD, like whether they are more likely, whether it's more likely that their deficits are coming from shame versus other groups. And it would make sense because here I'll go into the develop model, if that's okay, the developmental model. So basically, the idea is the way mentalization develops is when you're a little wee baby. You come out of the womb and you have some tools, and those tools are your emotions and the way you express them. And you have no idea who you are yet because you're a baby, your brain is mush and you know you don't have a prefrontal cortex. That's very online at this point and you don't have a lot of reflective capacity. So you're basically this little moldable, squishy, little screaming thing and your environment, I mean you have lots of instincts and embedded data and everything. But your environment is going to do a lot to shape that and develop it. And if that's the case, your early tools are pretty important and they're pretty important in helping you make sense of who you are and what's going on in this big scary place you've just, you know, shot out of your mother into. So if you are a baby and as you grow up you know you cry, you cry, cry, cry and your mom comes and holds you and says, oh you look so sad, I'm so sorry you're sad, you know, like, let me rub your back, let me rub your back, let's sit here in this Then you're going to understand that when you cry and make whatever face you were making at your mom, and maybe if you cry in a particular way, that that means you're sad. And now you have a word to put to this particular experience. And that when you're sad, you can reliably expect, if this happens over and over again, if your mom keeps comforting you, that like that's going to make people want to take care of you and comfort you and conveniently, that is what sadness is designed to do. So you are getting basically, like, correct, appropriate social feedback for that emotional experience that you're having and when you do that with all of your other emotions and you're like, oh, okay, like now I'm angry. And then your mom helps you make sense of why you were angry. It made you angry when you got pushed over on the playground and now you want to, you know, yell at him. Okay, I get it Like, yeah, I understand, frustrate me too, right, you get all of this feedback that suggests what you're thinking is normal, it makes sense, it makes sense to other people and it can reliably get the same kind of feedback from other people. And when you can get the same feedback from other people, then you can start to make consistent sense of who you are.
Dr. Jacqueline Trumbull: 27:30
If I take ballet lessons and my teachers all consistently tell me holy shit, you should be a prima ballerina when you grow up, then I start thinking I'm a ballerina, that's something about me, that's true. Everybody else thinks it's true. I have evidence suggesting it's true. So that's something I'm going to identify with. If everyone tells you you're smart, if everyone tells you you're beautiful, et cetera, now of course you're going to start to get some people who don't say that you know, like, um, I've been consistently told that I have high emotional intelligence and that I should be a therapist. But last week a Redditor said I have extremely low EQ and they can't even fathom how I could ever be a mental health professional, right, if I didn't have an identity shaped around this. I wouldn't be able to buffer myself against that. I would be very and I was confused right myself. Against that, I would be very and I was confused, right, because it's that was a very strong claim.
Dr. Jacqueline Trumbull: 28:24
But the problem is now we're taking a different kid who comes out and they scream and they get hit. I'm like, oh my God, okay, so I guess when I'm upset, I get hit, but then another time when they scream, they get cuddled, and so, like this is weird. Okay, sometimes when I scream, I get hit. Sometimes I get cuddled. Third time when I scream, they get cuddled, and so, like this is weird. Okay, sometimes when I scream, I get hit. Sometimes I get cuddled. Third time when I scream, everybody ignores me.
Dr. Jacqueline Trumbull: 28:50
Okay, what is the screaming thing I'm doing? This kid is going to be like, when I scream, no one's helping me understand what's happening. No one's telling me it's because I'm hungry or because I'm cold or because I want to hug, like, and they're giving me really weird social feedback. I can't predict what happens when I have this emotional experience. So what is this experience? I don't know. I don't know what it is I'm feeling. I don't know why it is I do these things. It's just something in me says scream, and then I scream and then I'm hit and sometimes I'm soothed and sometimes I'm ignored. So I don't know whether I should keep doing this or not And'm not getting like consistent social feedback.
Dr. Jacqueline Trumbull: 29:20
So okay, now this person's saying that I'm a good at ballet, but this person says I'm bad at ballet and I don't have any kind of core place from which I can know exactly who I am and why I feel the things and what I'm feeling. And so who knows if I'm good at ballet? I don't know. I guess I'll just believe whatever somebody says to me in the moment, like it's the, it's the best thing I've got to hold onto is just whatever you tell me I am or who you tell me I am right at this very moment, cause I can't. There's no predictive quality to it. It's going to change next moment. So I guess then I'll believe that.
Dr. Jacqueline Trumbull: 29:51
And so now you have the person with BPD, having this develop, you know this identity like problem where they're just like I don't know who I am. And if you don't know who you are, it's really hard to mentalize, because you don't know what your own emotions are saying. How are you supposed to know what other people's emotions are saying and how are you supposed to know how other people feel about you when you're not getting any kind of consistent information? And so you're just this kind of like big ball of confusion? And the other thing is that sometimes it's a really bad idea to mentalize, because if you're a little kid whose mom or dad abuses them and doesn't take any good care of them and is really chaotic, then what are you going to do? Think, yeah, it must mean they don't love me, they don't care about me. Okay, yeah, I guess. Okay, like, that's not a good, that's not a helpful thing to believe, necessarily, and so blocking mentalizing can be adaptive.
Dr. Kibby McMahon: 30:47
Yeah, there's also this, this other layer that the mentalization literature adds on to to this, like what you were describing as a nice, like bio-social theory of um, how important it is for caregivers and the people around you to help you make sense of your own emotions right and help you regulate. And the piece that the mentalization group Bateman and Fonagy talk about is that they're at some point in the kid's development they get the idea that you're, they're looking at your, they're looking at their mom and their mom has a picture of you in their mind Like it's not just oh, you're sad, it's oh, you're sad, you are sad. And then there's this we're so good socially that there's an understanding that, oh, I'm a baby, I'm sad, but mama is not sad, mama's seeing me, oh, she's thinking about me. Wait a minute, I'm thinking about mom. Right, it's crazy to to also see it happen with my toddler, where there is this like this beautiful connection with the baby, where you are one like that kind of level where emotions are shared and we're in it together and babies until I think that, like two or three, they don't have an idea that you are separate from their mom. Yeah, until this, the perspective taking theory of mind, part of your brain starts to develop around, I think, age three, where they go. Oh wait, I have a separate brain and you have a separate brain and I'm sad, but you don't seem to be sad. Actually, I feel like the world is ending right now because I'm upset and probably hungry, but you seem calm. So I'm going to feel safe because I'm going to assume that you also have a perspective on it that I don't have, right? So that's like such an important part of our social emotions is that we developed and really evolved uniquely to be a bunch of brains together. Right, I have a mind and I have my own feelings and you guys have a whole bunch, and my survival relies on trying to figure out what you guys are doing and thinking and feeling, but also how to communicate what I need to you guys, and then we all coordinate this whole dance together of minds and feelings. Right, we're all one, but we're all kind of separate.
Dr. Kibby McMahon: 33:19
So that autonomy, that separation, is something that they think that people with BPD don't have. It's like. It's like being stuck like a toddler right when they I watch it and my mom I watch it and like people who have like severe emotions, dysregulation. They're like oh, I'm mad and you hate me and I'd be like no, I, I meant something else, you misinterpreted. They're like no, that's impossible, because what I think and feel was the whole world Right. And so it has this narcissistic, self-absorbed quality because their emotions are the only thing that matter. But the theory is because they just don't realize that that's not true, that other people can feel different things than you, which is so basic. But think about what the world would be like if you felt like your emotion was literally the only thing that existed.
Dr. Jacqueline Trumbull: 34:11
Yeah, I mean, if you and get crazy feedback to your emotions, then it's difficult to make sense of what that other person is thinking or feeling, I guess. And so how can you create a mental representation of yourself in their mind? Like for something to make sense, there has to be a through line. There has to be some aspect of consistency. So if you get crazy chaotic stuff, you're not going to have a through line. If you get intensely negative stuff, you will have a through line, but it will be deeply shameful. I am hated and I think. I think people with BPD often get one of those two outcomes. Um, people with BPD often get one of those two outcomes. Did your, did Jackson learn how to say daddy before mama? You know that's. Do you know why that theory?
Dr. Kibby McMahon: 35:09
It was what you were just talking about. Because, like, because the he recognized the babies, recognize a dad, a separate beings, faster than mom.
Dr. Jacqueline Trumbull: 35:16
Yeah.
Dr. Kibby McMahon: 35:18
I know it's it's. It sucks because, because, because, like there, when he was developing autonomy, he was especially like like nasty or annoying to me. I'm like really nice to Alex, like I would. He would be working on something and I come in and I would like say hello or say and he'd be like no, go away, mama.
Dr. Kibby McMahon: 35:39
And at first I was like, but I learned that it's because that they just they're learning autonomy, so they need to feel that separateness and they like do things to push you away Right, Like this big no phase when they're two, like no, no, no, Just because you have something to brush your teeth or eat something, and even if they're going to, they just want to say no, to be like I'm a different person and I'm going to make this decision. I'm going to eat that, but not because you told me it's really fun. It's a really fun time.
Dr. Jacqueline Trumbull: 36:07
Fronege also talked and this kind of confused me, but he talks about how people with BPD will often need to create an emotional experience in another person that they can see out in the world in order for them to make sense of what's happening inwardly. Have you heard this? Like what? No, that's cool. Like if I'm feeling panic, but I can't own that because I don't, I don't have a way of making sense of my own emotions.
Dr. Kibby McMahon: 36:32
I might call you and be like we need to talk and then hang up To make, to make me panic, yeah, to be like oh, it's real now that someone else feels it, yeah, yeah.
Dr. Jacqueline Trumbull: 36:42
That's interesting. I don't know if research backs that up, but, um, I was reading the mentalization based treatment handbook and I was talking about that, so, um, I can also just imagining Jackson being like I'm mad, she's me, let's make her mad, and then I can see it out in the real world and I can play with it and understand it. You know what I mean.
Dr. Kibby McMahon: 37:00
Yeah, I mean it just feels like mentalization and developing mentalization good empathy skills is really about learning that we have edges. Right Like if you just feel like you're just like a bunch of emotion and we don't have edges, we don't have borders between me and you. Oh my God, talk about regulation. I mean, how do you even manage a feeling that doesn't have any boundaries, literally so?
Dr. Jacqueline Trumbull: 37:24
yeah, I had a friend who would talk about. She's like I can't even tell who I am unless somebody's mirroring for me, like unless I'm in front of somebody talking, and that's why she would vent at me so much and spew so much towards me, because she's just like I have to, like somebody has to witness this, or I can't experience it, or something like that. Um yeah, and of course that's a huge burden on the loved one. So it's, it's a problem.
Dr. Kibby McMahon: 37:50
What do you think is going to happen with all these kids who now, these kids these days but, like you know, who are seeing themselves in videos and photos on their phone, all like since they were babies? Instagram, like all the social media, where you're literally seeing yourself as an external representation all the time?
Dr. Jacqueline Trumbull: 38:14
uh, I don't know. I mean, I grew up looking at pictures of myself. I'm more concerned about the fact that they're not being mirrored by real people and they're going to be mirrored by AI, and AI is going to tell them who they are.
Dr. Kibby McMahon: 38:29
By the internet trolling right Like you know, it's we. The social feedback we get now is even worse because you don't even get real mentalization. You don't really get how everyone was thinking and feeling. You get like this, really one-sided bias.
Dr. Jacqueline Trumbull: 38:53
Like you suck, you're terrible, right, this like almost like drive-by shooting of emotion, of social feedback. Reddit was so hard for me to let go of because I knew that at a certain point they were no longer reacting to me. They were reacting to an avatar of me that was made up of a lot of false memories that people on Reddit created and like attached to me, and yet it was still so hard to relinquish like, no, that's that's me, that's me they don't like. It's me that they're um, you know that's me they don't like.
Dr. Kibby McMahon: 39:24
It's me that they're um. You know I don't strongly identify with the public version of you.
Dr. Jacqueline Trumbull: 39:28
Like you know, it's fun. Now I'm like having this meta moment where I'm like maybe this is what it's a little bit what the bp experience is. I don't know what the public version of me is. I don't. I didn't receive consistent feedback, so I would put out a part of myself, but I don't know what that consistent whole story that was telling. Because when you're an adult and like a full fledged person with a lot of angles and nuances and you know colors and shades and whatever it's like, you just put out a two sentence caption with a picture on Instagram and then you do it again and again and again and again. Like who is that person? I don't know. It's hard to see that person as separate from myself, but of course, other people aren't really knowing me from that. They're only knowing little snapshots.
Dr. Kibby McMahon: 40:17
I mean, I only had a taste of what you experienced, but I I posted that post about, like the pov reel about um, a story and a situation that I've heard from many different people and people in the cool line community, where um, it's peop, it's women who are noticing that their husbands are getting more depressed and drinking more, getting more withdrawn and tend to go on YouTube channels that are more right wing, right Like the manosphere, at the masculine kind of, and this was from both sides of the pockets and I said POV, your husband is blah, blah, blah, blah, blah, right, and this is not my life.
Dr. Kibby McMahon: 41:01
This is not what Alex like, it's not me at all. It literally was like I made a meme but like you used me as the video and put the words over and getting like so much internet, like flack, so many conservative men saying awful things, like you know well, if my wife looked like you, I'd drink too. And like you know well, if my wife looked like you, I'd drink too. And like you know you liberal women are the problem and you know like there was a level of like this is so silly and this is not even me, but you can't help but take it personally, and also, I guess maybe there's a part of the shame that makes it even worse when you can't, when you can't defend yourself at all, like when you, when it's literally like people with none of his usernames saying all this awful things to you um, it did. It doesn't make any difference to like, write back to them or defend yourself in any meaningful way, because it's just kind of like, you know, it's just like insults raining down. It's not a one-on-one interaction.
Dr. Jacqueline Trumbull: 42:08
So I wonder, I don't know, I'm just, I mean, look just like a person with bpd cries and one day they're hit with little hitting and the next day they're hit with screaming and the third day they're hit with comfort. It's like when you go out on instagram after the bachelor and you post something and you get a thousand people telling you, oh my god, you're the most amazing person ever. But then you get 300 people telling you you're pretentious, trash and you lied about getting a phd and you're so stupid and you use such stupid words and you're not that hot and what else. You're back and, uh, whatever, you're just like. Well, that's pretty fucking compelling. Like I mean, a thousand people seem to like me, but 300 people is a pretty big number, and like they really hate me.
Dr. Jacqueline Trumbull: 42:55
So I don't know, I don't know if this piece of me that I, that's like morsel right of me that I left out in the internet, I don't know if that's a good thing or a bad thing. I don't know if it's a like thing or a dislike thing. It's both, and so how am I supposed to make sense of that? Okay, I'll try another one. Same thing happens. Fuck, I don't know.
Dr. Jacqueline Trumbull: 43:12
Right, it's like hard to it's hard to conceptualize of what that is. You're, in person, like I've got a whole history of evidence of people loving me and affirming me and experiencing me in a particular way, and then that kind of self-esteem comes back. But online you are. You're putting out a different persona. You're just putting little morsels of yourself out there and people are eating it and some of them are spitting it back out and some of them are enjoying it, and you're just like I don't know, know what, I don't know how to make sense of this. And so, of course, like it's difficult then to discredit the negative information you get, because you don't know if it's good so are you saying?
Dr. Kibby McMahon: 43:55
this is what happens with people with borderline personality disorder is that they just have such a difficult time understanding who they are and having a grounded sense of themselves that shame can be just overwhelming. Kind of like what you're talking about here, where you're like a buffer against shame is like, oh, I've had a lot of experiences where people loved me, but if they just literally have nothing to go on, then shame might be just too much.
Dr. Jacqueline Trumbull: 44:22
Well, yeah, because how, if you have nothing to go on, if you truly don't know whether you're a good person or a likable person or whatever, and someone says you suck, you're, you're not going to have a lot to push back on, you're just gonna be like, oh God, I suck, like I'm bad, because I don't have a whole back history of evidence telling me otherwise. I better believe this because what, like? Why wouldn't I right? Like that experience of shame is way, way, way different than being able to say, well, this person doesn't like me in this moment yeah, and it's also interesting that people with bpd tend to hypermentalize right, it's like this overthinking?
Dr. Kibby McMahon: 45:08
I mean, tell me more about hypermentalization. I understood it, as they tend to have too many thoughts. They tend to read into other people's thoughts and feelings more than they actually exist. Is that like overthinking other?
Dr. Jacqueline Trumbull: 45:23
people's thoughts Essentially, but you can have just one single thought. That's hypermentalized.
Dr. Kibby McMahon: 45:27
So I what does that mean?
Dr. Jacqueline Trumbull: 45:30
It means that I make a mentalized inference for which there is not sufficient evidence. So if you frown at me and I say she hates me, that's a single thought. But it's hypermentalized.
Dr. Kibby McMahon: 45:45
Oh, I see, I see, but like all mentalization has that a little bit right. Like we don't have all the evidence but we get. We're making a lot of guesses of what people are thinking and feeling and if it's accurate, it's accurate right, like well, right, so no one says that hyper mentalization is inaccurate.
Dr. Jacqueline Trumbull: 46:04
And so this is all this measurement. Difficulty is like yeah, you're right, like we are all making inferences. Some of us are are making inferences with more reasonable evidence, I suppose.
Dr. Kibby McMahon: 46:17
Um. So people with BVD, because of their shame, tend to, um, just make more interpretations and guesses about what other people are thinking and feeling just make more interpretations and guesses about what other people are thinking and feeling.
Dr. Jacqueline Trumbull: 46:33
They make more, not necessarily more in terms of quantity they're not.
Dr. Kibby McMahon: 46:35
I mean, they're just making guesses without evidence.
Dr. Jacqueline Trumbull: 46:38
Yeah, but they tend to be negative and like more. But I mean, I suppose you could hyper-mentalize in the opposite direction. You know, we know, that people with BPD split about themselves. Sometimes they think they're the coolest shit that's ever been Right. And so in that name, I hypermentalize and say this person loves me. But we don't typically talk about that in the literature. It's more like negative hypermentalization. And yes, it could be correct. Like I could.
Dr. Jacqueline Trumbull: 47:00
Correctly, I could be hypermentalizing and say that you hate me and, lo and behold, you actually do hate me, but there was just no evidence for it and I don't know if they do this because of shame. When we included shame as a covariate, the group differences disappeared. I would imagine it has a lot to do with shame, but it also, I think, fundamentally is just a pretty good survival strategy if you grow up in abuse. If you grow up in abuse, you want to make more wrong guesses in a particular way, like more type one errors versus type two. It's amazing. I've been six years in a program and I can never remember which is which.
Dr. Kibby McMahon: 47:37
But if I want, to err on the side of caution.
Dr. Jacqueline Trumbull: 47:41
You want to err on the side of caution?
Dr. Kibby McMahon: 47:42
Yeah, no-transcript tends to hyper mentalize or just you know, from extreme shame, like it sometimes feels like you are. You are speaking on behalf of a character that that person has made up for you, Like you're being. That person is seeing things in you or making guesses about you that you're like. This is not. I don't know where this is coming from, and then you run the risk of gaslighting them by saying no, that's not true.
Dr. Kibby McMahon: 48:42
For example, like one of my big fights with my mom is that I said some things that she interpreted as like really negative. I said, maybe it's the fact you have on people, and she interpreted that as like I was saying something super negative and I wasn't. And then she interpreted the next part of the conversation as you're not allowed to see Jackson ever again, my son. The next part of the conversation as you're not allowed to see Jackson ever again, my son, Even though I had invited her over to see him that day a couple times and I remember it was such a weird experience to stand next to her and she was like, wow, you told me you never, you don't need, I can never see my grandson again. And I was like let me show you the, the, the text messages where I invite you over, and she just kind of shook her head and was like oh well, never mind. And so I feel like I was in an argument when I wasn't even in the argument, right, Like she was fighting against someone.
Dr. Kibby McMahon: 49:41
That wasn't me like accusing me of thinking or feeling or intending things that I didn't wasn't me like accusing me of thinking or feeling or intending things that I didn't, and I like in that scenario, like how do you defend yourself? All I could say is is I didn't say those things. That was incorrect what you felt and thought. But yet that's also kind of invalidating to her experience, which she just felt so rejected and ashamed that it just like hovered everything that she was seeing. So it kind of leaves you in a bind as a loved one.
Dr. Jacqueline Trumbull: 50:10
Well, this is. It's just so funny Cause I was thinking like I, you know, I feel pressure to do what you're doing on social media and start making these videos and everything. But I feel very nervous about that for a number of reasons, but one of them has to do with a little um card that I saw at the VA. That was called signs of gaslighting and it was quotes like that never happened or that's not true, or you know, like these things. And I was like, yeah, okay, these are signs of gaslighting. They're also signs of somebody who's defending themselves against something that didn't fucking happen. Right, like, yeah, if somebody is saying that's what you said and that's not what you said, because that's and that's not what you intended, or whatever, like you can't call that gaslighting, but they're going to feel gaslit, and so now we have a problem and it's one of the reasons why gaslighting is being flung around all the time.
Dr. Kibby McMahon: 51:07
Yeah, and the other thing is that, yeah, I mean it's Sorry, you talk. No, go for it.
Dr. Jacqueline Trumbull: 51:14
Well, I was just going to say. The other thing is that hypermentalization can become a self-fulfilling prophecy. If I tell you over and over again that you don't like me and you don't care about me, you're going to get fed up and stop liking me. And now I'm correctly mentalizing.
Dr. Kibby McMahon: 51:31
Right these core beliefs and schemas we have such a drive to confirm them? Right? If I feel like no one loves me, I'm going to act in ways that kind of push other people to reject me and not love me, Just because confirming these beliefs about ourselves sometimes feel a lot more organizing than just being like whoa, everything I know about myself.
Dr. Jacqueline Trumbull: 51:52
It might not be real right, right, it's a rat's nest and it's super sad it is.
Dr. Kibby McMahon: 52:01
I think that this is where um, the dbt, um skills of learning that feelings aren't facts, really come in nicely Because, gosh, like I wish I wish so many people learned this. Where it's like, yeah, you might feel ashamed, you might feel like my daughter's not letting me see my grandson ever again, but that might be the shame talking and that might be the shame. And some people, feelings have really shaped the way they think, right, like some people go oh, I feel ashamed, but I but I know this is not, this is just the way I feel right now.
Dr. Kibby McMahon: 52:39
I don't I don't think everyone hates me, but some people feel the shame and go oh, everyone hates me, and that's true and there's no other possibility of truth, right? So you know? And DBT is like learning that like feelings aren't always facts, like feelings can really shape your thoughts and the way you see things, but like that's not always true. Yeah, I just wish.
Dr. Jacqueline Trumbull: 53:05
Well, I think that's crucial. I think another important piece here is, like another covariate that I had in my study, which is it's kind of like it's another factor that kind of comes in and might explain some of the differences you find so covariate was just a shameful schema Like so how much do our core beliefs explain this? And it was significant with hypermentalization. But I think what's probably happening more is that if you have this schema, you're more likely to feel state shame, and then that state shame is what's going to screw up the mentalization. Um and so, but being able to name like okay, I've got this core schema that says that I think I'm worthless. Does this help me any more in life? Talk with your therapist, yes, no, maybe. So, okay, not really, it's not really helping me.
Dr. Jacqueline Trumbull: 53:52
Then, when you're in a situation being able to name that okay, I can tell I'm making an assumption that this person doesn't like me. And I know about myself that I have this core belief that I'm unlovable and defective and worthless. So might this be influencing things? And actually, that same friend that I talked about, she caught herself a couple of times and she was like hey, um, I just did this thing where I read what you said in a particular way, but I'm trying to ask now, instead of making assumptions, did you mean that you don't like me?
Dr. Jacqueline Trumbull: 54:24
I was like, no, that's not what I meant by that. I'm so glad you asked, right, like you caught. You caught the schema. So for me it's like when I see patients, I have to know I have an incompetent schema when I am not insisting on them doing homework. Is this maybe that schema at work? And do I need to catch it and try to do the opposite? Right, like take a chance on myself and then understand, like, embedded in that is, my feelings are not facts, they're telling me information. Some of this information might be useful, some might not be useful, but I got to slow down and rifle through it and really think about it.
Dr. Kibby McMahon: 55:00
Yeah, these are all these metacognitive or mindfulness abilities to people to step back and see, like, oh, wow, look at this belief that I have that's affecting the way I see things will then affect the way I feel. Like I have this belief, I'm broken, which will make me think that someone hates me or they're going to reject me or think badly of me, which will make me feel really ashamed, which will make me shut down. So it's just, I've noticed that since we've did our episode on self-hatred, where I noticed how much of my core schemas are negative, I'm like going around the day being like wow, so many of my thoughts are trying to confirm or like check that. Like are they better than me and why am I not doing enough? Why am I not better? Why am I like what haven't I done yet? Oh, that's not good enough. Like just noticing that that's a running inner dialogue all the time it's helpful.
Dr. Kibby McMahon: 55:53
It's like it's kind of it's disorienting to watch my core scheme, core shame schemas spinning around and around all day. But once I see it it's like kind of like seeing you know the matrix where you're like, oh, this was all you know, a bunch of ones and zeros Like now can.
Dr. Jacqueline Trumbull: 56:13
I fly.
Dr. Kibby McMahon: 56:13
Like what can I, what you know what? What now so?
Dr. Jacqueline Trumbull: 56:16
that's exciting.
Dr. Kibby McMahon: 56:19
Yeah, yeah, exciting is the word for it, yeah.
Dr. Jacqueline Trumbull: 56:25
There is a therapy called mentalization based therapy. I don't know how frequently it's done, but I think the general idea is that your therapist is going to help you get a sense of your own and others mentalizing based on how they respond to like the way. I mean you've been to a training, so actually I'll hand it over to you to describe I think we should do a whole episode on that. Oh, okay.
Dr. Kibby McMahon: 56:49
So stay tuned. Mentalization based training.
Dr. Jacqueline Trumbull: 56:54
But I think the gist is like the therapist tries to give you what you missed when you were a kid consistency of responsing, organizing Do I say responsing. Consistency and responses. Do I say responsing, consistency and responses, organizing um helping you make sense of what you feel and what other people make feeling.
Dr. Kibby McMahon: 57:12
But we can do a separate episode um anything else, super interesting to try to figure out how to develop mentalization abilities and people who struggle with it anything else, but I think it's uh wine o'clock now. I think it's time for you to come over and watch? Yeah, we should watch love island. There's the uk and the us version, and a shout out to any any little helpers who want us to do episodes on.
Dr. Jacqueline Trumbull: 57:43
You know analyzing these, because we would love to so we always think about we were going to do the other one, the other one, the trashy one, the one where they jeopardize their relationships and then cheat on each other.
Dr. Kibby McMahon: 57:58
It's a whole of them. Yeah, temptation, yeah, it's like temptation, something, something.
Dr. Jacqueline Trumbull: 58:04
Yeah, we were going to do that and then we were like like we're a serious podcast, just kidding. That was not what happened.
Dr. Kibby McMahon: 58:10
we procrastinated and then the moment passed we're so not serious that we didn't do the unserious episode and decided to talk about your dissertation and said so. If you want to hear us talk about love island, either us or uk, please send in your questions. Send us. You know, on the show notes you can send us a text. You click on that and just write us a message. You know, I don't know, just say hi oh my god, I'm gonna add doctor.
Dr. Jacqueline Trumbull: 58:37
I want to add my title clinical. Yeah, I don't want to do this on air, but yeah, we're gonna we're gonna add in in Dr Jacqueline Trumbull, everywhere. So we're.
Dr. Kibby McMahon: 58:51
Dr Jacqueline Trumbull, and if you want to link your dissertation to this so people can read it.
Dr. Jacqueline Trumbull: 58:59
Once it's on ProQuest, people can read it.
Dr. Kibby McMahon: 59:03
I'll link it on the show notes. So you should be really proud, it's a really cool study. Proud, it's a really cool study. It's a really cool topic. Fame ruins everything. Don't feel shame. Don't do it. You know it doesn't help do it. When you feel shame, just shove it down. Feel other things still.
Dr. Jacqueline Trumbull: 59:19
You probably want hurt people and like it uh but yeah, but don't hurt us. Um, instead, give us a five star rating on spotify and apple podcasts so that we won't feel shame, and I will give you a clue now about our mental status. After you do that, it will be happy, we'll be happy we will like it, we will like it and we'll like you if you do that okay, we like you guys, and we'll like you if you do that.
Dr. Kibby McMahon: 59:48
Okay, we like you guys.
Dr. Jacqueline Trumbull: 59:48
anyway, We'll see you all next week. Bye, Bye. By accessing this podcast, I acknowledge that the hosts of this podcast make no warranty, guarantee or representation as to the accuracy or sufficiency of the information featured in this podcast. The information, opinions and recommendations presented in this podcast are for general information only and any reliance on the information provided in this podcast is done at your own risk. This podcast and any and all content or services available on or through this podcast are provided for general, non-commercial informational purposes only and do not constitute the practice of medical or any other professional judgment, advice, diagnosis or treatment and should not be considered or used as a substitute for the independent professional judgment, advice, diagnosis or treatment of a duly licensed and qualified healthcare provider. In case of a medical emergency, you should immediately call 911. The hosts do not endorse, approve, recommend or certify any information, product, process, service or organization presented or mentioned in this podcast, and information from this podcast should not be referenced in any way to imply such approval or endorsement.
