Wednesday, June 19

Interview with Eli Somer

Question Time on maladaptive daydreaming

The following article is the transcription of the video interview that Valeria Franco had with Professor Eli Somer, the first who have studied maladaptive daydreaming.

You can watch the interview at this link.

Valeria Franco: Hello everyone, this is Valeria Franco and today I have a very special guest joining me, Professor Eli Somer. Welcome Professor.

Eli Somer: Pleasure to be here.

Franco: Professor Somer, you were the first to have studied Maladaptive Daydreaming, in 2002, and so today I would like to talk with you to gain a better understanding of this problem.  I have asked my online communities if they had some questions for you and I have gathered here the most interesting ones. 

Somer: Alright.

Valeria: The first one; Is Maladaptive Daydreaming a recent disorder or has it always existed?

Somer: Well, I don’t think that disorders develop suddenly out of nowhere. I mean this is part of the human condition, to be daydreaming is something normal that over 90% of people do it every day.  Here we’re talking about a special trait that has been defined in 2002. Has been identified and defined in 2002, a special trait that can lead to an overuse, to an excessive use. My belief is that it’s been there all along, since it has not been identified and defined well it’s probable that people were misdiagnosed or were simply not identified correctly and that people were sort of embarrassed to talk about it. Because many people with this condition who I have talked to told me that they thought that they were the only people in the world who have it. 

Valeria: Yes, that’s true.

Somer: How we give it a name, and communities forming like the community that you are leading in Italy and I hope that together we will have a voice, and together with scientific evidence, that we will have a voice that will convince the main classification books to include this disorder someday in the future.

Valeria: So in the past you think it was covered by other diagnoses?

Somer: It always existed but it is very similar to- it has some overlap and similarities to disorders. First of all many people who have this problem have depression, have anxiety, have other issues. It’s most probable that people came to their doctors, presented their concerns, and were treated for other existing disorders. But it is also possible that the symptoms were given another diagnosis, were seen differently, because mental health professionals use the criteria and the diagnostic categories that they are familiar with to understand what they are seeing in front of them.  For example I could imagine that someone describes to their doctor that they have- that they see all kinds of scenarios in their mind with people talking and interacting and so on. To a naive mental health professional this may sound, for example, like hallucinations in schizophrenia. I have been told by some individuals that is a diagnosis they have received in the past while my impression that they never suffered from schizophrenia which has many other issues that are not present at all in Maladaptive Daydreaming. 

Valeria: Alright. So then exploring, are Maladaptive Daydreamers born this way or do they become like that after specific life event or traumatic event? 

Somer: It’s a classic question of ‘what influences mental health issues?’ Genetics or environment? And the answer is always a combination of both. The evidence that we have is that people (who we have diagnosed as meeting the suggested diagnostic criteria for Maladaptive Daydreaming) report that they have always had this problem. Since they can remember themselves, or since childhood, they remember engaging in extensive fantasies. My impression is that it’s something people are born with, this ability to fantasise with great clarity, with a lot of vividness, with great detail, this is a special ability that some people have. It is also possible that it is hereditary, meaning that the likelihood of it being in first-degree families is perhaps bigger or larger than amongst strangers. So I think it is an innate, possibly a genetic, condition that people can get addicted to.  But since it is so rewarding, it is so pleasurable, to have it, it’s possible that people with depression or with anxiety or with social anxiety or with bad memories or with stressful environments (like conflict or child abuse circumstances) people who have this ability and are surrounded by stressful circumstances it is possible that they are more likely to use this fantasy to calm themselves down to distract from emotional pain. You can see how a trait that is inborn can become very useful, particularly since it is so pleasurable, it is so rewarding, so it can become useful as a coping mechanism to address stress and emotional pain. Indeed our research shows that childhood abuse, for example, is more prevalent among Maladaptive Daydreamers, although you don’t need to have childhood abuse or a history of abuse to develop this, individuals who have gone through very difficult childhood circumstances and have this ability of course will use it to dissociate, to distract, to comfort themselves from existing distress.

Valeria: If you have a problematic life you are more likely to get addicted to it. 

Somer: Exactly.

Franco: Otherwise maybe you are just an Immersive Daydreamer. 

Somer: Exactly, you’re using the term that we like to use for the trait “Immersive Daydreaming”. And that in itself is not a problem, of course. 

Valeria: Alright.

Somer: What makes Immersive Daydreaming a problem is when, as you, again, a term that you introduced in our discussion now, when people become addicted to it, when they lose control.

Valeria: Alright, can Maladaptive Daydreaming be affected by a sort of “adrenaline addiction” due to the need to cause ourselves a sense of euphoria? And if that is the case could it have a physical dysfunction origin?

Somer: We don’t know, if I start with your last question, we don’t know that.  You are actually asking ‘are the brains of individuals with Maladaptive Daydreaming or Immersive Daydreaming different, in some way, from the brains of people who are unable to daydream very vividly?’   I would assume the answer is positive that the brains are different but we don’t know what mechanisms work differently. For that we would need to do research with brain imaging, with brain scans, to find out what areas of the brain light up during daydreaming that is not immersive compared to daydreaming that is immersive. This kind of research will also answer the first part of your question, are reward mechanisms activated in the brain that explain the addiction that some people experience. What we know from the reports of individuals that we’ve interviewed and we’ve talked to and from reading the online conversations of individuals with Maladaptive Daydreaming is that in many many cases life in the innerworld life in the fantasy world is much more exciting much more rewarding than the external real life. This is of course because one is the director, the film director of the inner movie, and since it feels real (people have a sense of presence in these fantasies) the possibilities are endless. One can really create an idealized world full of love and excitement and wish-fulfillment and if that feels real it is frankly very understandable why people would prefer to stay in the fantasy.  Unfortunately it is sometimes at the expense of real like obligations that people have; to take care of your health, to take care of your hygiene or your house or your school obligations or your work obligations or your social obligations, so if this becomes at the expense of these obligations- then we’re talking about a problem. 

Valeria: Yeah.  How can we tell Maladaptive Daydreaming from regular fantasy in children especially when they are very young?

Somer: Well, first of all children are indeed more capable of daydreaming vividly than adults. We see it in the animal world. In the animal world, for example, if you watch National Geographic movies, the example I use is of the cheetah standing on the termite mound observing, scanning, the horizon and her cubs are in a fantasy world pretending to do some hunting and they are chasing each other and biting each other, not viciously, but they are practicing all sorts of hunting and other skills that are necessary for their survival. But the mother cannot afford to do that because that would be unsafe so the mother is anchored; she has lost this ability or doesn’t use it and is anchored in reality scanning the environment protecting her cubs while her cubs are in a fantasy world, they don’t pay attention to things. So this is an ability probably prevalent among children who use it to practice and to sort of regulate their feelings but also prepare for their development. And we lose it, we lose it as we grow. So what was the actual question about childhood..?

Valeria: How can we tell in the child has a problem?

Somer: Right, right, right right right. First of all, of course, we are much more tolerant about this condition when children are concerned because a child may tell us, for example, about an imaginary friend and that would be very normal. If an adult tells us that he or she has an imaginary friend then- by the way for me its not a big issue unless it interferes with functioning and causes distress- but that would be unusual, more unusual. So I suggest that we use the same criteria for psychopathology that we use for adults and the criteria are “does this behaviour cause distress?” emotional suffering, and/or “does this behaviour, mental behaviour, cause dysfunction?” does it interfere, does it impair the responsibility and the daily obligations of the child to be part of the family, to go to school, to study and to concentrate? If the answer is negative for these questions, the child is happy and is capable of socializing and capable of attending school and concentrating and so on, then it shouldn’t be regarded as a problem. Then it’s part of normal childhood behaviour. On the other hand if the child does for example attract criticism or ridicule because a lot of these behaviours are associated with stereotypical movement. For example some of these children would act out their fantasies, like some of the adult Maladaptive Daydreamers, they would talk out loud, move their mouth or some other body part this can look strange to some other children and children sometimes can be cruel in their criticism.

Valeria: Yes.

Somer: If the child is happy about it but is attracting social isolation and ridicule then its better to work with the child to control this better. Again, so to summarize, let’s use the two criteria for mental health for psychopathology; distress or emotional suffering, does it cause it, yes or no? and does it interfere with normal functioning?

Valeria: Yes, very clear.

Somer: Good.

Franco: Very clear. So the next question, this is peculiar, does Maladaptive Daydreaming requiere visual imagery or can it happen also in people who can’t have visual imaginings?

Somer: To be able to answer such a question we need to be able to do research. So I guess the question is ‘can people who can’t visualise very clearly, but they can imagine sounds very clearly, can they become Maladaptive Daydreamers?’ Yeah, yeah if the person immerseshim or herself in for example music and imagines music to the point where they are not functioning and not interacting with the external world then it is a sort of a fantasy. A fantasy that is not visual. But let me raise another interesting issue, are people who are visually impaired, who are blind, do they have a fantasy world?

Valeria: That’s interesting, do they?

Somer: I think that they do but again it a question that requires research. I think that they do, of course, because they experience the world differently, not through visual images but through other sensation through somatic memories throughauditory memories. And in fact i have one case of a person who is legally blind who has Maladaptive Daydreaming

Valeria: Oh, that’s impressive.

Somer: Yes, I’m working with her. So it is possible, without the capacity to visualise, to engage in fantasy that involves other senses.

Valeria: Ok so what do we know about Maladaptive Daydreaming and food? Some people say they don’t eat while they are daydreaming because they don’t want to feel their body.  Is there a connection between the relationship with food and Maladaptive Daydreaming?

Somer: A lot of these questions are excellent. Why I am saying that they’re excellent is because we don’t know the answers here so these are questions to be investigated because the field is very young. First of all we do know that the fantasy in certain cases of MD is so rewarding that people prefer to do that than meet their physiological needs. People sometimes prefer the fantasy rather than sleeping, they prefer to engage in their daydreaming. They prefer their daydreaming to relationships and to sex, and some people prefer their fantasies to eating and to “waste time” on eating because the experiences inside are so much more fun. But what you are describing, the way the question was phrased, is very interesting to me because it indicates that some people need to lose touch with their bodies in order to have a perfect fantasy. Which is a very intriguing, very interesting, comment and maybe suggests that some people need to hypnotise themselves and have an altered state of consciousness, almost a spiritual experience, a mystical experience where they are not in their body. Because the body of course belongs to the external reality, the real world, and so the body reminds the daydreamer that they are present here and now. So the need to disconnect from the body is very interesting. It reminds me of other dissociative experiences. For example derealization/depersonalization is a dissociative experience where people do not experience their reality as real or themselves as real. So we see an overlap, a relationship, between Maladaptive Daydreaming and dissociative phenomena. Our research supports that, we found when we looked at correlations, statistical correlations, between Maladaptive Daydreaming and dissociation we find significant correlations. This is probably a construct, a mental construct that belongs to dissociation where people are creating some disconnections between different mental functioning. So we’re not talking here about the connection to food itself but food, in this particular question, represents a grounding to the external reality. People don’t eat because eating is one way to be grounded in the body in the external reality and they want the opposite. They want to disconnect from the body and into the fantasy world, so this is how food is connected here.

Valeria: Yes, they are refusing food like they are refusing the reality itself.

Somer: Yes, but not forever. Food is a distraction because it connects to the reality and interferes with the fantasy.

Valeria: Yes. 

Somer: But, of course, with this example we can see how Maladaptive Daydreaming can have health consequences.  Because it can interfere with sleep and interfere with eating and also the stereotypical movement can also cause orthopedic problems. If a person, for example, walks back and fourth for hours this can cause some problems in the feet. This is what people are reporting.

Valeria: That’s remarkable. 

Somer: Yeah.

Valeria: Today TV and social media tend to show success as easy, especially in artistic fields; does the mother culture influence Maladaptive Daydreaming creating a gap between expectations and reality?

Somer: To prove that we will have to compare Maladaptive Daydreaming across cultures. To compare traditional cultures who are not exposed to the media and with modern western culture. That will be a difficult study to conduct because most of our studies, all of them, are conducted online. Anybody who is connected online is already exposed to the internet.

Valeria: Yes, true. 

Somer: Even if we sample people from traditional countries if they are online that means they are exposed. It’s a difficult question to answer. I think the question refers specifically to fantasies about success, comparing oneself to celebrities but this is one specific form of daydreaming. One specific form of fantasy of having unlimited success, like as a singer or as a performing artist or so on but a lot of daydreams are not related to success. I don’t think that the disorder itself is associated with that. For example many many people report that their daydreaming is more concerned with compensating for emotional needs that they have. Of course some people have the need for recognition, I understand that, but many others, for example, would daydream about relationships, about idealized families, to compensate for something that they never had. Still others daydream about- they are not even present in their daydream. They will daydream about complete fantasies, about worlds, imaginary worlds, like Harry Potter type fantasy worlds or science fiction fantasy worlds and they are unrelated to success in the media. I think that the contents of Maladaptive Daydreaming is a fascinating issue to explore and the contents, what is happening, is absolutely related to the emotional and psychological needs of the person. And that varies from person to person.

Valeria: Yes, and that, actually, was my next question. If there is correlation between the content of the Maladaptive Daydreaming and the real life. For example feeling powerless and daydreaming about being a superhero or, as you said, not having a good family and daydreaming about the perfect one.

Somer: Yes, yes, I think there is such a relationship. We just completed writing up a new research paper on this topic and we found evidence that certain personality traits are associated with specific motives and themes in daydreams. For example people with social anxiety sometimes would compensate themselves and comfort themselves by imagining themself as socially very popular and easy-going with others. People who have narcissistic needs would imagine themselves as very powerful, controlling and influential. People with attachment needs would tend to fantasies themselves in secure attachments, where they’re being loved and they’re being taken care of. So there is such a relationship, yes, absolutely.  Still, for others- I mean not everybody who daydreams excessively necessarily has deep underlying issues. As we already agreed, the experience is so rewarding that maybe anybody is at risk, who has it, is at risk of getting addicted to it because it is accessible, it is legal, it is free and it is a lot of fun. This is what they tell me because I don’t have this ability. 

Valeria: Alright. The last question is this; do you have any suggestions for people who suffer from Maladaptive daydreaming? What can they do to improve themselves?

Somer: First of all, as you indicated, you are talking about people who suffer from this. A lot of people don’t see this as a problem, don’t have distress and are ok with the little price that they pay socially or in terms of concentration. But those who suffer from it deserve help. What sort of help? First of all, because I agree with your definition of MD as a mental addiction, as a behavioral addiction, I think the first idea is to consult with an expert who has some experience with behavioural addictions. Like gambling or sexual addictions or other habits; smoking, nail biting, these are examples of habits some people find disturbing and there are people who have gained experience in helping people gain better control over these habits or addictions, if you will. Thats number one, number two has to do with the nature of the daydreaming itself. The nature of daydreaming is about not being present in the external reality, so if people really want to be more present one skill that we have evidence that could be helpful is mindfulness. Mindfulness training is a skill that teaches people how to be better aware of external reality. That includes their body, their thoughts, but also what their senses are perceiving. So, addiction therapy, mindfulness skills, and the third component of this therapy is to explore our underlying issues. Because addiction has been conceptualized in the literature sometimes as a self medication for other issues. Addiction to alcohol, to drugs, to gambling is camouflaging and covering up other issues. Addiction to food. Addiction to daydreaming could also, in some cases, serve as a way to regulate emotional pain, emotional memories or other issues and before you take away the self medication you need to offer another-

Valeria: A better medication.

Somer: A better medication, a better way of coping, yeah. So some of the underlying issue must be resolved. If the underlying issues are complex like childhood trauma, childhood neglect, the therapy could be not very short but again just taking away the self medication is sometimes not enough. These are the four components that I suggest. 

Valeria: Ok, thank you very much. So that was my last question. Your speech was very inspiring, I really want to thank you for this interview and for all the work you have done all these years to help people with Maladaptive Daydreaming. Thank you very much.

Somer: You’re welcome, thank you for having me. 

Valeria: I hope to see you again very soon.

Somer: Ok, my pleasure, bye bye. 

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