Professor Warwick Middleton MD

Spreading the Word is a feature of ISSTD News where we focus on the work of people or organisations who aim to spread the word about trauma and dissociation to the broader community. In this edition we discuss the work and achievements of the Trauma and Dissociation Unit, located at Belmont Hospital, Brisbane, Australia, which has recently celebrated its 25^th Anniversary. The Trauma and Dissociation Unit was opened in 1997, a specialist inpatient treatment service developed by past ISSTD President, Professor Warwick Middleton, MD.

At the time this was a radical and somewhat risky step. When Professor Middleton was developing the proposal to the hospital, back in 1995-1996, the dissociation field was facing many attacks and challenges. He writes, “It did not seem useful at the time to emphasize to hospital administrators that units with a similar mission in the US were the centre of controversy, subject to lawsuits, and were, on occasions, closing.” (McMaugh & Middleton 2022, p 179).

Despite such challenges Middleton and his colleagues pressed on. TDU opened as a six-bed unit in January 1997 and has expanded into a nine-bed unit and then again expanded to its current capacity as a twelve-bed unit. Professor Middleton was a foundational Director and has remained involved with the unit since inception. A substantial number of psychiatrists, nurses and psychologists have had long-term involvement with the Unit. It offers an inpatient and an outpatient day program tailored for those in the complex trauma/dissociative disorders spectrum.

In a country where, until more recent times, dissociative disorders have been little-recognised, TDU has been for much of its history Australia’s only specialist trauma and dissociation unit. This has meant that TDU has treated people not just from their local catchment but also people from across Australia. In doing so the staff associated with TDU have liaised with referring and treating specialists across Australia, engaging constructively with colleagues about dissociative disorders in the process.

Throughout its existence, TDU has been a strong supporter of research and educational initiatives. TDU, working closely with the Cannan Institute, has from its beginnings convened, supported, or sponsored an ongoing series of seminars and conferences in the trauma and dissociation field, including a series of conferences involving the ISSTD (Sydney 2015, Brisbane 2017, Christchurch 2019, and Melbourne 2022). TDU has been a strong supporter of the ISSTD, The Delphi Centre and the Blue Knot Foundation. TDU hosted the national launch of the Blue Knot Foundation Treatment Guidelines in 2019. From the beginning TDU and/or consultants and staff associated with it, have been involved with foundational research on dissociative disorders. For example, Warwick Middleton and Jeremy Butler in 1998 published the first case series in Australia dealing with the abuse histories and clinical phenomenology of a substantial group of individuals with DID. Professor Martin Dorahy has headed an ongoing series of research projects involving TDU. Other researchers involved with TDU or its consultants, have included Mary-Anne Kate, Michael Salter and Kate McMaugh. TDU has played an active role in the treatment of those individuals subjected to ongoing incest during adulthood, a group that has been a particular focus of published research by TDU’s director, Warwick Middleton. Professor Middleton has published a case series and theoretical articles pertaining to incestuous abuse continuing into adulthood and has played a prominent role in ensuring that this type of abuse gains national and international attention.

On 26^th October 2022, a celebratory dinner was hosted by Belmont Hospital CEO, Mary Williams AM, to celebrate the first quarter century of TDU’s existence. (The dinner had been delayed by spikes in COVID-19 infections in this part of the world, such that by the time it happened, the Unit had been in existence for nearly 26 years.)

Despite the delay staff and consultants gathered to celebrate their milestone in treating many dissociative clients, as well as supporting and collaborating with colleagues across Australia. A great night was had by all as these photos attest.

One delightful aspect of the night was to hear a message from ISSTD Past President and prominent researcher in the dissociative disorders field, Professor Martin Dorahy. Martin, located in Christchurch, has been a long term clinical and research collaborator with TDU. His messaged was read out by Belmont Hospital CEO, Mary Williams, and accurately summarises the TDU journey.

To quote in part Martin’s letter: –

“Dear Warwick, Lenaire, Mary, TDU consultants, and TDU staff, I send my very hearty congratulations on the 25^th anniversary of the TDU. This is a monumental achievement given most hospital programs have a much shorter shelf-life… This success has been incredibly hard-fought, as there have been very tough times for the Unit and many people have contributed to making the TDU a viable and successful ongoing unit offering a range of services… The unit itself has contributed in immeasurable ways to so many patients’ lives and has also left an indelible mark on staff who have worked there, of which I am one. I was the Unit psychologist while conducting research there from 1999 to 2001. I have remained connected with the TDU, so have felt privileged to have the Unit as a place that has shaped considerably my career. The learnings and knowledge generated from the TDU go well beyond the confines of Brisbane, and have a national and international impact, a pipe dream, I suspect, 25 years ago, but a reality today.”

The data that Martin collected whilst working in TDU formed the basis for the first research PhD on dissociative disorders to be ever completed in Australia. TDU has met a variety of challenges over the last quarter century, some predictable and some decidedly left field. One is repeatedly reminded that kindness, empathy, safe boundaries and a capacity to patiently listen and to understand the language of trauma, go a long way in facilitating sound engagement.

Congratulations to TDU. Those working in the trauma and dissociation field in Australia look forward to further collaboration and ‘spreading the word’ about the treatment of complex post-traumatic dissociative disorders.