healthmedicinet

It was the late 1990s.  I sometimes got—and still get—calls from folks working with people who are highly dissociative, notably those diagnosed as having Multiple Personality Disorder.  I’m saying “folks” deliberately, because some mental health professionals are highly dissociative, too. It may be like the old axiom: we teach what we most need to learn.  Just sayin’.

One call in particular still comes to mind now and then. The woman on the phone was the service provider and she was distressed.  “What do I do?” she said. “My client had a stable integration for five years, and now she’s come back to see me, symptomatic!” I asked her what the story was. “She was a multiple, with over seventy-five personalities.  We worked for three years, and I integrated all of them.  I used hypnosis. And then she had five stable years after treatment,” she said. Then she took a deep breath.  “But she called last week sounding very scared and said she was having losses of time and headaches, like before.”

It sounded as if the person had done well in those five years.  She’d had steady work, had maintained some relationships that were decades old, and even created a few new ones that she now held dear.  No lost time.  No amnesia.  No reports from third parties of “meeting someone else in her body.”  She recounted several stories about how she had managed a number of situations that before would have resulted in dissociation.

Turning the old cigarette slogan on its butt (pun intended), some people would rather switch than fight. A person who has the ability to leave their body behind and not experience things that overwhelm them is gifted, yes.  Sadly, it can be the gift that keeps on giving, with parts of the self taking more and more of the difficulties of life while protecting the whole, almost like a fractal that keeps on expanding for some people.

The story continued:

“She had to have surgery, and she explained to the anesthesiologist that she didn’t need a lot of sedation to knock her out.  She called me three months later.  She’s telling me this, and then, all of a sudden, there’s another personality present, who’s apologizing for existing—saying the doctor took care of the consciousness but not the pain and this personality made herself to take the physical pain.  The personality I was talking to was so apologetic.  She said she felt ashamed for the trouble she was causing—all she wanted to do was take the excess pain!  I feel so bad!”

The first thing I did was ask if the therapist had talked to her clinical supervisor.  She didn’t have one.  My recommendation was that she find one as quickly as possible to help her process her own feelings and experience.  I recommended that she find someone who belonged to the International Society for the Study of Trauma and Dissociation, for starters.  If not there, the International Society for Traumatic Stress Studies.  People need people in their own field, with more knowledge and experience to help them with their experience of the work.  Everyone brings their own history, the past and the present, to the work they do.  Everyone is impacted by the work itself.  Supervision is critical.

After the call I began to think.  What bothered me about the story was the story underneath it.  On the surface, the client saw therapist, both worked hard, therapist used hypnosis to “integrate” the parts of the personality into the whole and everyone felt successful.  Only thing was that the process came unglued, making everyone feel like a failure.

The story under the story was much more complex. Here’s what I mean:

It’s true that everybody wanted everybody to feel good.  Adding good feeling to good feeling to accumulate a bucket full of good feelings is important.  It helps alleviate what is frequently a deficit.  In this case, the person paying wanted freedom from the impairments her current levels of dissociation were causing.  The person receiving the payment wanted to do good work, help her customer achieve her goals.  Provider and client both were appropriately proud of the outcome. The ability to face life’s “what if’s” without dissociating increased, a sign of filling in the development gaps dissociation inevitably signifies.

And part of feeling good is anticipating and discussing questions about the future that are present even if unspoken: What if Something happens—what if I exceed my capacity to cope?  What if the connection knit in hypnosis unknits?  Might I still make more me’s?  If I do, what does it mean and what do I do?  Folks need to have confidence in the possibility that, ironically, we will protect ourselves  even when we can’t defend ourselves.  Read this sentence twice.

Did anyone think about power and how it was used in the relationship?  When I heard the clinician say, “I integrated…” the pronoun was a giveaway.  At some level, it was her doing the work “to” or “on” the person she was seeing.  Call it semantics, whatever you like, the bottom line is that what we say is pretty informative about what we believe.  Professional training teaches clinicians to have the power to diagnose and the authority to “treat” the problematic behavior catalogued in the Diagnostic and Statistical Manual of Mental Disorders.  Different professionals prefer different schools of thought and subscribe to the use of different techniques.  In all, the clinician has the knowledge and skills, and the client has the problem to which the clinician applies their knowledge and skills. Unfortunately, this includes a distinct power gap.  It promotes the challenge in which the provider “treats” and the client passively “accepts” treatment. The client is the only one who can incorporate different ideas, thoughts, feelings, and behaviors into their life.  No one can do it for or to them and expect it to stick.  And most people don’t even think about the power dynamic in a conscious way.

Maybe folks didn’t think about the linguistics of the process.  For years, I’ve ranted about two of the most common terms used in helping people with profound dissociation: integration and fusion.  Let’s start with “integration” –for anyone who has ever dealt with race riots, or who has contact with the challenges of the messy and imperfect experience of blending races, cultures, or groups, it’s problematic.  Think Civil Rights era—the iconic image of integration.  So, a person with a history of profound dissociation is supposed to buy in to integration as an outcome?  Well, duh.  That’s not such a good image.

I see the same semantic challenge for fusion. Fusion is a nuclear event that will destroy a lot of things if it happens. Or it’s connecting bones together in the spine using rods, screws, glue, whatever it takes, so they can’t move again. Or fusion is the blending of multiple cuisines (okay, this is a particular kind of fusion I can sink my teeth into). Or fusion is a type of car built by Ford.  The words don’t work.  Of course, a lot of folks may be so desperate for enduring calm in the chaos that they—externally—may not hear the words or register the dissonance.

Inherent  self-preservation would cause any self to hunker down in the presence of integration being “done to” those around it, hide out symbolically in the recesses of consciousness. Language incorporates a sense of history, social consciousness, and process.  If language implies the “killing off” or “loss” of one’s self, resistance is utterly appropriate.

The 90s were a period of breath-holding wildness about dissociative disorders...  In the 90s very few people thought about dissociation in common-sense and sensible ways. There was fear, distrust, misunderstanding and more than a little hysteria associated with the diagnosis. The condition’s name was changed from Multiple Personality Disorder to Dissociative Identity Disorder and people with the diagnosis came up with a new tongue-twister: “I’m a DID because I got done to and when I’m done I’ll be a done DID.”  Bad play on grammar, maybe a good point of view: being able to laugh at oneself is a good thing.   Thinking sensibly about dissociative disorders has shifted some, yet not nearly so much as is needed to make better sense of a phenomenon that challenges everyone.

Shame is easier to engender than we think—for everyone.  Back to the story of the clinician and her client. I heard myself thinking, “How wonderful!  A state of consciousness created itself to protect her in a situation in which she couldn’t speak for herself…” and “How sad that it felt shame for doing a good thing,” and “How sad that this clinician feels shame for the good she did, too!”

So what? The “so what” is the often overlooked nature of how we treat ourselves no matter where we sit in this picture.  If the creation of a new self results from excess pain when under anesthesia, be grateful!  And give that gratitude to whatever aspect of self helped with that, and to every individual and collective cell of being!  The incredible and hard-to-erode self-contempt of despising aspects of the self, even the aspects created out of compassion and care, only creates a greater need for dissociation.

Like the Beatles said, “Love is all we need.”  My add is “for self, first”.

 

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Image Credit: Thomas Leuthard via Compfight

 

 

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And they are apparently too stupid to realize how easy it is to ensure they are called out for their bad behavior.

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    Last reviewed: 29 Dec 2013