Whose Treatment is This Anyway?

From time to time I visit the madinamerica.com website. I am also subscribed to the pods-online.org.uk newsletter. Through these 2 sources I came across Ms. Noel Hunter who recently completed her doctoral dissertation fully entitled:

“Whose treatment is this anyway? Helpful and harmful aspects in the treatment of dissociative identity disorder phenomena”

Noel Hunter, MA, MS

Long Island University, Post

I’d like to do a brief review of her dissertation in case any of my readers would be interested in obtaining the complete dissertation so you can examine it for yourself. If you read this blog, you are probably interested in alternative opinions about how to view and heal what is known as dissociative identity disorder. I believe Ms. Hunter is uniquely qualified in her search for what works in the vast array of treatment methodology when it comes to d.i.d.: she admits in her dissertation that she had been diagnosed and treated for d.i.d. However, in a recent email with Ms. Hunter she wanted to clarify her objection to the current bio-medical model of the brain and mental health issues and thus she objects to the diagnostic categories as well which would include her ‘having’ d.i.d. But she was willing to affirm her experiences in the past that aligned with d.i.d., but said, “I do not have these experiences any longer and haven’t for many, many years.”

As with so many issues, there is a ‘public stance’ that the experts take on a subject. For d.i.d. the ‘gold standard’ of treatment guidelines is found at isst-d.org here: http://www.isst-d.org/default.asp?contentID=49

But if you’ve ever studied a subject in depth and been able to ‘look behind the curtain’ as our favorite wizard from Oz forbade Dorothy to do, you will know that the ‘unified front’ the experts present to the general public is often just a façade. And for that reason, I find Ms. Hunter’s dissertation refreshing. She is willing to take the reader ‘back stage’ and allow us to see the debates and disagreements and dilemmas surrounding this disorder that many experts feel we are too ignorant to understand. Ms. Hunter takes us backstage and gives us a tour that has direct implications for everyone trying to cope with and heal d.i.d.

After a brief introduction Ms. Hunter jumps into her subject with a literature review of d.i.d’s history, the DSM, alternatives to the DSM construct, and various existing treatments both specific to d.i.d. and generic to the disorder but which are used by therapists. She then moves into a 20+ page explanation of the methods that she used to examine and scientifically categorize the interviews she had with 13 people with d.i.d. for her dissertation. Yes, this section is dry, but it is an explanation of the processes that she used to try to remove her opinion as far as possible from the conclusions of her dissertation. So if you like that kind of stuff, dig in. If not, you probably can skip the “Methods” section.

The next section she gives the “Results” of her interviews with her 13 interviewees. From these people she discusses the “helpful aspects of treatment” and then the “harmful aspects of treatment” that were shared with her from the perspective of each person she interviewed. And finally she included “helpful aspects” of healing that the interviewees shared that were outside of the professional services they received from therapists. From these results, Ms. Hunter gave 2 broad recommendations to therapists. First she implored therapists to resist the denial and disbelief that seems to pervade the general public as well as the clinician when it comes to the stories of trauma survivors. Secondly she shares the need for systemic improvements in the mental-health system that all mental health patients need for their healing.

The last section of the dissertation is titled “Discussion” and is the author’s attempt to wrap all of her findings up. She does not attempt to tie everything up into a ‘neat’ little theory. She seems able to acknowledge the mishmash and contradictions of her interviewees and the subject itself as she summarizes her findings.



Is a Person with D.I.D. ‘Broken’?

My wife and I have been married about 27 ½ years. The first 20 years were an odd mixture of us being loving and affectionate, but the relationship was always laced with an underlying level of stress, blowups and frustration because of how she neglected me and my needs. Then about 8 years ago, she had a change of heart, and shortly thereafter she entered counseling and was diagnosed with dissociative identity disorder. Thus began our journey to help her and our relationship heal.

 About 5 ½ years ago I began to blog here on WordPress about the journey we have taken together to heal her disorder. I try to read various sources about d.i.d. from experts and those who experience it. One of the topics that comes up from time to time is whether someone with d.i.d. is or should perceive him/herself as ‘broken’ and whether that person needs ‘fixing.’ It is apparent that these terms connote a lot of negativity when used by some.

 Dissociative identity disorder can develop when a very young child is traumatized over a long period of time. A second key component in the causation of d.i.d. is the lack of a loving, primary attachment figure who can help the traumatized child heal and reframe the trauma. At a basic level the disorder causes the personality to be dissociated, fractured, or ‘broken.’ Instead of an assimilated personality that reflects a lifetime of learning to balance differing perspectives and desires within a person, the personality becomes a mishmash of traits and needs that can go dormant or are pursued independently by the various ones in the d.i.d. network.


The Biomedical Model of the Brain

All of us live with assumptions that affect every part of our lives. These assumptions help us form mental paradigms from which we operate and assimilate new and old information. As I’ve sought to help my wife heal from dissociative identity disorder, I’m sometimes uncomfortable with what I read from various mental health sources (professional and layman) as I’ve tried to make myself more knowledgeable about this disorder and how best to help my wife heal from it.

A couple months ago I found a link to this website (madinamerica.com). It seemed to advocate a paradigm outside what I typically read in mental health circles AND it is largely authored by psychiatrists and psychologists. Then recently one of their articles had a link here (abct.org/docs/PastIssue/38n7.pdf) that directly dealt with the prevailing mental-health paradigm and assumptions of the ‘biomedical model of the brain” and its objections to this paradigm. This issue is in The Behavioral Therapist, volume 38, no.7, October 2015 and is authored by experts in the field of psychology and psychiatry. I was curious if this publication was from the fringe of the field or not and so I checked out Wikipedia here (en.wikipedia.org/wiki/Association_for_Behavioral_and_Cognitive_Therapies).

I’m not going to go into detail what The Behavioral Therapist takes an entire issue to cover. Please, please read this for yourself. Be informed. This issue considers some fundamental concerns that those in the mental health field have with the prevailing biomedical model of the brain. It also explores implications of what that paradigm means specifically for how therapy is conducted and especially the wide-spread use of medicine to treat mental disorders. If you are taking any psychiatric drugs, you owe it to yourself to see what the evidence of 30 years of clinical trials reveals especially when it comes to the effectiveness and long-term effects of these drugs. There seems to be a dichotomy between the evidence and what the public is commonly told.

On a happier note I have often wondered how someone who has no supporting spouse or SO might try to replicate some of the attachment theory methodology that I espouse on this blog. Recently one of the blogs that I frequent asked what I see as a related question here, Lazarus and Lithium, and another lady whom I also follow provided this organization (paws4people.org) as a possible solution. No dog can do what a supporting spouse or SO can do, but I think this is a great, second-best option. And so I wanted to pass along the information to any who might be interested.

I’m sorry for the lack of hyperlinks, but as the note in my sidebar indicates, I got in trouble on WordPress over the use of hyperlinks in the past. So please just copy the address into your search bar and it should get you where you need.

Please take time to read and be informed. I tried to keep my opinions out of this as much as possible, but many of the experts within the mental health profession are concerned with fundamental issues that will affect you and your loved one as he/she attempts to be healed of this disorder. I would love your comments and/or critiques on any of the links and material with which I have provided you.


Sam, I Am

Lying and Dissociative Identity Disorder

My wife and I have been on the healing journey from her dissociative identity disorder for 7 years. I’ve had a lot to learn as I’ve helped her heal in the trenches. And my time on wordpress began to expand my knowledge of the disorder as I saw how it affected the lives of others, too.

One of the women that I follow on wordpress did a recent entry in which she talked about how the mental health professionals she had sought help from had repeatedly disbelieved what she had told them. I was saddened and upset that the experts who should have been her advocate, instead treated her like a liar and denigrated her experience in spite of the evidence of trauma that they clearly noted.

And yet there is a component of dissociative identity disorder that may foster lies and exaggerations. If those of us who are helping don’t understand this aspect of the disorder, we could end up as damaging to our loved ones as those in this lady’s life were.

Before I enter into the subject of lying and d.i.d. I want to state that I would guess (as I only have real-life experience with my wife) it is rare for trauma victims to be perpetual liars about their past trauma or about how d.i.d. manifests itself in their lives. The trauma survivors I read on wordpress are clearly not narcissists! They find it shameful and horrifying that such things happened to them. There’s usually a part of them, often the host, who would do anything in the world to NOT believe what happened to them. They often wish the disorder and the telltale symptoms would simply go away. I could write so much more, but will leave it at this: I highly doubt people with d.i.d. are habitual liars in general especially when they are in a safe and loving environment.

However, there is a component of d.i.d. that fosters lying under certain conditions, and I want to discuss that so that we who help won’t hinder the healing process.

The first thing to remember is that d.i.d. develops in an environment of extreme physical, emotional or sexual abuse when a child is very young. This disorder arises as an abused child desperately tries to cope with massive, repeated trauma. Moreover, the victim will try to develop strategies to protect as much of his/her psyche as possible. Therefore, if lying is seen as a way to mitigate or escape punishment and abuse, the child may choose to lie rather than suffer more trauma. So a trauma victim can learn from an early age that lying is valid way to escape negative consequences. This doesn’t mean he/she will be a perpetual liar, but it does mean if things feel unsafe to a person with d.i.d., this habit may get triggered into action.

The second thing to remember is until a significant amount of healing has occurred, most people in the system will not be able to share memories with each other. So for an outsider like me, I can’t expect my interactions with one girl to be remembered by another. This is not lying. Until the dissociative walls come down, I have to treat each person in the system as I would physically different people who have their own set of experiences and memories. However, this understanding is often unavailable to all but the closest companions of one with d.i.d as it seems rare for someone with d.i.d. to ‘out’ her/himself in general.

The third thing I learned while helping my wife is maybe someone in the system simply wants to be believed no matter how outlandish a tale she tells. When Amy first came out, she used to tell me that she had been a spy in Europe for a time. At first I tried to refute her, but I finally decided to validate her and asked her to tell me more about it…and that was the last time she ever brought it up. I’m still not sure what to think about her proclamation as it was not typical of any of the girls or even of Amy in general. Maybe after a lifetime of being disbelieved, Amy had a need for someone to believe IN HER no matter what she told them. Maybe being a spy was simply a childhood game of imagination, and Amy wanted me to play along and not be an old fart. Or maybe it was a real memory wrapped up in the symbolic terms a child could understand. Whatever it was, it was important to Amy that I believe her without an explanation, and I was willing to be that kind of a person for her.

And lastly it’s important to understand that until each insider feels completely safe with an outsider, the rules of silence and secrecy may not allow him/her to tell the truth, or at least the entire truth. We on the outside do not have the right to expect any information that is not freely given. We must be willing to prove ourselves to be a safe and trustworthy person to each one in the system. That’s where I am right now with Jenny: my relationship with the other 7 girls did NOT earn me a pass with her. I must earn her trust just as I did the others.


Neural Plasticity and Dissociative Identity Disorder

Seven years ago Karen and I began a healing journey together: her from dissociative identity disorder and me from myself so that I would be a good partner for her healing journey. Seven other girls have joined my wife and our family along the way. We started this journey like most people: completely ignorant about d.i.d. But from the start I purposed to welcome these new girls into my life, and the attachment wiring in me kicked into high gear as I did so.

As I began reading the literature about d.i.d., I learned that the genesis of this disorder typically comes from early childhood trauma. But the trauma that causes the dissociation then metastasizes throughout the personality, arresting and truncating the abilities that each person holds within the system. And so I’ve come to view these as the unholy trinity in this disorder: trauma, dissociation and arrested/truncated abilities. It’s not enough just to deal with the trauma that a person experienced. The dissociation and arrested/truncated abilities must be addressed too.

And so today I’d like to discuss what should be seen as a source of hope for people with d.i.d.: neural plasticity. For further and better information you can follow the addresses below or google it for yourself.

Neural plasticity refers to the changes in neural pathways and synapses of the brain due to changes in a person’s behavior and environment. Scientists used to think that only children exhibited neural plasticity but adults were ‘set in their ways.’ We know now that’s not the case. The human brain remains changing and adaptive throughout life. However, our brains ‘reward’ use of neural pathways and ‘punish’ disuse. In other words if you use a skill constantly or begin stimulating the brain in new ways, your brain strengthens the pathways that are necessary for said skill and/or stimulation. The converse is true as neglected pathways can atrophy from disuse. Sadly that’s the chasm that someone with d.i.d. must overcome: neural pathways atrophied from a lifetime of dissociation.

Those of us who aren’t dissociated can ignore skills we had in the past, but if we choose, we can pick them back up and with some effort reinvigorate those pathways. But for someone with d.i.d. they must face the unholy trinity that drives this disorder. It’s not enough to heal the trauma, stop the panic attacks and flashbacks and body memories; and undo the lies and programming of the abusers. The person with d.i.d. must begin to establish the pathways between the people within the system network. For older d.i.d. patients like my wife who is almost 50, it means creating or invigorating pathways some of which have been dissociated more than 45 years. And that doesn’t even address the last part of the trinity: maturing and connecting all the abilities that were frozen inside with each of the other girls.


Anchoring Insiders to the Outside in Dissociative Identity Disorder

My wife and I have been on a healing journey together from her dissociative identity disorder. When I look back over the last 7 years we’ve been walking this road, I know she is not the only one who has radically changed. I have had to change to become the kind of man who was safe for everyone in the network. And I had to deal with my own issues and demons to do that. I couldn’t view this as her problem: it was and is our problem, our journey.

And so there’s been a lot of self-discovery that I’ve made during this journey. One thing I learned about myself is the term ‘singleton’ as it is commonly used in d.i.d. circles isn’t accurate when it comes to non-dissociated people. I’ve mentioned it in the past, but if you watch the things you read, you’ll see ‘multiple language’ used concerning non-dissociated people. We talk about ‘part of me’, ‘not being fully engaged’, ‘being divided’ on an issue, being ‘double minded’ and a host of other terms that describe the multi-faceted nature of everyone’s personality.

Then earlier this year someone made a comment on this blog about her inability to ‘switch at will’ like 7 of the 8 girls in my wife’s network can (and I am working on it with Jenny). Her comment has had me thinking about that ever since. I suggested that my wife collectively can switch ‘at will’ with 7 of the girls in the network because I’ve trained her brain. But I struggle with explaining what I’ve done to make that transformation. Or to put it another way: I think I changed my wife’s subconscious experience of d.i.d. and made it something that she (collectively) consciously controls now. And that conscious ability to switch among various parts of her personality is simply what non-dissociated people do all the time; I think.

In the ISSTD guidelines they state only 6% of people have ‘florid’ or ostentatious showings of d.i.d. which I take to mean switching with the others in the network:

Most clinicians have been taught (or assume) that DID is a rare disorder with a florid, dramatic presentation. Although DID is a relatively common disorder, R. P. Kluft (2009) observed that “only 6% make their DID obvious on an ongoing basis” (p. 600). R. P. Kluft (1991) has referred to these moments of visibility as “windows of diagnosability” (also discussed by Loewenstein, 1991a). Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stress disorder (PTSD) symptoms that are embedded in a matrix of ostensibly nontrauma-related symptoms (e.g., depression, panic attacks, substance abuse, somatoform symptoms, eating-disordered symptoms). (isst-d dot org)

But it is the ability to switch ‘at will’ and instantly access the abilities of each member in the group personality that truly separates a dissociated multiple from a non-dissociated multiple (singleton). Sadly most of the dissociated multiples that I follow on wordpress fight against switching instead of realizing that learning to switch ‘at will’ with everyone in the group is the path toward full healing. But I do understand their fears if they don’t have someone alongside to help limit the scary aspects of letting go (switching) during the connecting process.

With Jenny’s entrance into our lives, I have the opportunity to train another part(girl) of my wife’s mind to come under her (collective) conscious control using the various means I have detailed in past entries. I call the process ‘anchoring’ the insiders to the outside world.


An Update on Jenny

Well about 2 months ago I announced that we had an unexpected addition to my wife and marriage: Jenny. Since then I’ve been actively trying to establish a relationship with her in all the ways I did with the other girls. I have bought her various gifts to validate her importance to me and so that she can “have her own things”. It still amazes me how very important it is to each girl that she has things she can call her own. Jenny has repeatedly ‘asked’ (via pantomime) me about her various gifts to reassure herself that these truly are for her. But she shares them with the other girls just as they share their things with her.

Jenny’s entrance has not been without hardships. Because of the swooning issue we lost their Surface tablet to the bathtub shortly after she joined us. So I had to play mediator and stop the finger pointing. In the end they were happier with the replacement that I bought them. Then the very next week, we had a much larger incident, which I am not allowed to detail. That event forced me to redo the hallway in our upstairs and clean the carpets downstairs. It’s a renovation and task that have desperately needed done for many years. Karen has said that ‘other than the trauma’ from the incident, she’s happy that I finally was motivated to fix the hallway.

The swooning issue has caused us all some concern about letting any of them drive the car. So far we seem to be able to tell Jenny to ‘stay inside’ if Karen or the others are driving, but there’s a real fear of ‘what if she comes out’ unexpectedly? Can she drive? Would she panic and go back inside and swoon the body which undoubtedly would cause an accident? It’s a fear that is being magnified as my wife has to leave next week for Boston to help our son move back home. I was going to try to do it myself in a two-day marathon during the weekend, but the time-frame is such that without taking vacation days, I really can’t. Plus my wife and I don’t want to lose our few, precious vacation days unless absolutely necessary.

Her entrance has also put on hold some of the things we were doing to connect Amy and Shellie to Tina. That is a huge disappointment because I really thought we were getting close to expanding Tina’s world greatly on the inside. Tina is still separated from all the girls except her sister, Sophia. That needs to change!

As Jenny has moved outside the debilitating headaches that each girl caused initially are back. Unfortunately the headaches that Jenny’s arrival has caused have only been surpassed by those that Tina caused. My wife has spent the last 3 weeks lying on the couch or bed nearly unable to function. We hope that the duration will not be anything like Tina caused, or we could be looking at a full year of this. Only time will tell.

Another challenge with Jenny is that just like Tina initially, she is scared of me. So if I’m holding the other girls and Jenny pops out, she leaps away from me. When we are on the couch ‘together’ I’m not allowed to sit next to her. That’s a boundary I am actively working to make healthier as I started out having to sit on the floor while she was on the couch. Then I moved onto the near end of our L-shaped couch with one section between us. And now there’s only 10″-15” between us most days. She will still motion with her hand for me to scoot a little further away, and then I will move an inch or so. But we are making progress there.

Jenny is also challenged by her inability to speak. However, unlike Tina who still cannot speak without the help of her sister Sophia after being outside 3 ½ years, the part of the brain that Jenny controls has been working to give her the ability to speak. Just a few days ago she spoke a number of sentences to me on the level of Sophia. However, the stress of doing so causes her more headaches. So I’ve encouraged her to pace herself until her brain is able to accommodate the new ability without causing pain to everyone.


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