James A. Chu > Quotes

“Self-destructiveness may be a primary form of communication for those who do not yet have ways to tame their excruciating inner conflicts and feelings and who cannot yet turn to others for support.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“Unspeakable feelings need to find expression in words. However... verbalization of very intense feelings may be a difficult task.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“THE RETURN OF THE REPRESSED: RELIVING DISSOCIATED EXPERIENCES

The reexperiencing of previously dissociated traumatic events presents in a variety of complex ways. The central principle is that dissociated experiences often do not remain dormant. Freud's concept of the “repetition compulsion” is enormously helpful in understanding how dissociated events are later reexperienced. In his paper, "Beyond the Pleasure Principle," Freud (1920/ 1955) described how repressed (and dissociated) trauma and instinctual conflicts can become superimposed on current reality. He wrote:

The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it. .. . He is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past. (p. 18)

If one understands repression as the process in which overwhelming experiences are forgotten, distanced, and dissociated, Freud posited that these experiences are likely to recur in the mind and to be reexperienced. He theorized that this "compulsion to repeat" served a need to rework and achieve mastery over the experience and that it perhaps had an underlying biologic basis as well. The most perceptive tenet of Freud’s theory is that previously dissociated events are actually reexperienced as current reality rather than remembered as occurring in the past. Although Freud was discussing the trauma produced by intense intrapsychic conflict, clinical experience has shown that actual traumatic events that have been dissociated are often repeated and reexperienced.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“Dissociative symptoms—primarily depersonalization and derealization—are elements in other DSM-IV disorders, including schizophrenia and borderline personality disorder, and in the neurologic syndrome of temporal lobe epilepsy, also called complex partial seizures. In this latter disorder, there are often florid symptoms of depersonalization and realization, but most amnesia symptoms derive from difficulties with focused attention rather than forgetting previously learned information.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“Posttraumatic stress disorder (PTSD) also has dissociative symptoms as an essential feature. PTSD has been classically seen as a biphasic disorder, with persons alternately experiencing phases of intrusion and numbing... [T]he intrusive phase is associated with recurrent and distressing recollections in thoughts or dreams and reliving the events in flashbacks. The avoidant/numbing phase is associated with efforts to avoid thoughts or feelings associated with the trauma, emotional constriction, and social withdrawal. This biphasic pattern is the result of dissociation; traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“Switches among identities occur in response to changes in emotional state or to environmental demands, resulting in another identity emerging to assume control. Because different identities have different roles, experiences, emotions, memories, and beliefs, the therapist is constantly contending with their competing points of view. Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process. It is countertherapeutic for the therapist to treat any alternate identity as if it were more “real” or more important than any other.

Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”
― James A. Chu

“Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stressdisorder (PTSD) symptoms that are embedded in a matrix of ostensibly non-trauma-related symptoms (e.g., depression, panic attacks, substance abuse,somatoform symptoms, eating-disordered symptoms). The prominence of these latter, highly familiar symptoms often leads clinicians to diagnose only these comorbid conditions. When this happens, the undiagnosed DID patient may undergo a long and frequently unsuccessful treatment for these other conditions.
- Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p5”
― James A. Chu

“Extreme versions of DID occasionally develop in response to particularly horrific ongoing trauma (e.g., children exploited through involvement in years of forced prostitution), with so-called poly-frgamentation, encompassing dozens or even hundreds of personality states. In general, the complexity of dissociative symptoms appears to be consistent with the severity of early traumatiation. That is, less severe abuse will result in fewer dissociative symptoms, and more severe abuse will result in more complex dissociative disorders.”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders

“The primary treatment modality for DID is individual outpatient psychotherapy.

Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”
― James A. Chu

“Treatment for DID should adhere to the basic principles of psychotherapy and psychiatric medical management, and therapists should use specialized techniques only as needed to address specific dissociative symptomatology.

Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”
― James A. Chu

“The difficulties in diagnosing DID result primarily from lack of education among clinicians about dissociation, dissociative disorders, and the effects of psychological trauma, as well as from clinician bias. This leads to limited clinical suspicion about dissociative disorders and misconceptions about their clinical presentation. 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).
- Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p4-5”
― James A. Chu

“The DID patient is a single person who experiences himself or herself as having separate alternate identities that have relative psychological autonomy from one another. At various times, these subjective identities may take executive control of the person’s body and behavior and/or influence his or her experience and behavior from “within.” Taken together, all of the alternate identities make up the identity or personality of the human being with DID.

- Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p7”
― James A. Chu

“The DID patient should be seen as a whole adult person with the identities sharing responsibility for daily life. Despite patients’ subjective experience of separateness, clinicians must keep in mind that the patient is a single person and generally must hold the whole person (i.e., system of alternate identities) responsible for the behavior of any or all of the constituent identities, even in the presence of amnesia or the sense of lack of control or agency over behavior.
From p8
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision: Summary version. Journal of Trauma & Dissociation, 12, 188–212.”
― James A. Chu

“The identities may develop in number, complexity, and sense of separateness as the child proceeds through latency, adolescence, and adulthood (R. P. Kluft, 1984; Putnam, 1997).
—Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”
― James A. Chu

“A substantial minority of DID patients report sadistic, exploitive, and coercive abuse at the hands of organized groups.

Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”
― James A. Chu

“true acting out is an expression of intense underlying affects without conscious awareness of them, not just another undesirable and difficult patient behavior”
― James A. Chu, Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders