David Yeung's Blog, page 16

When Patients Present Memories of Abuse

For most people, and for many therapists encountering DID patients, the first question that comes to mind is whether or not to take the reported memories of abuse to be truth or fantasy. But, there is an even more fundamental question that is at the heart of the matter: Why is that the first question for so many people, whether they are trained as therapists or not?  

In my experience, it is because most people simply don’t want to believe that another human being would do something so evil to an infant, to a toddler or to any small child. People don’t even want to believe such things when it is adults doing evil to adults. This is clearly shown by the disbelief during World War II of the initial reports of the concentration camps, of the genocide in Rwanda, and of the Cultural Revolution in China – among other horrific events. And so, people continue to suspend belief, and such horrors continue without protest, until the evidence overwhelms the bias against looking at the evil of which human beings are capable. The same is true with child abuse.

The raw unvarnished truth is that the abuse of children, physical and sexual, happens. The raw unvarnished truth is that such evil has happened in the past, is happening in the present and in all likelihood will happen in the future. The terrible consequences echo throughout the life of the child with ramifications in future generations in that family and for all of society. This is clear for anyone to see, if they are willing to actually look at the abuse and its cascading effects.

Consider the inclusion of fantasy as part of that first question arising when one hears a tale of abuse. To the abused individual, the use of the word fantasy, whether it is said out loud or is expressed in the subtext of a therapist’s body language, can only sound offensive and demeaning. But still worse, it is a confirmation of the ongoing fear ingrained by their abuser that no one will believe them that such things happened.

It usually takes months of waiting to see a specialist, after perhaps years of gathering the courage to tell a doctor one’s innermost private and excruciating history of early sexual abuse. How would you feel if you were finally able to disclose even a hint of the trauma, and then consider how you would feel if the person you are looking to for healing and support, the person in authority evaluating your trauma history, is hesitating as they consider whether or not your memory is some kind of fantasy. It is important to know that they are generally not hesitating because they think you are lying. That is a second step. They hesitate because they simply don’t believe that another human being, particularly a parent or close family friend, could or would do such a thing.

But, no therapist can establish a genuine therapeutic alliance with a patient if they cannot listen deeply to such trauma material, remaining present without judgment. This means keeping one’s own mind stable without doing an on-the-spot calculus concerning the details of the patient’s recounting of abuse. Forget the calculus, you will get the truth of the trauma far more directly and accurately by remaining fully present and grounded for the patient. In that way you can see the totality of the context, presented verbally as well as in body language. The assessment needs to be about whether or not there has been trauma is the point, not the details.

My advice to therapists is to sit still and project genuine empathy, empathy based on understanding that any individual talking about being abused has experienced trauma. As with any memory, traumatic memory does not need to be 100% accurate in its detail because it will be accurate in its context.

Look at an ordinary memory, for example my memory of my childhood bedroom. I remember it as being quite large. There is no doubt that if I were to walk into that bedroom today, it would appear to be quite small. But no one would challenge my memory of that bedroom as being fantasy. It would be taken for granted that when I was a small child (the context of the memory), I would definitely have experienced it as much larger than I would experience it as an adult.

So, when listening to a patient’s memory of trauma, particularly a flashback of trauma, don’t be stuck on proving or disproving “fantasy.” To proceed with therapy, it is enough to know that there was trauma that is reaching into the present and trapping the patient in its past.

The use of the word fantasy can be traced back to the very beginning of psychoanalytic theory. When Freud formulated his theory of neurosis by the end of the 19th century in Vienna, he had already encountered many patients who talked about early sexual experiences with their fathers. He privately wrote to a friend that it was a highly significant discovery, like discovering the source of the Nile. The discovery suggested, for the first time, that there was a causal link between hysteria and early childhood sexual molestation.

When Freud delivered his first lecture on this causal connection, the academic and medical authorities were quite unreceptive to this discovery. He explicitly used the terms incest, rape and gross sexual abuse in describing the experiences related to him by his patients. Krafft-Ebing, then one of the most prominent physicians of the time who was senior to Freud both in age and professional stature, described Freud as “spinning a fairy tale.”

Having felt the ice-cold response to his discovery, Freud then changed his theory and used the term “fantasy” to describe the recounted sexual experiences he heard from his patients. He then postulated that it was a kind of wishful thinking that infant girls had for their father.

There have been many explanations for this change in his view: Was it beyond his imagination to believe that these molestations in fact took place? Unlikely, as his original presentation was quite explicitly about molestation, not imagination. Did he change his words and his mind to ensure the survival of psychiatry in the harsh intransigent academic world of Heidelberg and Vienna which at that time was the center of science and medicine in the Western world, or perhaps as a way to preserve his own reputation in order to be able to continue his work? Possibly. Was he afraid to force a confrontation with leading lights of society whose daughters told him of having been abused, a confrontation he might easily lose? Quite possible given that this is something that continues to happen up to this very day, when people are terrified to confront abusers that are leading lights of today’s society.

Regardless of why he changed the theory, and whether or not he then reverted to his original view, his use of the terms “seduction” and “fantasy” enabled society and the abusers to infer participatory intent in the abused children instead of forcing an acknowledgment that the abuse was exactly what it was – rape, incest, and assault, just as he had originally characterized it.*

Later, much later, psychiatrists like Judith Hermann, in her extremely clear and invaluable book “Father-Daughter Incest” published in 1980, elaborated the truly sinister aspects of such early childhood sexual abuse experience.

Today, we should correctly appreciate Freud’s discovery of the link between hysteria and the psychological experience of a patient’s childhood. At that time, it was well beyond of the imagination of others. People were then, and many still are, stuck on searching a biological root for the phenomenon which, in Freud’s time, was called hysteria. There are still psychiatrists obsessively denying the impact of early childhood abuse on adult patients as they search for a biological cause of the mental phenomenon that results, whether it be deemed hysteria, DID, PTSD or other diagnoses.

Based on my clinical experience, the odds are that Freud’s patients were indeed victims of incest, sexual assault and abuse. As the studies and news reports continue to highlight the ongoing patterns of molestation across religious, cultural and ethnic lines, it is a phenomenal disservice to patients to presume as a therapist that there is a burden of proof a patient must meet before the therapist is willing to try to establish a therapeutic alliance. The moment such a burden is placed on the patient, the ground for a therapeutic alliance is likely poisoned.

Sit still, be kind, project empathy. A patient will experience anything else as the therapist assigning himself the role of judge and jury. Remember that no memory is foolproof, no memory is incontrovertibly accurate in all details. But also remember that the heart of the matter, the energy of the memory, is accurate in context. Don’t fear acknowledging the context; sit still and listen deeply.

* “Assault on Truth” by Jeffrey Masson (1984) has some convincing alternative explanations of Freud’s views on abuse as well as the development and possible repudiation of the seduction theory.

The post When Patients Present Memories of Abuse appeared first on Engaging Multiple Personalities.

Self-Soothing Techniques for Those Unable to Locate a DID Therapist – Part 3 of 3: Practical Suggestions Continued and Conclusion

Part 2 of 3 discusses practical suggestions for self-care. This Part 3 of 3 continues that discussion.

E. Slowly Engage The Practice Of Mindfulness – Including Walking Meditation

This kind of practice is allowing your mind to become more stable. You begin by holding your spine as straight as you can. You train in focusing on the here and know. The most important thing is to accept yourself and simply start taking one breath at a time. Do not congratulate yourself when your mind seems calm just as you shouldn’t get annoyed and scold yourself if you drift off course. It is the nature of mind that we keep drifting off the course in meditation. The practice is to always come back to the here an now when you notice that drift.

Begin with very short sessions. Do not aim for even 10 minutes to start with. Aim for doing it during the time that you are taking just one breath. Then do another breath. You can just start with 1 breath as the entire session until you feel at ease.

Ordinarily, our mind is always chattering and full of distractions. When you can stop this chattering, even for a split second, or the time to it takes to breath in, you are into the practice of meditation – paying attention to the reality of the now. This is no mean feat. It may seem like a drop in the bucket, but the ocean itself is made up of water droplets.

I suggested very short sessions for a reason, a warning. As always, one must be aware of the very real risks of re-traumatization. For individuals with DID, sometimes creating that little space results in the alters seeing it as the opportunity to emerge uncontrollably, flooding you with their many separate agendas. These usually include retraumatizing flashbacks.

While taking one breath alone is unlikely to provoke an immediate flood, please check yourself. If you begin to feel the flooding of a flashback starting, stop the mindfulness practice by moving your body. Stand up from your seat. Stretch your arms fully. Straighten your legs completely. Identify the room you are in right now. Perhaps start your journaling ritual (see below) and allow some communication to happen in that way.

Go back to the mindfulness practice the next day, but don’t try to just jump back in trying to extend the duration of the practice. Always check your sense of safety first. Take this approach until your mindfulness practice is stable enough to allow thoughts to arise without the retraumatizing flooding of flashbacks.

When your mind begins to stabilize, you start to be aware earlier on and ever earlier on in the flashback cycle. The sooner you see the cycle start, the easier it is to ground yourself and avoid retraumatization. Consider how much easier it is to stop a car going 5 miles an hour than a car going 100 miles an hour. In that same way, grounding yourself at an ever-earlier stage of a flashback cycle is far easier than trying to put the brakes on a full-blown flashback.

Remember to take baby steps: Connecting to the safety of the here and now for even a fraction of an in-breath is better than just digging into flashbacks and being trapped in the retraumatization cycle.

F. Establish Empowering Rituals.

We can make a positive ritual out of a simple sequence of thought and/or conduct so that it is turned into a daily habit. It only takes repetition to build a habit and a routine – good or bad. So, take the steps necessary to build a positive empowering habit.

We all already have a routine when we get up in the morning and one before retiring at night. We have already ritualized and habituated ourselves to these routines. So, we do not have to struggle thinking about them. Build into this existing habit the focus of learning to feel safe and secure.

For example when you wash, at the sink or in the shower, imagine that you are not just washing the day’s dirt off your hands and face, but that you are washing down the drain the feelings you might have of having been dirtied by abuse. When you wash your hair in the shower, as you rinse out the shampoo, imagine that all of the physical and psychological dirt along with the sense of being soiled, simply goes down the drain. Imagine that you leave the shower both physically and, even just a little bit, psychologically cleaner than when you entered. You can extend this into brushing your teeth and other ordinary cleaning activities.

I often encouraged my DID patients to establish a clear ritual for safe communication with and between alters by ongoing journaling. In essence, it is creating a form that is empowering because it is within your control. Pick a book to write in that is only for this purpose. Establish a place and regular time to journal. It can be used for meetings of all the parts, it can be used for parts to leave messages for other parts, it can be one of your places of refuge. Always begin with some grounding exercise(s), open the journal, allow everyone inside that wishes to say something to do so by writing in the journal. In that way, communications from different parts can be shared with the host and other alters.

A critical point of this approach is to authorize the closing of the journal if things become triggering. In such circumstances, close the journal in accordance with the ritual you have established, with the express intention of allowing what has been raised to be processed. Include the promise of allowing further journaling on that triggering issue as soon as the system is able to process it. Then, and most important, following closing of the journal and always putting it away it its designated place, do a closing grounding exercise.

Often, the best grounding following journaling is to go for a walk outside. When walking, keep your senses as open as possible to the air that you breathe, to the trees you walk by, to the stability of the earth that you walk on. The earth, in particular, has the capacity to ground the energy the journaling has generated, in the same way that when you connect a lightning rod to the earth, the lightning’s electricity is safely absorbed.

Concluding Remarks

All healing that is effective has to come through one’s own effort. So, consider working on self-soothing practices before you have a therapist. The more you participate in such practices, the more effective and self-empowering is the healing. This way, when you are able to connect with a therapist, you will have already started to build a strong foundation for the therapist to support your continuing healing journey.

All the above may be used as complimentary tasks for healing even after you have found a therapist, but make sure you tell the therapist what you have been doing in terms of self-care. It is an opportunity to assess the therapist and for the therapist to assess you – and for the therapist to give you further direct guidance for self-care.

None of these self-soothing approaches are a panacea, a cure-all. They are merely, but potentially powerfully, supportive of the overall healing process. Remember that DID is not the pathology, it is the resultant display of extreme trauma. Its manifestation in alters is the message, the instant emoticon you could say, that there is deep unprocessed trauma. In my opinion, the problem is not the alters. It is the amnestic barriers and the resulting internal conflicts, which get played out both internally and externally, that are the problem.

Above all, understand that healing is possible and is within your capacity.

The post Self-Soothing Techniques for Those Unable to Locate a DID Therapist – Part 3 of 3: Practical Suggestions Continued and Conclusion appeared first on Engaging Multiple Personalities.

Self-Soothing Techniques for Those Unable to Locate a DID Therapist – Part 2 of 3: Practical Suggestions

Here are some suggestions for self-care in practice:

A. Create Imagery For Yourself That Is A Sanctuary, A Place Of Refuge.

You can easily make your mouth water simply by imagining sucking on a slice of lemon. If you can do that so easily, have confidence that, similarly, you can create a mental image of a safe place where you can rest and recuperate. Begin to heal your wounds by creating that place of refuge where you can allow healing to take place. Do not underestimate the power of suggestion. Here, we are using that power of suggestion to heal ourselves. It is the exact opposite of what abusers do, which is use the power of suggestion coupled with abuse so as to try to deny you this innate ability we all have to heal.

If one breaks a bone, the doctor puts the broken pieces as close together, and immobilizes the injury in a cast. Now the fracture is stabilized with the bones fragments held in place. This allows for the body to go through its non-conceptual and completely natural healing process. The cast is the safe environment which allows your bones to heal together while protecting the injury from further disturbance.

You don’t have to give instructions to each part of the bone to grow a little this way, a little that way, now join with this other piece and that other piece, and now all of you grow together… The knowledge of that healing is already available to you as a result of having a human body. The job of the doctor is to make sure the bones are close enough together that they will knit strongly and quickly, and that the injured area is protected from breaking again due to external forces during the healing process.

For someone with DID, the same kind of process can be put in place. The parts are brought together in an environment in which they can become close rather than in conflict. Within the visualized place of refuge, they can start to knit together. In that visualized place of refuge, they are protected from re-traumatization, which is the equivalent of a bone breaking again in the previous analogy.

When a child is hurt outside of an abuse context, a protective adult holds the child, soothing her with soft words and reassurance. That nurturing kind of remedy is love in action, highly creative and healing. So, within the place of refuge you have established through imagery, when the protective parts are close enough to hold the frightened ones, the injured ones, the ones that continue to feel torment, self-soothing and healing can take place.

Healing is best visualized in kinesthetic (sense of touch) terms. Through the sense of touch, one can connect with warmth and security through the imagery of being enclosed and protected in a cocoon. Caterpillars transform into butterflies while protected in the cocoon. Your place of refuge can serve you in that same way.

There are many DID individuals who have expressed positive experiences using a healing blanket, one which is weighted that they feel safe under. To me, this is reminiscent of the circumstances of a fetus in the womb. Before birth, one is protected by the tremendously strong uterine muscles of the mother’s body, floating gently in the warm liquid of the amniotic sac, protected without effort.

There are both religious and secular imageries that can be used. One should strive for a kinesthetic imagery that creates a physical sensation that is beneficial for the hurt individual or part seeking relief. For patients of mine that were devout Christians, I borrowed the imagery from Jean Vanier that “Prayer is rest; it is to be still, to abide in the presence and in the arms of God, knowing that we are loved just as we are; we are held and safe.” I would literally ask the patient to feel the sense of gentle pressure one experiences while being hugged. For patients of mine that were atheist or agnostic, a similar imagery was used without an anthropomorphic God (God in human form).

For one patient, the imagery that she found most helpful, i.e. most safe, was to be alone on a tropical island with a white sand beach that was so warm and comforting in the sun while all the while a large thick tropical forest, which started at the edge of the sand, kept anyone else from finding her. She could feel the very fine sand warm against her skin warming her from below and the sun warming her from above. She could smell the ocean and feel its warm breeze.

Use the imagery that is kinesthetic and safe. Religion vs secularism is not the point. Healing the sick is the purpose of psychotherapy so find the safest, most acceptable and effective way for you to re-learn the empowerment of experiencing safety in a place of refuge so that you can heal.

Traumatized individuals often have forgotten what it is like to feel comfortable and secure. So, small step by small step, explore ways to establish the sensorial feeling of comfort and security. There is comfort and pleasure in simply eating a piece of warm buttered toast when you have a cold, or drinking a glass of water when you are parched. In some mindfulness groups, the teacher starts their instruction in class by handing everyone a raisin. Participants are instructed to appreciate the simple sense perceptions connected to that raisin: how it looks, how it feels to the finger tips holding it and the teeth biting it, and how it tastes when it is in your mouth.

Comfort is usually accessible as we encounter ordinary objects in a our everyday life, but we have forgotten about it, or are in such a hurry that we bypass the experience. We need to allow ourselves to re-experience it. I suggest the following simple ways you could try: When you go to sleep, feel the comfort of a warm heavy blanket enveloping you. Re-create the primal environment of the baby floating in the womb. Explore the foetal position when you are in bed and see how comfortable it is when you curl up in that position under the blanket. Don’t tell yourself about it or guess at what it might be like. Instead, actually feel the sensation.

Experiment with physical comfort. A security blanket, literally, is one that is heavy, warm and protective. There is a direct sensation of protection and comfort that happens when you are all nicely wrapped up and tucked in.

Though your own effort, imagine you are on a beach, a castle at the top of a mountain or in some other place of refuge that you choose. Find and define your safe place wherever you want to nurse your wounds. In that place, re-learn the sense of comfort and security which can be generated in and through your body. You have the power to generate the feeling of comfort and security. Make the time and space to practice doing so.

B. Stay Connected To Your Body

1. Sunlight – bright light increases the production of serotonin in the body. Spending time in the sunlight can absolutely improve your mood and also soothe muscle aches. Full spectrum lighting can be helpful if you live in areas where there is little sun.

2. Massage – physical contact from working your muscles stimulates the release of endorphins. Massaging your own scalp and using shower massagers can provide an affordable alternative to expensive treatments. Massage therapy can feel wonderful.

3. Meditation – meditation helps the nervous system operate at its best. There has been quite a lot of research has been done to confirm its benefit. There is more about this later.

4. Physical Exercise – one of the best natural ways to produce serotonin, dopamine and endorphins. Vigorous exercise is best because the stronger the physical demand you place on your body, the greater the release of endorphins. You should try weight training as well as high and low intensity exercises. Work out only for so long as you can based on your capacity at the time. You want exercise to gradually strengthen your body, not to overwhelm it. Engage in regular physical exercise in muscle building, cardiovascular aerobic exercises, and stretching exercises. Learning and practicing yoga and taichi can be very supportive of both the mind and body.

5. Music – music is powerful and can move you emotionally. That is why you can tell what is going to happen in a movie scene based on the music. Good music can absolutely help your mood and get you positively grounded again. Try and listen to mostly upbeat music. Try dancing to it in the safety and privacy of your own home – combining the music with joyful exercise.

6. Laughter – savor the feeling of laughter with friends (or with other alters you might connect with) or watch a good comedy movie.

7. Sex – is a powerful producer of endorphins. One must be very cautious as it comes with responsibility, obligations and is often connected with dangerous triggers for retraumatization. I may be castigated for suggesting this but, as I suggested in Engaging Multiple Personalities, if sex is important for you, and particularly if you are unattached, the safest sex for healing and grounding may be masturbation.

8. Acupuncture – increases circulation and stimulates the release of endorphins. Of course, one must find a well-trained and capable acupuncturist just like when you look for any other professional.

9. Nourishing Teas – in the absence of diabetes, a warm ginger, honey and lemon tea can make you feel quite nice.

Remember the general principle that you can gently retrain the body and mind so as to correct the feelings of “I am a powerless victim”, feelings which are inherent in the process leading to DID. A gentle transition through kind and inviting body connections is therapeutic. Do not seek an easy way out that is simply a repetition of the experience of dis-empowerment – such as self medication through drugs, alcohol or other compulsive behaviors. If you feel better physically, through exercise and connectedness, you will gradually enlarge your capacity to work with all the parts as a team, in harmony. Keeping the mind in a creative mode through art music communing with nature and the like are foundations for improving and healing the wounds of DID.

C. Stay Connected with Others.

Close friends for support are essential in healing. Join an online support network so long as the administrators are properly protective of the members, on guard for individuals who are not there for the purpose of supporting others seeking to heal their DID. Online groups can have a truly positive impact. Active groups usually have people online 24/7 so that if you need to communicate with someone supportive in the middle of the night, it can actually happen. Make sure when joining such as a group, that they require warnings to be posted before writing anything that might be triggering.

Join a choir if you like music and singing. Join a photography club, a drawing or pottery class if you are artistically inclined. Join a hiking club. Well-defined interest groups are safer and more functional than other social clubs. These amateur groups are usually filled with enthusiastic members and they offer valuable support within the specific interest that can help you build a creative hobby. Connecting with people in such clubs can fill your life with warm memories.

Altruistic volunteer groups of people who are willing to contribute their spare time for the welfare of others can enrich you life in very meaningful ways. There is nothing more rewarding than to devote time to turn your kindness towards the less fortunate.

In this vein, remember that spending time with animals can also establish a sense of well-being and non-judgmental connectedness. This is discussed in more detail later on. In short, if you don’t have a pet or cannot afford one, there are always opportunities to help at an animal shelter. Supporting an abandoned or traumatized dog or cat is another way to nurture the strength of your own compassion. Training in that way can also lead to establishing roots of internally focused kindness – toward alters that can help the amnestic barriers slowly and safely begin to dissolve.

Note that I have not included traditional support groups in this category. That is not to say that they do not have value, and often tremendously positive value. However, one must be careful to keep to the specific purpose of such support groups. Alcoholics Anonymous, Gamblers Anonymous, Narcotics Anonymous and the like all have long and important histories of making real positive differences in the lives of people with those addictions. The very nature of such groups is that the focus is the addiction. Here, I am suggesting connecting with groups where the focus is quite different – not about dealing with a deep problem but instead about singing, art, hiking and so on.

Please do go to and continue to participate in AA, GA and NA meetings as much and as often as is helpful. Nevertheless, there are predatory individuals that attend such meetings so keep the boundaries quite firm.

Just as you need to maintain firm boundaries when you might encounter individuals that are triggering, understand that there are reasons protective alters emerge. Respect their intentions always. By maintaining firm boundaries, you let them know that you are giving credence to their assessments. Having done so, invite them to re-assess the individuals periodically. This is a way to gently allow them to moderate the hypervigilance common to protective alters while allowing them to fulfill their protective function.

D. Being With Animals.

Pet therapy has been extended to help individuals in many ways with many different kinds of difficulties. For example, there are now courts that permit service dogs to support child witnesses testifying about being abused. There are service dogs for the emotionally disabled, just like service dogs for the blind. It is obvious to all, when a service dog, or almost any dog or cat, is brought into a nursing home or old folks’ home, it immediately gently energizes the atmosphere, and brings joy to the residents. Horses have also been incorporated into PTSD therapy. Pet-Therapy is an encouraging trend.

I have a few colleagues, and am aware of other therapists, that have dogs in their office. One in particular has a three legged dog he rescued from the SPCA. The impact of having that dog in his office has been incredibly effective in communicating to patients that his office is a safe place. Were I to be starting out as a new psychiatrist, rather than being retired as I now am, I would consider having a dog or cat around for my patients.

If you are emotionally traumatized, consider having a service dog. There are substantial costs to get a trained service but tremendous potential benefits. As an alternative, you can go to the local SPCA and claim a rejected and/or traumatized dog. He/she will understand how you feel and will give you years of companionship. It can be a tremendous healing experience.

A dog is usually quite in tune with how its owner feels. When a stranger appears at the door, the dog will sense how the owner feels about that stranger and behave accordingly, either aggressively defensive or behaving in a warm and friendly way. For those with DID and the deep experience of betrayal trauma, a dog is far more reliable assessor of both your state of mind and that of the other person. Further, from the point of view of protective alters, a dog is far less likely than the host, or another person, to be deceived into betrayal by someone’s surface smile.

The post Self-Soothing Techniques for Those Unable to Locate a DID Therapist – Part 2 of 3: Practical Suggestions appeared first on Engaging Multiple Personalities.

Self-Soothing Techniques for Those Unable to Locate a DID Therapist – Part 1 of 3: Background

This post is to encourage the development of self-soothing skills. It is not psychiatric advice, as I am retired, no longer have patients, and cannot give therapeutic counsel. I am posting these thoughts and recommendations based on approaches I took with some of my patients that had positive results. If you do not have a therapist at the moment, please make sure that you remain safe as you consider or try developing self-soothing skills. If these seem like they might be helpful to you, and you do have a therapist, please discuss them with your therapist before trying any of them.

I have posted this because it is common knowledge that there is a dire unmet need for competent DID therapists. This is true all over the world. Even if one gets past the barrier of being able to find a therapist who acknowledges the validity of DID as a diagnosis in accordance with the DSM, one still has to find a therapist within that group who is willing to work with DID patients, and who has the time as well as the training to do so. These obstacles can sometimes appear to be insurmountable, at least in the short term.

The clear problem facing DID individuals then is what to do in terms of self-care if circumstances dictate a long waiting period to find a therapist. However, we can start with the understanding that even in therapy, self-soothing techniques are complimentary to basic one-on-one psychotherapy. Just as Olympic athletes in training needs to do daily weight-lifting and stretching exercise routines, self-soothing practices should be part of the routine for DID individuals.

The fundamental point of any self-soothing practice is learning to be kind to yourself. In general, DID individuals are in conflict and pain – often both internally and externally. They generally experience being trapped in a haze of confusion, sometimes with and sometimes without an ongoing conscious awareness of their DID circumstances. They are struggling with the consequence of dissociation. This can show up in the conflicts between the host and some alters, between alters, and with others they encounter in society. There is the ongoing suffering from the pain of early childhood trauma, whether it was physical and/or sexual assault or lack of emotional attachment to the primary care taker.

With DID, just as with any other form of PTSD, one is easily triggered into flashbacks. In a flashback, your body is behaving out of the host’s control. On an ongoing basis, there is likely an accompanying self-destructive behaviour such as substance abuse, eating disorders, and/or attacking one’s own body.

Substance abuse is related to taking a short-cut, using chemicals for self-soothing as are eating disorders. Repeating self-destructive behaviors has a similar impact and consequence. Unfortunately, these do not fundamentally do anything for your healing. It simply provides a short term impact that creates an ever increasing need for more of whatever substance or conduct is being abused. Relying on this kind of external and negative source of comfort falls short of processing the basic trauma, because it does not empower you.

Without processing the trauma and gaining the self-empowerment that goes along with that processing, one continues to feel empty, weak and passive. There is a loss of personal power, or dis-empowerment, that began with the original early abuse. DID has that component of PTSD which robs the individual of his or her innate basic confidence because the nature of abuse-based dis-empowerment trains you to believe that you will always to be a victim, no matter what. This fundamental dis-empowerment needs to be exposed for the lie that it is, a lie told by abusers to further subjugate the abused.

The basic therapeutic approach to correct this destructive imprint involves re-empowering the DID individual. Positive conduct that promotes the personal power and confidence of someone with DID would be a most beneficial adjunct to the therapeutic goal of processing the trauma.

Is there some basic principle to follow? The answer is yes; definitely yes. Learn to make friends with yourself. This is not a platitude, it is an actual thing to practice. You must learn to be kind to all the parts. That can only happen when you are open to understanding why the different parts may seem to have competing attitudes, agendas, and demands.

Do practices that strengthen the system as a whole. You are all in that one body together so stay connected and learn to function as a team. Visualize you are like an Olympic team with a distinct common goal in mind. As an Olympic team, you have a target and a purpose, which is to score goals. The target and goal here is to be kind to each other.

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Guidelines for Therapists On First Encounters with a DID Alter

I am writing this because, in my psychiatric practice, I made many mistakes over the course of learning to work with DID. From the perspective of having been retired for the last 9 years, I have reviewed my patient histories so that others may learn from those mistakes. This is the core of my purpose in publishing Engaging Multiple Personalities Volumes 1 and 2.

The education and training I received as a psychiatrist gave me no clue as to how to identify and treat DID patients. In particular, there was no guidance or even discussion of how to relate to a DID alter that might appear in a client session. Because the first encounter with an alter is critical to establishing the necessary therapeutic alliance required for treatment, psychiatrists and other therapists need to be aware of the pitfalls of not being prepared for such an event as well as the benefits that can arise from proper preparation.

In general, DID is rarely diagnosed during the first many therapeutic sessions. According to various authors and studies, most DID patients are only diagnosed after cycling in and out of the mental health care system for several years. This is because, unlike other disorders, DID cannot be discovered through questioning or “digging out” information from the patient.

The foundation of therapy is understanding that the diagnostic procedure is a mutual process: The therapist is assessing the patient just as the patient is also assessing the therapist. Until the patient feels safe with the therapist, and thinks the therapist is or may possibly be trustworthy, the patient is not going to share their innermost secrets or confidential material with the therapist. The DID patient, in particular, due to amnestic barriers between the host and alters, will likely be barred from even being able to access that information. Through decades of experience interacting with people, alters are hyper-vigilant in evaluating who is likely or unlikely to understand their plight. They will not risk being ridiculed by someone unlikely to listen with empathy, although they may conduct themselves with aggression if they feel threatened by the therapist and/or therapeutic environment.

In the event that the DID system deems the therapist worthy of being shown an opening to those innermost secrets, an alter may suddenly “jump out” in the middle of a therapeutic session. In such a case, at least for me in every case in which this happened, the therapist will likely feel “a shiver up the spine” sensation. It is a somewhat indescribable experience. To see a little boy suddenly appear in the body of a 45 year old woman in a business suit, with a young boy’s posture, manner of speech, and emotional presentation, amounts to more than a simple surprise. I developed a code of behavior for myself to follow when first knowingly encountering an alter.

These are the rules I established for myself (the therapist) in such a situation. I hope they will be of benefit to others.

1. I shall remain stable in my own mind, calm and non-reactive.

2. I shall treat the alter with respect and appreciation that he/she is willing to be seen by me and to talk to me directly.

3. I shall contain my curiosity and refrain from asking for a complete personal history of the alter as that could be interpreted as an interrogation.

4. I shall just wait in a silence of empathy. The alter will likely tell me all he/she wants me to know, with minimal leading questions.

5. The ultimate guideline of decorum is that I behave as if I were being introduced to a new person at a social event: I metaphorically shake his/her hand and sincerely say, “It is nice to meet you.”

The most common mistake therapists make is based on the idea that getting rid of the alters is the prime goal of treatment. In fact, the therapist should realize that the appearance of an alter is a golden opportunity to access and clarify the confusion created by the dissociation. The alter is the main path, the highway so to speak, to access the information needed to enable the alter(s), and the system overall, to process the trauma. Because of amnestic barriers, in many cases the host is not even cognizant of the abuse history. The alters hold the keys to the mystery of what is hidden behind the compartmentalization of the alters, what is being blockaded by the amnestic barriers in the personality structure of the patient.

Avoid seeing the appearance of an alter as the pathology. The amnestic barrier of dissociation is the real pathology. The priority now is to get acquainted with that sequestered part, which is essential in the healing process. That part may hold much information about the abuse history. Be prepared that there may be an abreaction in detailing the abuse history. So, do not demand details of the trauma and do not provoke the patient to recount them. Letting the alters feel comfortable and secure enough to establish a proper therapeutic alliance is the best, quickest and safest approach to avoid retraumatization. With a proper therapeutic alliance, therapy can generate a positive cathartic experience. Without it, there is only retraumatization.

The first question to ask is not about the personal history of the presenting alter. Rather, it is to find out the age and function of this alter. The age is important so that you use language that is age appropriate to the alter. If the alter doesn’t wish to say their age, then take your cue from how they are speaking to you in terms of how you respond to them. In my experience, the alter will usually tell you whether he/she is, for example, a protector, a persecutor, or perhaps a fearful and suffering child still holding the abuse memory so that the system can function in some capacity without the constant burden of the trauma. The alters generally are quite aware of their function, and sometimes can phrase it exactly in that way.

It is critical to understand that an improper reaction on the part of the therapist can lead to disastrous results and will probably close off any future communication. The unwary therapist taken by surprise may make inappropriate demands when a 45 year old patient starts behaving like a toddler, and blurt out an admonishment like, “Don’t play games with me. Act your age. Go back and sit on your chair.” In other words, harshly denying the alter right in front of you! Such a reaction, spontaneous or otherwise, is negating the person-hood of what appears in front of you. There can be no therapeutic alliance if you deny that alter.

An alter sincerely considers him/herself a separate identity. Why not just accept the alter on his/her own terms, exactly the way you would when meeting any patient who first comes into your office? No therapist can dismissively brush off a client and expect to work with that same client in any genuine way. You are going to have to work with this alter so treat him/her respectfully. This is the first rule.

In chapter 1 of Engaging Multiple Personalities Volume 1, the suicidally-depressed woman patient in her business suit suddenly morphed into an arrogant and proud 5 year old boy, boasting about his bravery and dismissing me as an idiot. I reacted calmly, and respectfully thanked him for talking to me. I addressed him in a matter of fact way inquiring for his name and purpose in being there. The result was to establish a therapeutic alliance with that alter but also to all the other alters that were listening in and watching. It was the key to the system preparing to trust me.

Conventionally speaking, of course the boy is not a separate person. But we are not meeting the alter in a circumstance where a government ID is required for entry into our office. We are talking about meeting an alter in the context of psychotherapy. Psychiatrists should have the flexibility of mind to accept that if there has been severe ongoing early childhood trauma, DID and the consequent appearance of alters, is reasonable, logical and appropriate to the circumstances. In this context, it is ridiculous to hold on to some argument about whether or not alters truly “exist” at all!

Don’t argue with an alter, trying to convince her that she is really the host. You may be legally correct but therapeutically it will be a disaster. We need to remain focused on what works as therapeutic intervention for healing from such trauma rather than trying to force our understanding of our own experience onto the patient.

Therapeutically, the boy alter should indeed be treated as a person in need of healing in his own right. For those therapists that simply cannot wrap their head/mind around the notion of an alter, perhaps an analogy would be helpful. To refuse to treat the DID patient because the alters are doing the talking rather than the host that you think you should be speaking with is ludicrous. It would be like saying you won’t treat a mute patient because they can’t tell you how they contracted their illness. You would not feel justified in denying treatment to a mute because someone else in their household told you they were running a fever, vomiting and sobbing all night long.

Please respect to bravery of the alters to come out and communicate directly. Anything other than that will ruin the therapeutic contact. Treat the alter as if he or she were a completely separate identity and the result is that you will benefit all the others, including the massively unhappy frightened host.

The other common mistake is to be anxious to learn the details of what is hidden. In the past, therapists were so focused on getting that information, on an almost gossip level, that injections of sodium amytal, hypnosis, or outright interrogations were used. Instead, by preparing the alter by letting him/her know that you are ready to listen, and providing a milieu of reassurance and support, a cathartic experience will naturally follow. You will get all the information you need to conduct psychotherapy.

There is no need to push. A cathartic experience is only therapeutically useful if done in a secure environment making sure the patient is not re-traumatized in the process. It should be done in a gentle way, as if the therapist is holding the hand of a child revisiting the trauma scene. The role of the therapist is bearing witness to a crime often committed decades ago, guiding and comforting the survivor as he/she goes through the journey once more, but this time with the critical difference being that he/she is no longer going through it alone.

Another task the therapist has to perform is to gently remind the survivor that the “here and now” is where safety is found. This has to be repeated many time until it hits home. There are all kinds of ways to convey this message. Mostly I would point this out through the “touch sense” (the kinesthetic sensation), reminding the alter that the traumatic experience happened in a different place, at a different time, and with people that are not now in the room. Often the alter is stuck in the past, usually decades past, and feels surrounded by the enemies that were the original abusers. Replacing the palpable fear of the past with a comfortable bodily sensation of warmth and relaxation, of heaviness in the limbs and so on, is often quite helpful. The therapist is now helping the system process the PTSD symptoms. This pointing out of “the past and the present” is essential. I would use all kinds of signs and clues to point out the passage of time and the difference in location.

Trust your own experience but be prepared so that you remain stable should an alter jump out to meet you. Know that it is a sign that the patient is showing his/her trust in you. The alter is giving you, the therapist, the chance to prove that you understand and will treat the alter with respect and acceptance, that you will not laugh at him/her, and that therapy will now take a positive turn. The alter is sharing with you a deep secret. Don’t waste this golden opportunity for therapy. Do the right thing!

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When Alters Despair

A question came up from one of the readers of Engaging Multiple Personalities who is DID. As it seemed to be a topic that was relevant perhaps to many DID individuals, I thought I would share some of my thoughts. As always, it is important to understand that I am retired and cannot offer therapeutic advice to anyone. Please do work with your therapist and know that healing is possible.

The basic question was not about angry alters, rather it was about alters that hold so much depression and trauma that the only solution they see is to die. They don’t want to harm any of the other alters or the host, they just see no exit from their pain.

I can tell you that my life experience (I am almost 80 years old at this point) is that no one wants to suffer. Whether they are DID, have PhDs, are poor, are wealthy, are young or old, no one wants to be in pain. Much of our lives are spent simply trying to avoid pain and seek comfort.

My DID patients usually had severely depressed alters that would present their logic for why they (and everyone else in the system) would be better served if they were gone. With only the experience of holding traumatic memories – and walled off by the DID from any experience other alters might have of laughter, enjoying food, and a warm glance from a genuine dear friend – their desire to give up on life is understandable

It was always difficult to establish a bridge of communication to help those alters shift their perspective. But, when that bridge was established they were able to begin to shift their perspective, if only for a moment and if only just a little bit. Once that happens, it is as if the clouds are starting to soften and maybe even part after a huge storm. The thick black clouds begin to get a touch of grey. The sun may not yet be fully visible, but at least there is more confidence that it is up there somewhere.

Alters stuck in their despair understand that each alter shares the body with all the other alters, including the host, so a peaceful death of one alter without affecting the body simply doesn’t work. They don’t wish to harm anyone, therefore they are looking for something other than suicide. Like other alters who are holding the most difficult trauma, they simply don’t see a way out. That is because they arose in response to an abuser psychologically hammering into them the belief that there was no escape from the pain then nor would there be in the future.

The fact is that these alters have taken on an incredible amount of pain so that the system can survive and function. In fact, I had patients with alters that had sequentially arisen to take care of a certain level of trauma and then, within and during the same traumatic event, when the pain increased too much for that alter, another alter would arise to take on that increased level of pain – and so on. These alters were taught that there is no relief that will ever be available to them. Nevertheless, relief is what they want and the only solution they see, because of amnestic barriers, is to die.

I would sometimes give my patients, and specifically those alters, an analogy to their experience that some of them found helpful: I would point out that for one person to lift a 500 pound weight is generally impossible. But, if 500 people share the lifting of that weight then each one is only taking on 1 pound – easy to do. In this case, the intensity of the pain held by the alter in despair is the 500 pound weight. Clearly they can never lift it alone, and therefore see no escape from the pain.

However, the more other alters engage, befriend and share with that alter, the burden being borne solely by that alter eases a bit. Maybe at first from 500 pounds down to 499 pounds. That is still too much for any one to bear, but with each engagement, if a few pounds are shifted, then the path to relief starts to become clear – even for the severely depressed alters. That is the point when the black skies lighten just a bit. Sharing their burden is not easy for the despairing alters to do, and is also something that many of the other alters don’t wish to try. After all, holding that despair walled off within an amnestic barrier is why that alter was likely created. So, effort needs to be made to encourage the non-despairing alters to take on just a small touch of the pain.

The corollary to this is that when you share joy, it increases. Kind of like when everyone is watching a movie and laughs at a funny line. It is experienced as much funnier than one experiences the line watching that same movie alone. So, the guidance is to try to share the burden and share the joy. Both of these are difficult for an alter in despair to try because it goes against the imprinting by the abuser that no relief is possible.

Without pressuring them, make sure the alters that want to die begin to listen to the joy that some alters feel. They don’t have to immediately experience it if they don’t want to or cannot, but it is kind of like inviting them to at least listen at the door until they feel safe enough to come join in – even just enough to stick their toe inside. In short, these is how you and that alter who really wants to put an end to the suffering without harming the commonly shared body can proceed.

The above suggestions are methods to work in the mind(s) of the system. How this might be done in the body is the next issue.

Sometimes, I suggested to my patients that they might invite the despairing alter to go for a restful sleep. This is not to tell them they are unwelcome. In fact, it is just the opposite. It is like when someone is ill, you want to bundle them up safe in a warm bed with warm honey tea and buttered toast. They can stay in bed resting while you guard the door, so to speak.

I would suggest for this alter to go on a short “retreat.” Let me elaborate further by giving an example. An ideal retreat for me is going to a place that has a quiet garden, eating very simple food and spending some time walking in a forest, smelling the wild plants, listening to the birds and maybe the noise of a small babbling brook. If you can do this even for a few minutes, for a few hours, or for a few days, without books, radio, e-readers, i-Pods etc., it can be very healing.

Allow nature – here meaning the outside world and your body’s interaction with it through the senses – to bring you back to the complete “here and now.” Try to bring a complete attention to the present, the present breath, the gentle tired feelings in your legs and the slight hunger in the stomach before a nourishing simple meal. This is a way to use the sense experience of the body to comfort the distressed alter.

Invite the troubled alter specifically to join you in that simple retreat, without being heavy handed. If they say they don’t want to come, no problem. When you go, they will automatically be there with you so long as you leave the door open for them through your good heart. Again, it is like inviting someone waiting just outside the door to listen in, perhaps they are too frightened to enter but they want to hear what is happening.

I know this suggestion may be met with resistance by some individuals who do not like its possible religious overtones, but the Earth holds all of us. Being undistracted in nature, allowing our senses to engage it, is not particularly religious.

If it is too difficult to get to a forest or garden space, my other suggestion is simply giving that alter a period of therapeutic sleep. Invite him/her to go for a long weekend of therapeutic sleep. Let them know that this kind of sleep is to allow a period of deep safe rest and healing rather than simply a time of avoidance. When you do this, make sure that as part of the invitation, they know that when the therapeutic sleep is over, you will have a meeting with them, speak directly to them, invite them to be your friend and share your experience of peace and safety of the garden/forest walk. At the meeting, listen to them speak of what is on their mind without judgment. As with any alter, they need to process their trauma safely.

Healing does not depend only on talking and thinking, it also requires rest and re-organization. It is like setting a fractured bone. You put the fracture in good alignment with the main bone and keep it in a plaster of Paris cast. The cast is a safe protected place where the pieces to grow back together. The good alignment is kindness. As best you can, always be kind.

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The Power of Dissociation

Without in any way trivializing the trauma that is the core of early childhood abuse, there is a fascinating aspect of MPD that is deserving of further exploration. The fact is that dissociation allowed the abused child to survive. That, in itself, is cause for appreciation of the power of the dissociative response. It is the habituation to dissociation as a response to triggers and unprocessed trauma arising that causes such tremendous difficulties for the patient including amnestic barriers and internal conflict. For some, dissociation can produce unexpected hosts of achievements as part and parcel of the impact of the disorder. In therapy, there is often an over-emphasis on the damage that has been done without a concurrent expression of how genuine healing is possible – that there is hope.

Among those with DID that I have treated as well as those I have encountered after my retirement, some have accomplished extraordinary things both in recovery and in the world. While I discussed this aspect briefly in Engaging Multiple Personalities Volume 2, I believe it is worthwhile to go deeper into this aspect of DID.

It is clear to me that I failed to diagnose certain patients as DID in a timely fashion because of their external accomplishments. I was misdirected by my own admiration for them. I will not identify those patients for obvious privacy reasons but they included people in the top tier of their various professions, in both business and academia.

The first point to make is that for anyone to survive the intensity of trauma that gives rise to DID, they must of necessity be extraordinarily brave, strong and resilient. Anyone coping with and surviving ongoing abuse as a child crafts strategies on a survival level that successfully deal with vicious adult abusers. Some abusers are hiding in plain sight as valued members of the family and/or community. Some abusers are individuals that frighten law enforcement, other adult family members and other adults in the community. Consider the pressure a child is under dealing with abusers which the outside world either cheers as a valued individual or fears as a dangerous individual. For the child, there is no hope of escape, nowhere to run, no refuge.

Dissociation is a most brilliant survival strategy for such a small child. Fundamentally, that is the point I have tried to make in both volumes of Engaging Multiple Personalities as well as on my blog. To both therapists and those with DID, I say please do not turn away from the alters. However angry, mean, sad, or panicked they may be, it is the alters that were the means of surviving the abuse. The difficulties that DID individuals have is dealing with the aftereffects of habituating the use of such a radical means; the only means available to them as children.

Alters arise holding pieces of trauma as well as their own habitual modes of interacting with the world. The ability to dissociate provides a tremendous opportunity for an alter to completely focus when they are in control of the body. The single mindedness allowed survival as a child by focusing away from the trauma as it happened. As an adult, the dissociation via triggers can be an ongoing trap of retraumatization. Alternatively, it can be used to successfully accomplish things in the outside world. On a very basic level, dissociation allows DID individuals to go to work, take care of themselves and others such as their children, while holding the unprocessed trauma temporarily at bay until the system is overwhelmed.

There are those with MPD who may excel in multiple disciplines. For these individuals, each dissociative part, each alter, can develop their focused interest in a topic without distraction. Any scientist, scholar or artist, has this ability of total concentration when working to the exclusion of other distractions. With the ability to dissociate somewhat completely at will, the result of such total concentration can be excelling in a field. If one part is an academic, another an artist, and still another an athlete, how interesting that might be.

Individuals who have publicly disclosed their DID have often been ignored or had their DID denied. However, there are a few individuals whose standing in their respective communities allowed them to disclose their DID without quite the same level of disparagement as others have experienced or rightly may fear. This is not to say that such individuals experienced no negativity following their disclosure. However, because of their stature, they gave pause to the deniers of DID. Indeed, they created the opportunity for non-DID individuals to begin to see DID in a less perjorative light.

Robert Oxnam is an academic who revealed his MPD in his autobiographic A Fractured Mind (2004). Robert is a scholar of Asian studies, having taught in US universities as well as having lectured in Beijing University – in Chinese. His most famous role was to lead a cultural tour of China for the likes of Bill Gate, Warren Buffet and president HW Bush. He also was a China expert advising the former US presidents. He has authored several books and served as the head of the Asia Society in New York. However, apart from the focus on Asia, he plays the cello, and is now a prominent sculptural artist. Beyond that, at different stages of his life, he was a competitive archer, an accomplished cyclist and a prominent, in some circles, rollerblader.

Another MPD autobiographer is Herschel Walker (author of Breaking Free [2008]). He was his high school valedictorian and a Heisman trophy winning athlete. He was an NFL player, and then excelled as a world class bobsledder, sprinter and mixed martial artist. He is a successful businessman in the food industry. In his autobiography, he mentions that his ability to dissociate allowed him to be apparently untouched by pain in the midst of crushing blows from opponents – to their utter consternation.

Going back to the earliest days of psychiatry, Anna O. is believed to be the first MPD patient whose case history was described in detail. Her case is found in Freud’s book—- Studies on Hysteria (1895). Freud missed the diagnosis, or, to be more accurate, there was not an applicable diagnostic category at the time other then the general one of hysteria. Even in missing the diagnosis, he did note her concern about “time-loss” and having “two selves.” Both of these are primary and often the first indicators of a potential DID diagnosis. At different times, Anna O would speak different languages and refuse to believe, for example, that she actually knew others. There are several other points that would lead one to consider a DID diagnosis that are clearly laid out in the case history.

Anna O (real name Bertha Pappenheim) was at one time a patient of Breuer (a colleague of Freud and co-author of Studies on Hysteria). He stopped treating her as she was becoming progressively worse and had to be institutionalized for a period of time. Breuer told Freud that she was deranged; he hoped she would die to end her suffering. One can imagine the depth of her depression through Breuer’s comment. However, she later achieved renown for her social work, such that the West German government issued a postage stamp in honour of her contributions to that field. She was an author of several novellas, poems and plays. In addition, she was a translator and a writer of several important pieces attacking the trafficking of women in eastern Europe and the Orient. Her focus on helping others who were sexually traumatized is not uncommon in the DID world. In my own practice, I saw clear examples of this practical application of empathy by DID patients in dealing with children and other at-risk individuals.

Unfortunately, the term MPD has trivialized the concept of dissociation into parts, offering endless possibilities of theatrical materials for movies and TV series. They tend to emphasize the histrionic parts of the multiple facets of a single patient. This trivializes the pain of the original trauma that caused the dissociation as a defense to protect the fragile ego. It somewhat makes light of the damage done to the growing individual and the possible ill effects impacting the next generations as well as the untold misery affecting many people involved.

Psychiatry struggles to find a better name of the affliction, changing it from MPD to DID in 1989. I wonder if this change has made any difference. Die-hard disbelievers still cling to the pseudo logical argument that if a person can have more than one identity, then two persons hold the same passport or one person can have multiple passports – completely missing the point of the disorder. The book by Schrieber reawakened interest on this issue but some professionals got distracted by a fascination with the multiplicities of the “personalities”.

Because of the word personality or identity in the diagnostic label, many psychiatrists cannot make the paradigm shift to accept the concept of DID, nor accept DID as a genuine psychiatric disorder. Some serious academics still deny DID as a mental disorder, declaring it to be a condition that is produced iatrogenically, or otherwise non-existent. This mistaken view is much to the detriment of the welfare of DID sufferers trying to find a therapist. Even worse, it teaches new psychiatrists something that is simply wrong. Out of their ignorance, they will then perpetuate the same mistaken view and impact an even wider circle of patients.

By studying the successes that individuals with DID have had in healing, in worldly activities and in displaying great empathy helping others, psychiatrists and other therapists can learn quite a bit about trauma, its treatment and the possibility of truly leading those with the disorder into health. The successes can be used to give hope, the critical element in working with those trapped in retraumatization cycles, that healing is possible, that joy is possible and that their very survival as a child is a mark of how creative, strong and successful they were as a child all the way through to this present moment.

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The Body Keeps The Score

If someone breaks a leg, is burned, or is otherwise physically injured, it is easy to see. It is shows right there on the surface of their body. Maybe they are wearing a cast, or have a scar, or some other clear sign of damage. But when someone has been traumatized, it is not always so easy to see. Nevertheless, it is there – locked in the body. Often you can see it in someone’s posture, in the way they flinch when a sudden noise surprises them, or in the way they try to hide from a gaze.

We all lie to ourselves and to others, usually in small ways that are not a big deal like, “I am walking out the door right now” when we are still inside getting on our shoes. But we are capable of lying in ways that are quite dangerous, to ourselves and others. Why is this important to understand when dealing with trauma? It is important because lying is conceptual, it is manipulating thoughts and strategies. While the mind can do that quite easily, the body cannot. The body doesn’t operate like that. When working with trauma, remember that words can be deceiving. Words can misdirect the attention both of the patient and the therapist. Instead, trust the body. The body doesn’t have the capacity to lie. The truth is locked into the body, and the body will confirm the words that are true.

Memories of early childhood trauma usually do not come in logical, sequential verbal narratives. This is because it is mostly implicit memory rather than explicit, demonstrative memory. Explicit memory is simply not available when abuse happens in infancy, when it happens to you as a toddler, or when you were a young child. In other words, when the abuse occurred before a child’s developmental unfolding of logic, of conceptual grasping of reality and thinking, one cannot expect to recall it as if describing last night’s television show that you watched as an adult. Abusers count on this, knowing that the child will be unable to express a logical, sequential and, for the most part, fact-checkable explanation of their pain – now or in the future.

As a psychiatrist, my primary concern was with treatment, with healing an injured patient. For both the patient and therapist, my advice is to refrain from searching for a logical, sequential, and verbal expression of the abuse experience. This is personal experiential stuff. If your body is telling you that you were abused, that is the foundational truth. Searching for confirmation of details is not nearly as important as trusting the truth held by your body.

How it happened, when and where it happened, are less relevant unless you are still in the physical orbit of the abuser. Trying to force the implicit bodily memory of abuse into an explicit narrative memory will likely cause further confusion and doubt. The body will allow access to the implicit memory when patient feels safe enough to permit it, or when there is enough stress that the patient’s ability to suppress the implicit memory is overwhelmed.

When the implicit memory arises, don’t dissect or argue with it. It is true on its own foundational terms. Appreciate the wisdom of the body in keeping a record of the trauma, and the wisdom of the child to have survived the abuse. Allow the memory to be as it is, to be expressed as needed, but this time in the safety of the therapeutic environment. This enables the patient to start to experience the distinction between an explicit memory of the past and the present discharge of implicit memory.

Practice the “here and now” formula. In short, you are, at the time of this one breath in the therapists office or in your protected place at home, safe and whole. In the midst of implicit memory, breathe. You are breathing anyway, so why not pay just a bit of attention to it. In the moment of this very breath, one can access a powerful feeling of stability. Practice just experiencing that feeling without trying to extend it, manipulate it or otherwise hold on to it. Why not try to hold on to it? Because it is now the next moment, the next fresh breath, the next opportunity to experience safety.

The more often you can experience the safety of a here and now moment, the more that experience – on its own – will leak into your everyday life. Work on creating the habit of noticing your breath when any past difficult memory starts to arise, implicit or explicit. Each time you connect with that safety in the breath during the remembering, whatever happened in the past begins to weaken its present grip on you.

It is a process of very small steps. The past will not suddenly lose its power, but it will begin to do so gradually. With processing the trauma gently, slowly and safely, the past will cease being so potent. It will become more and more like an ordinary memory, with limited impact on the present.

As the trauma is processed in therapy, the body will shift just a bit, letting go a little bit. What I said to my patients was that I wanted them to leave my office feeling just a little better than when they came in. In that way, there was no pressure to have a giant breakthrough with the attendant pitfalls of loading such pressure on them. Instead, my patients would make small gains without retraumatization. It was with gratitude that I could see a patient walk out of the office a little more gently, a little more erect, and feeling a little more safe inside, than when they entered.

This is not to say that patients were on a continuously uphill trajectory of healing. Everyone’s life has ups and downs. This is true whether seen over the course of days, weeks, or months but also over the course of minutes, at times. So, each session with a patient was a new starting point – how did they come in that very day and how did they leave.

The body keeps the score, and communicates it every moment. Be open to its messages.

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Characterizing DID: Illness or Injury?

Language has power. Whether you examine it from the point of view of ordinary communication, advertising, or threats, words and how we use them have tremendous impact – some of which is intentional and some of which isn’t. This is because the words are chosen based on the experience of the speaker/writer while the impact of the words is based on the experience of the listener/reader. For those with DID, words are tied intimately to the body language of the abuser. For people without DID, they often fail to understand the power that words have to trigger retraumatization – because they fail to understand the physicality, violence and/or threats of violence, that accompanied those words.

Given that a word may have one meaning to one person and be experienced quite differently by another, I want to look at the use of the terms illness and injury in DID. I had not thought about this before, but in a DID Facebook group, one member defined himself as injured, not ill. In considering the refusal to consider himself ill, going against most therapeutic models, he was quite clear: he had been injured. He advised me that this distinction came from a therapist at Del Amo’s National Treatment (Trauma) Center. I believe this critical distinction is both accurate and subtle.

Illness and injury are often used as synonyms. Conventionally speaking, this is not usually a big deal but while they can sometimes be used interchangeably, they are not exactly the same. An illness is something that people understand to be bacterial, viral and, at least subconsciously in almost every circumstance, potentially infectious. An injury is something that is the result of some external force exerted on a person, whether deriving from a fall, a chemical, or something done by one person to another. This is not something that people, even subconsciously, generally view as potentially infectious.

The truth is that the trauma of child abuse is not an illness that arises due to a microscopic life form such as a bacteria or virus invading one’s body. Those attack one at a cellular level. The body’s defenses rise to fight the illness, sometimes successfully on its own as in a common cold, and sometimes successfully with medicines.

Child abuse is an external force – physical, psychological or, often, both – that attacks and injures the child as an entire individual. In situations of child abuse, there is no cellular defense that can rise to fight the abuser. In the case of trauma resulting in DID, the mind’s defenses rise in the form of multiplicity to survive the external force of the abuser.

When someone breaks a child’s arm, the broken arm is classified as an injury. If the bone protrudes from the break and becomes infected, the infection would be considered an illness but the broken bone would continue to be classified as an injury. In fact, the root of the illness (the infection) was the injury. We must keep this distinction in mind when examining the etiology and resultant manifestation of DID.

Characterizing DID as an injury, rather than an illness, has the potential to benefit those with DID as it is a more accurate classification of the source of DID. Thinking of DID as an illness implies, conventionally speaking, that one needs rest, medicine and homemade chicken soup. But, no patient with DID got it because someone sneezed near them in a crowded bus, or because they ate at a restaurant where the chef didn’t wash his hands before cooking. No patient got DID because they stepped on a rusty nail. Patients manifest DID as a result of very real injuries that unrelated to the microbial world.

This re-characterization may enable those with DID, and those without it that engage them – whether therapists, family, friends – to see them the same way one would see a person who has a broken leg. That person, perhaps with a cast, needs extra help. They need to be protected from anything or anyone banging into the broken leg intentionally (an abuser continuing the abuse) or by accident (a non-abuser unaware of interpersonal triggers). Just as a bone takes time to knit as part of the healing process, DID takes time to process the trauma as part of its healing process. Let us understand the injury so that we – patient, therapist and supporters – understand the importance of protecting both the mind and body during the course of healing.

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Disclosing Your DID: A Cautionary Note

I am delighted and honored that Robert Oxnam, author of A Fractured Mind: My Life with Multiple Personality Disorder (Hyperion, 2005) has most kindly consented to be a guest blogger on this topic of disclosing one’s DID to others. I am confident that his generosity in writing this piece will result in much benefit to the DID community. His ongoing willingness to share his experience with others is a tribute to the power of genuinely walking the path of healing.

“Disclosing Your DID: A Cautionary Note”

From: Robert Oxnam

October 16, 2015

I’ve been asked by my good friend, David Yeung, to offer some advice about the wisdom and dangers of disclosing your DID condition to others beyond your family and a trusted circle of close friends. Having published my DID story a decade ago, he knew I had lots of experience with the ups and downs of openly revealing the disorder.

Looking back, I think my disclosure motivations were similar to many who have struggled privately with DID over many years. I wanted to be honest about who “we” are inside and how we’ve coped with a difficult life. I wanted to embrace my outer associates – family, friends, workmates – just as I had learned to embrace my inner identities. As one publisher said to me – “I think you’re writing this book so you can own the rest of your life.”

And so, I blithely pushed ahead, wrote the book, and awaited the results, good or bad. In retrospect, I was very fortunate to have a relatively favorable outcome – roughly 80% of the responses were positive/very positive while 20% very negative/outright vicious. Many in the media world embraced the book and, for a few weeks at least, it became a bestseller. I was deluged with supportive emails and letters, especially from mental health professionals and from fellow DIDs. But nasty anti-DID shrinks unloaded on me and some reviews were laced with haughty and mocking language. Some former friends and even family backed away; while others implied that I was making up the whole story. Just go to Amazon.com, check the reviews of A Fractured Mind, and you’ll see the whole spectrum.

In retrospect, I’ve learned a great deal about the volatility that surrounds our disorder, and “we” have learned how to find inner strength to cope with the harsher realities of DID disclosure. Most of all, I have come to realize that my 80/20 breakdown was an outright miracle and it could have been much worse. I have also concluded that my relatively-positive experience with DID disclosure has been an exception that proves the rule. What rule? Don’t go public unless you’ve thought it out carefully and are ready to face difficult consequences, short and long term. Remember, you’ll live with ever-expanding circles of “people who know and gossip” for the rest of your life.

Why was my experience an “exception that proves the rule”? I think there were four factors that prompted an 80/20 response rather than 50/50 or perhaps even 20/80.

1) “Inner Consensus.” In 2005, when the book was published, “we” already had fifteen years of post-diagnosis DID under our collective belt. We had fully identified the whole raft of inner personalities, found ways to break down the walls that separated us, and gone through a long-term merging process. The remaining five identities committed ourselves to a cooperative framework called “cohesive multiplicity.” And then, “we” openly discussed the pros and cons of going public. Eventually, we reached a heartfelt decision that, for our own sakes, and for the potential good of others, it was essential to write the book. And, we also agreed that each of us would tell his/her story separately so that none of us felt left out or diminished by the experience. In short, we were all ready for the reactions, come hell or high water.

2) “Controlling the Narrative.” The book itself was “our story” in our own words. Before anyone might react to that story, they would presumably have read the book and thus encountered experiences and observations that we ourselves had revealed in context. So we were not just disclosing our DID, but also offering an orderly and positive framework for helping others understand DID. These are the messages in a nutshell: a) DID occurs because of vicious abuse inflicted on very young children, b) DID is an intelligent child’s way of coping with horrible treatment and staying alive in physical and psychological terms, c) There are great therapists who can treat DID with patience and care, producing remarkable results, and d) In addition, those without DID can learn from the disorder about how multiplicity is embedded in all humankind. And maybe, we hoped, non-DIDs could learn how to deal creatively with those inner forces and perhaps even find their own way to “cohesive multiplicity.”

3) “Timing.” When the book was published, I was 62 years old, at the end of a multi-faceted and successful career as a specialist in China and Asia. I was already pursuing other activities as a novelist, business consultant, and television journalist. I didn’t know it at the time, but I was also poised to enter the creative world as an artist working in sculpture and photography. Yes, I suppose one might say that my career trajectory was as diverse as my inner psychology. But my key point is that the timing was right to take a disclosure leap without fearing that I would lose my job and livelihood in the process.

4) “Highly Supportive and Admired Partner.” Vishakha Desai, my wife, has been and remains a crucial factor in dealing with my DID and coping with “going public.” It is impossible to imagine the arduous process of DID therapy and then public disclosure without her at my side. Vishakha has not only helped me in a thousand ways, but she has also become a fervent advocate for DIDs and dissociation therapists. She makes the powerful point that “DID denial” is really “the second abuse” – first the child is brutally abused and suffers severe dissociation, and then, many in the public and not a few shrinks deny that DID even exists. The fact that Vishakha is now a major figure in global education, culture, and business means that her insightful views are deeply respected. Many now see her as a role model for “DID partners.”

So my message is this… The desire for disclosing your DID is totally understandable, and even noble, but the potential dangers are substantial. You need to think out the strategies and consequences in great detail, producing a DID version of what the business community calls “risk analysis”, and what professional athletes call a “game plan.” Without such forethought, it’s particularly difficult to engage in a “partial disclosure”: letting a few more people know, trusting they will keep it private, but this risks a rippling effect if someone breaks your confidence. On the other hand, if you, along with your therapist and current circle of supporters, can create a plan that works for your inner DID system, and for your social and professional situation, then it’s worth considering disclosure.

When thinking about these issues, DIDs and our therapists are fortunate to have a wide array of communication routes, both online and at in-person conferences. One remarkable example is the annual “Healing Together” gathering expertly hosted by an organization with an appropriately-upbeat title – “An Infinite Mind.” I have had the honor of keynoting those conferences several times in recent years and will do so again in February, 2016 in Orlando, Florida. The Healing Together conference offers a wonderful chance to meet with hundreds of other DIDs and therapists, allowing attendees to be who they are without apology or having to hide. The conference offers a rich array of speakers – including several who are coping with dissociation themselves – and ample opportunity to raise whatever questions and viewpoints in a totally confidential environment. Above all, the chance to talk with other DIDs is enormously important, sharing our experiences and escaping the burden of feeling trapped and helpless. It is always helpful when getting ready to walk through a minefield to get advice from those have already traversed it and can point out the dangers.

I pray for the day when DID is universally seen as a treatable disorder, not caused by something you did, not posing threats to others, and deserving sympathy rather than suspicion. Then we can all reveal our disorder without fretting about unintended consequences.

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