David Yeung's Blog, page 7

The Role Of The Significant Other In DID Therapy – Part 1 of 3

The question of whether or not to involve a patient’s Significant Other in treating individuals with DID is sometimes raised by patients, and sometimes raised by their SO (“Significant Other”). From the vantage point of 10 years of retirement after 40 years as a psychotherapist, I believe the real question should be whether it is realistically possible to exclude the SO when treating individuals with DID. If the answer is yes, then the next question is how to evaluate the level of inclusion, which will depend on the individual qualities of both the patient and the SO.

This issue has been on my mind for many years. In traditional psychotherapy, therapy is conducted specifically between the client and the therapist. It is a relationship that is necessarily structured to be private and confidential between two individuals. Why is that structurally necessary? It is critical to engender the sense of safety in a patient so that genuine communication can take place without fear of exposure.

Occasionally, the therapist may deem it appropriate, with the explicit permission or request of the patient, to speak with the client’s significant other. This can be for the purpose of gaining additional information as well as insight into what happens outside the counseling sessions. It may also be for the purposes of assessing the potential support or danger to the patient resulting from the qualities of their SO.

In many cases, the significant other will be able to report symptoms, that the patient does not recognize as a symptom, which may be suggestive of DID or other pathologies, such as poor regulation of mood fluctuations. Signs suggestive of mood swings can be easily ascribed to a diagnosis of Bipolar Affective Disorder. Before I gained experience in the recognition and treatment of DID, I ran into such a situation.

In this patient, I saw what appeared to be a textbook description of hypomania. The patient, who came to see me for depression, presented a mood swing that was so convincing and infectious that I felt carried away with that sense of joy and happiness. I never considered the possibility that I was meeting one of her alters who emerged during that session.

In addition to misidentifying mood fluctuations as Bipolar rather than DID, manipulative styles of rage, meanness, and threats of harm can sometimes be ascribed to Borderline Personality Disorder. This shows the danger in making a diagnosis based on symptoms alone without an appropriate index of suspicion on diagnoses that may include the same or similar symptoms.

While the therapist and the DID client meet in the “therapeutic hour” once a few days or weeks, the client’s significant other will have much more opportunity to meet, knowingly or not, with alters of the DID individual. Alters come out when they feel safe, when they are under stress, or when they are triggered by some environmental cue. Most likely, alters have emerged in front of the significant other during the time they have been together.

The therapist is simply not present outside the therapy sessions, and is likely to miss alters that might appear at specific times during each 24 hours period, such as just before one goes to bed, or in the middle of the night. Often a DID patient’s husband has told me of a young child alter crying in bed at 1 am; clearly an alter emerging as a result of a PTSD flashback. Usually the child would shiver in fear crying, and saying “Please don’t hurt me!” as they mis-identified their spouse as the abuser of their childhood.

Therapists should be cognizant of this possibility, and realize the necessity of preparing the significant other with guidance on how they might respond in that situation. Ignoring the alter is not an appropriate option, while responding in a demeaning short-tempered way will be extremely counterproductive. Because the significant other is much more likely to meet alters in the privacy of the home, I believe that some context needs to be presented, with the permission of the DID patient, in order for the SO to be able to properly support the healing process.

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Some Risks of Hypnosis in DID Therapy

I have wanted to bring up the topic of using hypnosis in psychotherapy for quite some time. I delayed because I was afraid of the topic’s possible negative impact on some readers, but I have decided that the topic remains relevant and of concern.

While I grew to have a strong bias against using psychoactive medications as a primary therapy for DID, I continued to use such medications as an adjunct to psychotherapy. I found that medications, as an adjunct, could support some patients to enable the psychotherapy to assist them in processing their trauma. Perhaps it is possible to use hypnosis in that way.

I know that there are therapists who use hypnotherapy in treating those suffering from trauma and dissociation. My understanding is that some are successful in that treatment. For those that are helped in that way, that is wonderful. Unfortunately, I know psychiatrists who have used hypnosis in therapy inappropriately – to the extreme detriment of their patients. I am sure my bias increased as a result.

I went through my own period of enthusiasm in doing hypnosis. I attended some international workshops and conferences on Hypnosis in Seattle, Berkeley, Banff, and Phoenix. I have no doubt that my knowledge of hypnosis has been useful in my practice.

Even though hypnosis is a poorly understood subject, it is well recognized that about 10% of the general public are highly hypnotizable. Often a person’s expectation and readiness to go into a trance is so strong that all a hypnotist needs is more a matter of confidence rather than skill to put a person in a trance. Once a patient asked me to put her in a trance when I thought she was the worst candidate for hypnosis. I reluctantly obliged. Much to my surprise, she promptly fell into a deep trance. According to all the criteria I knew, she was not a good hypnotisable subject as she was highly critical, defensive, angry and obsessional. I soon realized that it was her willingness and readiness to go into a trance that put her into a deep trance despite those qualities. It had nothing to do with my skill, or lack of skill, in hypnosis.

My decision to stop using hypnosis was entirely a personal one, and is not a view shared by therapists in general. However, I thought it might be worthwhile to share my views and concerns with readers in the DID community.

[1] Dissociation is already a kind of self-hypnosis. All DID individuals I have met seem naturally easy subjects to be put into a trance.

While hyper-vigilance is a handicap, a symptom of PTSD, vigilance remains a necessary protection when navigating the dangers in this world. I wish to once again remind systems who are reading this that while protective alters should be encouraged to dial down their hyper-vigilance as best they can while maintaining their vigilance. I fully expect that some alters are appropriately vigilant in guarding against hypnosis as a protective function.

The fact is that all abusers develop manipulative skills as part of their abusive behaviour. It is no coincidence that abusers use the similarly phrasing when denying abuse to their targets, like “You must have been dreaming.” Part of the problem with hypnosis is that many hypnotists may use similar language, particularly in one technique of hypnotic induction called the “Confusion Technique.” In my opinion, this is a very serious danger to those with DID.

[2] It is easy to hypnotize someone with DID. But knowing what to do after putting someone in a deep trance is something that demands proper psycho-therapeutic training. It is simply not therapeutic to put a person in a trance to remove a symptom – expressed as or through an alter – by the power of hypnosis. That is not therapy. It does nothing to help a patient process their trauma. It is not empowering the patient in reclaiming their life from trauma, rather it is more in the nature of suppression and, therefore, will be likely only a temporary relief and other symptoms.

Knowing what to do for a patient means that it is not necessary to put that patient in a trance. It is wrong for a therapist to first explore the unknown roots of a disorder through hypnosis just because you have not formulated a treatment plan. With DID, hypnotizing a person to find out what they apparently cannot otherwise recall misses the key point: There is likely a very good reason why a given memory is hidden by one part of a system. Do not rush the process of healing by digging up memories. Letting the patient present them in their own time, when they feel safely empowered, actually allows them to heal faster. Why? Because crashing the amnestic barriers the patient has created under the stress of horrific trauma is a recipe for retraumatization – not healing.

[3] Hypnotizing patients further exaggerates the power-hierarchy inherent in the therapist/patient relationship with the dis-empowering nature of the hypnotist/client relationship. All psychotherapy should carry the implicit aim of “empowering” the patient. It is not a surgical relationship where the surgeon operates on the unconscious patient while doing all the work with his/her scalpel. Psychotherapy is only successful when it is a joint, collaborative venture.

[4] Many claim that the hypnotherapist is only enhancing the power of the client to solve his/her own problem. That is a good sound bit but it is not true in practice. Humans, simply speaking, are notoriously prone to corruption when handling power, as in the aphorism, “Absolute power corrupts absolutely.” It is so very easy for a therapist to control the client in a highly passive and suggestible state of mind. Real therapeutic success, therapy that empowers a patient such that they can deal with new stressors in their experience, is based on the patient’s confidence that he/she has gotten better out of their own effort.

[5] In hypnosis, you are rendered completely helpless. It is a myth that under hypnosis you cannot do anything that goes against what you really want. That is a lie. If you are told under hypnosis that the next person you meet who smiles at you is actually someone who is going to hurt your child, it is not too far fetched to think that you will kill him if you are given a gun. In a deep hypnotic trance, you lose your discriminating power. You can then be persuaded to believe what is suggested to you and perform the most irrational things.

These are several of the reasons for my abhorrence against the practice of hypnosis as psychotherapy. It gives the hypnotherapist too much power by taking power from the patient. All successful salespersons and politicians have acquired some skills of hypnosis, some of them don’t even know it. It just comes naturally to them.

Once again, for those that hypnotherapy has helped or is helping, that is wonderful. I am not suggesting you terminate therapy which is proceeding successfully. My biases are about caution. Best wishes.

The post Some Risks of Hypnosis in DID Therapy appeared first on Engaging Multiple Personalities.

Healing is a Path

I have previously posted my view that integration should not be held up as the goal in therapy. This is because the same dissociative pathways used in the past will be accessed once again to deal triggering stresses. I believe it is far more realistic for the therapist to encourage teamwork within a system so that the strengths of different alters, of ongoing grounding exercise strategies, and of developing internal support can come together to help when the system is once again under stress. And, as we know from our own lives, stress of some kind can be encountered with little to no warning any time – whether we are DID or otherwise.

From this point of view, healing means working towards the point where the hyper-vigilance of a DID system is lowered to the level of vigilance. That way, when difficult thoughts come up or stresses/triggers are encountered, one isn’t immediately launched into an uncontrollable flashback. In effect, healing means developing the capacity to navigate life without past trauma overwhelming you in the present moment.

My suggestion is to view healing as a path one travels. Empower yourself by using the tools of empathy and kindness toward all parts of your system, and grounding exercises to ease that path. A good therapist can open the doors to that path and guide you on it, but you are the one that needs to take the actual journey.

While the journey at times may be frightening and difficult, it is worth it. For safety and to avoid re-traumatization, the path begins and continues one step at a time. Best wishes.

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When Your Partner Is DID Too – Part 2 of 2

I have met many DIDs with significant others who are very kind and compassionate, just as I have met many DIDs who are pathologically bonded with significant others who are abusive. Attraction to both those in need of protection and those who are abusive is detailed in Karpman’s model of social drama triangle. It is discussed in Chapter 7 of EMP Volume 1 with respect to Victoria.

It is not uncommon that abusive people are also traumatized people. However, they choose to hurt others because of their own pain rather than process their trauma. Again, the Karpman model can be helpful to understand this. I point this out not because one’s own trauma is an excuse to hurt others, but because it helps clarify some of the dynamics of abusive relationships.

For someone who is abusive, I believe there is always a background of pain and hurt that makes him/her choose a cruel way of hurting others. It is an expression of their failure to process their own pain. It is only in this context that I think it is possible to begin to understand that part within the people who hurt us.

This does NOT mean that you permit such a person to harm you. This does NOT mean that you allow them to be near you if there is even the slightest risk that they might hurt you again. Understanding their context is in no way a reason to participate in any relationship with them.

Returning to the topic of partners who both have experienced early childhood trauma, remain cognizant of the presence of such parts in oneself and in your SO. Simply put, DIDs and DDNOSs need to be vigilant but not hyper-vigilant. This way, there is a gateway to understanding both the positive possibilities and negative risks of engaging with a DID/DDNOS person as your SO.

If this is the choice you make, it is critically important that both individuals engage with their separate therapists, establish on ongoing routine of grounding individually and perhaps together at times, and to pay attention to one’s own and one’s SO’s protectors. That way you set up a framework of self-care that you can tap into should something trigger you or your SO. It is a way to work on being a further support to each other.

Be careful as there are likely many hidden triggers that might provoke a needy, angry, or hurt alter in oneself or your partner. There will always be triggers that you do not know yet that can cause great difficulties. The difficulties can easily arise when two individuals with DID living together. It can happen that an alter may be provoked in one that may clash with or draw out an alter coming out of the other individual.

For example, if one needy and very young child alter in one comes out, it will be difficult for everyone if the alter that comes out from the significant other is an angry alter emerging in response. However, if a mothering and caring alter comes out, then it may be more healing for that engagement rather than conflict.

But another possibility is for both individuals to have alters emerge that are in a needy state. Neither will simply get their needs satisfied. Each may accuse the other as being non-caring or compete with the other which, functionally, would likely push one or the other into a different role in the Karpman triangle – from victim to either abuser or rescuer. This is a place where grounding exercises can begin to be very helpful on the spot.

Again, I want to remind the reader that these thoughts are not based on my experience with this particular set of circumstances but rather my conjectures about the issues raised.

I hope these conjectures from within my retirement are helpful to those with DID and their partners. I think it is also important for practising therapists to consider so that it raises their index of suspicion and concerns when treating patients that are DID or DDNOS – with or without an SO. Best wishes always.

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When Your Partner Is DID Too – Part 1 of 2

I recently received a question from a DID reader of my books and blog. The questions raised, which prompted me to write about this topic, are important.

The first question is critical to consider: “What are the chances of one individual with DID or DDNOS finding out that his/her SO (significant other) also has DID or DDNOS?” I have been unable to locate any studies that have collected such statistics. But, I suspect that this is not all that rare.

Given that I never dealt with this issue in my practice before retirement, please consider my thoughts as just that- my thoughts. They are based on my experience with my patients, not on clinical studies or any direct experience I have had with patients and their partners.

In DDNOS, the dissociated parts do not emerge as quite so solidly self-identified as with DID parts that exhibit executive functioning capability. Whether it be DID or DDNOS, an individual may have parts created through some traumatic past experience that crystallizes into a dissociated part which might be particularly cruel, angry, defensive, sensitive, or recklessly playful.

Given that, why would there be a tendency to bond with someone else who also has had severe early trauma with some resulting dissociative parts within their personality structure, whether DID or DDNOS? First, I think the protectors inside anyone with DID/DDNOS can likely spot another DID/DDNOS individual fairly quickly. Second, it would not surprise me to learn that the protectors within each individual made their own judgments as to just how safe the other individual with DID/DDNOS is likely to be for them.

I don’t think the process is all that different than when a protector assesses a potential therapist. There, the system decides whether or not the therapist might be safe enough to consider exposing one’s inner parts when exploring a possible therapeutic alliance. In circumstances involving potential partners, it would be an assessment about whether or not exposing one’s inner parts would be safe when starting to explore establishing a romantic relationship with the other individual.

Generally speaking, people are attracted to each other by what they find in common. In recognizing a shared common background, we get a surface and sometimes false sense of familiarity or security. For example, if you are travelling in a remote foreign country and happen to bump into a stranger who shares the same background, speaks the same dialect, or, for that matter, grew up in the same district in your city, there will be a tentative sense of security.

You assume a lot about this stranger because of that common experience. Your assumptions may be true. It also may be that this stranger preys on people by using that apparent familiarity and surface sense of security to bypass your normal protective instincts. Hence, my caution to those with DID about the importance of maintaining vigilance, as one dials down hyper-vigilance, and paying attention to warnings from protectors.

A common background of DID persons is their traumatic early childhood experience that led to their dissociative tendencies. They may also share sensitivity and empathy toward children facing adverse conditions. Following the logic of that internal experience of surface security and familiarity, we may be attracted to our SO because our common ground creates the sense that we are close to one another, that we understand one another in an otherwise unfriendly world. If you think about how important empathy is in healing, then it makes quite a bit of sense that you might gravitate towards another DID individual.

On the other hand, a DID can also meet and bond with the wrong partner, an abuser, for parallel reasons. This can happen when an alter inside fits their experience as a victim to match someone who fits their experience as an abuser. If both sides of a couple have a traumatic background, one victim part may meet up with the other’s abuser part to form a pathological bond. This is why an individual with DID is so at risk of being lured back to his/her abuser – whether it be the actual abuser or a new abuser with similar patterns of abusive behaviour.

Ruth, discussed in Chapter 5 of Volume 1 of Engaging Multiple Personalities, experienced that while she was in therapy. She packed up her children and drove about 100 miles to go back to “the lover” who was actually her abuser. She was rescued by a protector alter that took control at that point in the drive. The protector made sure she turned the car around and went home to safety.

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Suggestions on How to Read DID Memoirs

The several volumes of Engaging Multiple Personalities, 4 to date, are not DID memoirs. Rather, they are based on my experience as a psychiatrist treating patients with DID. In other words, I discuss in those Volumes the personal experiences of my patients as I understand them. This is fundamentally different than how those patients experience(d) their own DID; before, during our time working together, and sometimes afterwards in their journeys of healing.

At this point, there are many memoirs written by those with DID. I have had the honor of meeting a few of those people. I have read some memoirs, and more are being published each year. I believe this is a direct outgrowth and benefit of the internet’s ability to facilitate communities of support, communities of people dealing with the same struggles.

DID memoirs enable authors to further process some of their own journeys. At the same time, they can offer a helping hand to others with DID dealing with their own traumas. The more guideposts that are illuminated through the writings of those with DID – showing options, obstacles, and hope in healing – the more confidence is engendered throughout the DID community that healing is possible.

For me, the point of the memoirs is not to detail the despicable acts of cruelty that resulted in DID. Rather, it is that despite the early childhood traums, survivors have navigated their way toward healing. Publishing memoirs can also extend warmth and support to others with DID on their own healing journeys. In reading memoirs, there can be a tremendous sense of support from knowing that you are not alone in this. Healing can be an arduous task, and usually is a long winding journey. That sense of support that can be found in memoirs can engender hope, which is critical when one feels discouraged.

In each of the Engaging Multiple Personalities Volumes, I placed warnings to caution readers. Those warnings encourage readers who have a personal history of trauma to read them in a place of safety, in short doses, and to take steps necessary to avoid the re-traumatization that can occur when reading this kind of material. That very same advice is just as important when reading DID memoirs, perhaps even more so because the authors of DID memoirs directly experienced that same level of cruelty.

A therapist with skill and great empathy can, at best, approach a genuine understanding of the trauma with the concurrent risk of the therapist experiencing vicarious trauma as a result. But, that is still an understanding, not an experience. A patient can describe an experience using words, images and/or emotional body language, which is incredible important for the therapist to be able to help. But again, the therapist is still understanding the experience from the outside. It is not understanding the experience by having lived it.

For example, going into combat as a soldier involves a lot of ideas about what might happen, how it will feel, and how one might react. That is different than what actually happens when the bullets are flying, bombs are exploding.

When the reality of war is compressed into that very moment of direct experience, it is undeniable as you live it. It is not a guess, an idea, or an “understanding.” After the fact of the experience, your mind takes whatever protective measures it deems necessary to process the experience. For many, those measures manifest as PTSD.

It is my hope that psychiatrists and other therapists appreciate that early childhood trauma is indeed a battle in which a very young person, with little to no other defense mechanisms, may dissociate as a protective measure. With that understanding, compassion and empathy can expand. For those therapists with compassion and empathy who avoid DID patients, reasoning that they have no experience treating DID, it may be extremely helpful to read memoirs, whether they be by an individual, such as “A Fractured Mind” by Robert Oxnam or a collection from DID individuals, such as “Multiple Personality Disorder From The Inside Out.”

For those with DID reading DID memoirs, take care, stay safe, read in small doses in a protected space, and know that while everyone’s trauma experience has its own qualities, the overwhelming aspect of the trauma is something all those with DID share in common. Take heart in the bravery of others who have walked the path of healing before you and are sharing their memories to support and enable you to do the same. Best wishes always.

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Coping With Anxiety in the Pandemic

Since SARS visited Hong Kong in 2003, the world has had warning visits of Ebola, Swine Flu, Avian Flu and MERS-CoV.  Now, the pandemic of COVID-19 is upon us. We have been watching it grow rapidly in China and aboard the Diamond Princess cruise ship. It has spread rapidly in Italy, Spain, South Korea, and is now severely threatening the US, Canada, and many other countries.  Political leaders around the globe have reacted with varying degrees of alertness. We have witnessed country dependent degrees of control over its spread and growth.

As individuals, how do we handle the fear and anxiety we face with this viral threat? The question of dealing with fear and anxiety is one that is always present for those with DID. But now, we need to understand that just as individual trauma is processed individually, it can also happen in a society or, as now, sometimes on a global scale.

In general, fear has a protective function.. Within the context of DID, fear about survival triggers the dissociative experience in a young child. Epidemiologists are characterizing this virus as a survival issue for many people, economists are characterizing it as a survival issue for commerce.

It is fear that is motivating us as a society to adopt drastic measures such as school and factory closures, the cancellation of public gatherings, cruise ship trips, unnecessary vacation flights, and even restaurant dining. These measures will curb the growth and spread of the viral infection. This is an example of vigilance heightened appropriate to the threat.

What is left is handling panic or the excessive fear. This not unfamiliar to those accustomed to working with trauma and PTSD.  One point that is emphasized in the Engaging Multiple Personality series is the need to slowly transform hair-trigger hyper-vigilance into ordinary protective vigilance. I always point out that we must maintain vigilance, not eliminate it. Why? Because there are dangers in the world and we need to remain alert.

However, the opposite of hyper-vigilance is also on display in this pandemic. There are countries where leader(s) have ignored science and discouraged vigilance (hyper or otherwise) against all apparent facts. We see news reports of some young people in particular that are affirmatively ignoring and denying the social distancing recommendations. They put themselves at risk because they do not believe it is a danger for them that outweighs their need to some immediate gratification – like Spring Break.

So let’s stay appropriately vigilant. In that light, I would like to focus on the following points as a guideline in facing this Corona virus Crisis.

[1]   Be informed of what you fear.  For most people, COVID-19 infection presents from an asymptomatic state to mild symptoms similar to a cold or flu.  Some complain of a dry cough, abdominal discomfort, and breathing difficulty.   Only a small percentage of those infected may need special care in a hospital setting; for intubation, oxygen in “equipped beds” and so forth.

[2]  You have a responsibility of protecting others if you are sick. If you suspect you have COVID-19, don’t go to your doctor and potentially infected everyone in the waiting room. Instead, call the hospital for help and let them know you may have the viral infection. Note that several sitting US Senators self-isolated immediately upon suspicion of the virus while one who is actually a doctor was tested because of his high personal risk exposure. He continued to interact with colleagues for days without telling them he was a potential asymptomatic carrier. He was indeed infected. Again, an example of an inappropriate lack of vigilance putting a wide circle of people at risk.

[3]  Frequent hand washing is most important as well as avoiding touching door knobs and door handles with your uncovered hand.  Wear disposable gloves or have a tissue/napkin to cover your hand when touching one of those surfaces. Wear face masks if you feel any symptom and avoid touching your own face as a general rule. In person, keep social distancing. Better yet, maintain physical isolation if possible but make sure to connect socially through the phone and/or internet so as to avoid emotional isolation.

[4] Having put 1-3 into practice, pay attention the psychological aspect of coping with the stress. Do grounding exercises throughout the day. Preferably start the exercises before you panic so that when anxiety erupts you are already habituated to grounding yourself. It is a good practice to do them when you get up in the morning, perhaps once mid-day, and before going to sleep at night.

The following is my very personal view of the pandemic, so please take it with as many grains of salt as you think appropriate…

In the 14th Century, the plague killed one third of the population of Europe.  Despite subsequent medical advances, the plague has recurred many times since then. The last time that I am aware of was in October 2017 when it hit Madagascar and killed 170 people. Ebola had been hitting certain African states regularly. In modern times, we have had repeated corona virus infections of different varieties that we have hardly any means of control.

These epidemics regularly hit different parts of the world. We generally don’t hear about them because we (and our local media) tend to ignore them when they do not impact us directly. We usually have other bad news to worry about, such as fighting in Afghanistan, Iraq, Syria, Yemen and elsewhere.

I do not blame God or any extra-natural sources. It doesn’t seem helpful to me. As humans, we must learn to survive in an increasing complicated world. This has been the story of humanity throughout our history. A key to what is helpful is learning to appreciate that we are all interdependent. We have a long way to go to reach a world of peace and accord. Perhaps we can use this as an opportunity to move further toward that goal.

Life comes with needing to accept the fact there are periods of adversity and to work with them. For some experiences of adversity, we can learn to face them with insight, compassion for ourselves and others, and eventually with some equanimity. Indeed, it is time for us to rethink our place in the world and the universe. This is an opportunity for each of us, certainly for me, to question why are we here, what is our purpose today.

It goes back to the question I faced when beginning my retirement, what is the reason for me to get up in the morning? The answer began to dawn when going through my patient files as part of closing up my psychiatric practice. It seemed that my DID patients had gone through such profound trauma and taught me so much. It was difficult to be retired, unable to help any more. I began to try to organize my thoughts, which resulted in the Engaging Multiple Personality Series and blog posts.

I believe these writings have been helpful to many people, at least as indicated by emails and Facebook comments I have received from those with DID and their spouses/partners as well as sometimes psychiatrists and other therapists. In this way, the DID community has helped me process the vicarious trauma I experienced listening and trying to assist my patients. It continues to heal my heart.

I offer a quotation from Rabindranath Tagore which I have found inspiring:

“I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy.”

In my retirement, and in this COVID-19 crisis, I am seeking to make contact with some people I know who might benefit from a warm phone call, one that might penetrate their loneliness and isolation. I read books that I have always wanted to read but never before had time. I listen to music that nourishes me. I try keep my body active and supple, to prevent waking up with pain all over my stiff body. I also do my one-breath-meditation and walking meditation. This is the least I can do to be kind to myself. I also write my blog articles when the circumstances and spirit moves me.

With best wishes for your healing and strength.

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Public Virtue and Private Abuse – Part 2 of 2

Virtually any human being is capable of great deeds of kindness as well as of evil deeds. The decision to do something virtuous or to do something immoral often happens in a split-second. This is obvious when considering the profound power of peer pressure when a situation presents itself, whether in the context of bullying at school, assisting the murder of countless people in concentration camps, or torturing an animal. It is not easy to resist the group momentum that seeks to carry you along with it. It is also obvious when considering the profound power and opportunity one may have in private over people in thrall to you.

The exertion of one’s own internal moral authority to overcome such group or internal pressure is difficult, whether one is Gandhi, Martin Luther King, or anyone else willing to lay down his life in the service of protecting the most vulnerable in society. It is extraordinarily difficult for those of us who have not the spiritual strength and discipline to contest such overwhelming pressure and opportunity. Vanier clearly failed to stand up to the seduction of his power in private.

It is human nature that we can do either moral and immoral acts at any moment in our lives. It is not incompatible that one person can do both in their lives. Because our minds are not always stable, each opportunity brings that same choice to us. The important point is that we can also make the decision, again and again, to commit virtuous acts.

We humans are social creatures. That enables us to accommodate unacceptable behavior which to others or even to ourselves later on, is called rationalization. When we are tempted to commit a transgression of either society’s or our own morals, we all can readily make up a reason to allow us to do so. A famous American public figure once said that he did “it”, an immoral act, simply because it could be done.

I am not making excuses for anyone to commit immoral acts. Rather, I want to discourage cynicism and encourage hope. But it is important to acknowledge that our so-called power of reasoning is often weak and easily influenced by our own as well as other’s strong emotions.

Many of us, in a moment of impulsivity, step on the gas just to experience the sensation of going way over the speed limit. We think that we are unlikely to be caught, that no one will ever know, that it is not really going to hurt anyone, and so on.

With sexual transgressions, the rationalization is usually that “this is a special relationship, one that is high and above the usual mundane worldly liaison.” People can delude themselves that this relationship is special and sublime, that no one is hurt, that it is intensely satisfactory to both parties concerned and that the other person will be ok with it because it is intensely satisfying to me. The bigger picture, including the risks and potential/likely terrible consequences is ignored.

Once this borderline of deluded rationalization is crossed, the second incident begins the habit of thinking that this can be done without a problem. Even the questioning of why or why not becomes weaker. Sexual offenders almost never do it just once. Having experienced violating someone without penalty, with the second and third time the conduct becomes a habit – the beginning of.an entrenched pattern.

In most cases involving sexual transgression, the act is almost always predicated on a power differential between the parties. The perpetrator is usually of a higher social status and in a position of power. In the intimacy of therapy or spiritual counseling, it is easy to fall victim to the higher social status of the therapist, counselor or religious figure because they are bestowed in those dynamics with the seemingly magical power of a superior being, just as it is in child sexual abuse.

The perpetrator is always aware of this power differential. It feeds into his ego. In any moment, one can lose sight of and fall under the sway of pride, of greed. One gravitates toward the satisfaction of being admired and the possibility of sexual gratification. One can deludes oneself with the rationalization that this time it is the rare experience of true love, a genuine meeting of souls. One ignores the fact that the rationalization is a delusion.

It is hard to be a saint in any public sphere. It is hard to resist the temptation of seeking confirmation of one’s power and/or gratification of one’s sexual desire in a private sphere. It is difficult to resist the temptation of a great sensual (sexual) experience in a life full of stresses and loneliness.

Most people are not able to let go of the cravings of the ego for sensual experiences. Take for instance, a friend of mine who has such strong craving for good food, that he would go to one restaurant for its soup, to another for its orange duck main course, and to a third for its dessert of Tiramisu. No kidding!

Giving in to this kind of craving, played out by choosing this or that item in different particular restaurants is completely different from giving in to a craving that leads to abuse. Moving between restaurants does not involve the traumatization of anyone, so there is no harm. This is a qualitatively different gratification of desire. But other gratification actions may result in severe traumatization of another individual. That is what defines for me what is acceptable and what is not.

My conclusion is that good people are capable of immoral acts just as bad people are capable of kind acts. We should well remember that according to the great book that serves as the foundation of the 3 principal monotheistic religions of Islam, Judaism and Christianity, God’s chosen heroes were all imperfect specimens. Abraham, was despicable in that he offered his wife Sarah to the Pharaoh to save his own skin. King David coveted Bathsheba so much that he would send her husband to be killed in battle so that he could have her. Lot offered his daughters to be raped before they escaped from Sodom

It is unrealistic to separate people into all good and all bad. In short, we should hesitate to give anyone a blanket of “certificate of righteousness.” Human beings are potentially good and potentially bad. Let us first examine each of our own opportunities, as they arise, to be virtuous and kind then act appropriately.

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Public Virtue and Private Abuse – Part 1 of 2

In recent years we have encountered news reports of famous, well respected individuals being exposed as having a dark side in their lives; very dark side of sexually abusing women or children. Famous philanthropists, spiritual leaders, musical conductors, and people of great wealth have been credibly accused, and now fortunately some of whom are being convicted, of utilizing their position to exploit people under their influence. The list does not exclude psychiatrists, therapists, or healers – professional or otherwise.

We presume that those we revere conduct themselves in accord with high moral standards both in public and private. We then feel betrayed and at a loss to understand their (formerly) hidden heinous conduct that has now been exposed.

I am writing this as part of my personal response to the case of Jean Vanier. His life’s work inspired many people, including me, in their attitude and service towards the mentally challenged. But Vanier, always characterized during his life as a devout Catholic, had “manipulative and emotionally abusive” sexual relationships with six women in France, between 1970 and 2005. This is according to a statement by L’Arche International, the organization he founded that did and does so much to benefit the mentally challenged. https://www.bbc.com/news/world-51596516

While I truly hope the recent charges that surfaced after his death does not harm the work of the L’Arche International, I have no doubt that it will. Here was a man who for all intents and purposes was an extremely good person in public but whose dark side was kept hidden as he violated women in private.

It is important to remember that his conduct did not just the harm the women he abused. He knew or should have known that it would be revealed at some point and, as a result, that it would definitely harm the work of L’Arche. He put his own self-interests ahead of his care for the marginalized group that was the foundation for the power/charisma that he then abused.

There is a painful and extreme cognitive dissonance for me. I followed his public career with joy as he helped a very marginalized community. But the characterization of Vanier as a “devout Catholic” doesn’t compute with the abuse charges confirmed by his own organization. I feel betrayed both by his public persona and by myself in my presumption that his public deeds were in keeping with what I imagined were his private morals.

In trying to make sense of this, I thought about when I watched Cowboy movies as a young child. The first thing I did was try to identify who were the good guys and who were the bad guys. Until I did that, I couldn’t settle in to watch the movie.

Just like me, most young children are told that people are clearly divided into good and bad. This is simply not true. In the real world, that presumption is not useful in navigating one’s way because people are almost never 100% good nor 100% bad. There is no clear line of demarcation separating them.

For a child, it is their parent(s) that are responsible for protecting them from the bad people and bad circumstances that one encounters in life until they are old enough to have learned how to navigate this world of moral grays for themselves. For a very young child, they cannot possibly navigate the world unaided. For a child being abused by someone who others presume are indeed protecting that child, the level of betrayal is incredibly more horrific – as detailed in the work of Dr. Jennifer Freyd.

For such abused children, it is no surprise that abusers often appear to other adults as ordinary decent individuals while behind closed doors they are the exact opposite. A young child keys off of the attitude of other adults toward their abuser, and so are often unable to understand what is safe, what is normal, and what is simply evil. But children try to bond with their primary caregiver, no matter the conduct of that caregiver, because that bonding to the primary caregiver is a biological imperative.

This episode of Jean Vanier is a painful opportunity for me; a very small echo of the betrayal experienced by an abused child. It remains only a very small echo because Vanier was not responsible for me: I never met him. He did nothing to me personally but it is an echo of sorts because I do feel deeply betrayed.

At the same time, it confirms the advice I gave my patients when I was practicing psychiatry 1) to never ignore the messages from internal system protectors; 2) to be very careful when engaging with anyone those protectors caution about; and 3) to completely avoid anyone those protectors are going full red alert about. In particular, I recommend re-reading my posts on the issue of forgiveness: https://www.engagingmultiples.com/meaning-forgiveness-part-1/

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Using a Card for Communication

I received an inquiry from a DID FB group participant asking if I could suggest a card that might be carried by someone with DID. The idea is that it could be used to explain what they needed when dealing with a difficult public situation, like waiting too long in a doctor’s crowded office. In short, something that could be used in that kind of situation to let whoever you are dealing with know what you need without having to explain in detail.

The analogy that came to mind was the cards some deaf individuals use to alert people that they are deaf and so lip read or use sign language to communicate. For those who are deaf, it is something along the lines of “I speak in sign language. If you don’t, in order to help with communication, I also read lips so please look directly at me and speak normally.” This alerts others that there is an issue in communication for which there is a simple clear solution.

Here, we are talking about a communication card to do the same thing for those with trauma issues in public situations. The card language I suggest below identifies the issue, which is anxiety and panic, and the solution. It is not necessary to identify oneself as having DID or other dissociative disorders. (I have cautioned in other blog posts concerning the risks involved in that.) In any event, your DID diagnosis is more information than is needed in most ordinary interactions, like at a doctor’s office or for a meeting at a government agency administration office.

Perhaps something like:

“I have a problem with anxiety and panic. It can be triggered by being in a crowded or enclosed space as well as having to wait for appointments too lon g , even in a comfortable waiting room . If I have to wait in this room for longer than 1 5 minutes, it will be difficult for me . It is easier for me to slowly walk around the block while waiting . I will not be more than 10 minutes away. Please call me on my cellphone:  ____________ with a 15 minute warning and I will return immediately. Thank you for your understanding .”

Keeping it short (this will fit on a business card) and simple, avoids the need for detailed explanations. Most questions in those kinds of social situations begin with asking for identification information. I would not have that information on this card – just your cellphone. I suggest you have your driver’s license and Social security information separately ready to hand to a receptionist, for example, as needed. This again limits the need for you to speak if you are worried about being triggered in that environment.

Keep your verbal responses to a simple yes or no. Perhaps have a pad and pen if it is easier to write a short answer rather than speak out loud. This is the kind of accommodation that is made for many difficulties. Once you identify yourself as having an anxiety problem, I think it unlikely that people will suddenly conclude that you have DID and proceed based on their confused understanding of dissociative disorders.

The general public is well aware of anxiety issues and the idea of a panic attack. This may be a way to meet them where they are comfortable, in their understanding of anxiety, so that they can help you feel safe navigating the situation.

I never thought to suggest this to my DID patients when I was practicing psychiatry. In retrospect, I likely would have suggested it as something to try. I am happy to say that I continue to learn from the DID community. I hope this is helpful. If other members of the DID community have further suggestions, or perhaps better language, please do share that.

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