In her book about living with schizophrenia, The Center Cannot Hold, Elyn R. Saks speaks of how her psychosis served to protect her from painful thoughts and feelings, how the unconscious mind served as a defender of the conscious mind even in psychosis, and the truth of that reverberated as I recalled how my alters protected me in my dissociative disorder.
Many points in her story struck home for me, as may be true for anyone living with any mental illness, as well as for anyone who is different. Hers is not just a story for schizophrenics, although it is certainly that. Most mental illnesses have areas of overlap, just as Elyn Saks says. For me, my denial of dissociative disorder was a prolonged, steady denial, even when I’d befriended my alters and no longer feared them—I still denied my experience. I hid it from everyone and assumed, as Elyn Saks did with schizophrenia, that others were simply more skillful at managing all that “normal” phenomena.
PTSD was comorbid with my dissociative disorder. My PTSD flashbacks are massively disorganizing. I feel that I am shattering and being destroyed when I’m in a flashback: I feel like I’m breaking apart. The important part of this understanding is how my alters have tried to protect me. In the past, one highly protective alter slit my wrist and said she would keep slashing to stop me from slipping further into the disintegration of my flashback. It may seem counterintuitive to others, but she was organizing me, protecting me.
Another commonality with Elyn Saks’ story, along with denial and unconscious protection, has been my repeated rejection of medication, my need to be my “authentic” self, un-medicated. The one prescription I have allowed is an off-label anti-seizure medication that helps subdue and stop flashbacks of PTSD. I periodically and predictably attempt to wean off of this with varying degrees of success, always finding I need to resume it. I tell myself I should be integrated enough to stop taking it, yet integration isn’t the issue with residual PTSD. Every night when I take those pills, I feel a sense of defeat, as well as the nagging question of whether my dissociative disorder could relapse if I had another overwhelming trauma, even though it’s been three years since the last traumatic break-through of alters.
It was enlightening to learn of the efficacy of psychoanalysis in schizophrenia. Having read a few other personal accounts of schizophrenia, I had not learned this before, yet it was clearly of vital importance for Elyn Saks. I haven’t read many personal “success stories” of dissociative disorder, either. I’ve read of misdiagnosed and wrongly medicated DID patients, which complicated care. I’ve read second and third person accounts, but very few first person accounts, except my own. Other personal accounts contribute to the confusion, except from the ISSTD, the International Society for the Study of Trauma and Dissociation. Their work confirms what I know, (what Elyn Saks also seems to know): the only thing that truly works therapeutically is the relationship between the client and the therapist.
I had over a decade of consistent talk therapy with a therapist who understood me and treated me with respect. Just as Elyn Saks recounts, my therapist did not recoil from me, he stood his ground when I was at my most frightening. He knew better than anyone how I repeatedly abandoned and isolated myself when I was terrorized. He promised to protect me, to never leave. His steady, calm presence held me together.
Isolation is another commonality in our stories, along with the protective nature of our disorders, our denial, our resistance to medication, and the healing properties of long term talk therapy. Sometimes I think my self-isolation is just the nature of dissociative conditions, all the habits of a lifetime. Other times I’m think I isolate myself because I’m so different from everyone else. The truth is that when I feel threatened I have no memory of anyone else around me, they no longer exist—I know I’m alone.
When I attend a NAMI family-to-family group, I do so as a family member, not as the identified mental patient. But I identify from every perspective; I understand terror, I understand the need for autonomy, I understand the family’s helplessness. I understand.
It all silences me, a danger signal sometimes. If I speak up, will someone try to hurt me?