To dissociate means to detach, separate, disconnect. A person with a dissociative disorder experiences a disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity. Symptoms range from amnesia to alternate identities, or alters.
Dissociative disorder used to be known as Multiple Personality and that’s how many people still think of it. When I thought about it at all, it frightened me, it seemed very foreign, this happens to others, not to me, and I was phobic of my own alternate identities.
Fully one percent[i] of the general population has dissociative identity disorder, or DID. In cities the size of Portland, Oregon or Louisville, Kentucky, with populations over 600,000, that means that 6,000 people have DID, but many, if not most, are misdiagnosed or untreated. Dissociative conditions are frequently complicated by two or more concurrent diagnoses, such as anxiety disorder, panic disorder, depression, eating disorder, PTSD, and others, and diagnosis is often difficult. While all trauma does not cause dissociation, all dissociative identity disorders have trauma[ii] in their early histories. Disorganized early caregiver attachment style is an even better predictor of DID than trauma[iii]. And DID is treatable.
When I dissociated I sometimes just “went away” or spaced out unpredictably, and sometimes alternate identities took over for me, which I tried to overlook. I didn’t think of my alters as dissociated identities because I dissociated that thought as well. Essentially, I dissociated from my dissociation.
I had five primary alternate identities that I’d created to protect me when I was a very young child, and I did not accept their existence until I was an adult and they burst into my life. They “burst into my life” because I lacked the body-regulation skills controlled by the brain’s medial prefrontal cortex and insula that are customarily learned in secure attachment[iv] with a mother or other caregiver. I experienced what is meant by “the back-brain hijacking the front-brain.” Trauma is a back-brain process.
The experiential realization that “I am not who I thought I was” is one that most of us have acknowledged to a lesser or greater degree sometime in our lives. When I was faced with the probability and then the certainty of my dissociative disorder, I was alarmed at what I understood was a major psychiatric disorder, a craziness I hadn’t suspected in myself, who is this? and I predictably fled inside myself—I dissociated.
I have been gratified in my reading to learn that other patients also met their lived-in diagnoses with skepticism and disbelief. As my own alternate identities spoke up and relived memories in my body that were unknown to me, I protested that I must be making it all up somehow, that they could not be real; I must be wrong. That is a common response to finding alters in one’s life. My protest was typical and so was my effort to hide my internal voices and my “Parts,” as I called my alters.
There are ongoing studies that have established the validity and reliability of DID;[v] that dissociation can always be traced to early trauma; and that the only thing we know that truly works therapeutically is the relationship between the client and the therapist.
Early maternal attachment and the practice of mindfulness are both controlled from the same place in the brain, the medial prefrontal cortex[vi], to regulate our bodies, attune our communication, our response flexibility, internal and external awareness, empathy, insight and fear modulation.
Extreme emotional pain and inner conflicts are frequently triggered in traumatized, insecurely attached individuals when they meditate[vii], until they develop the emotional tolerance to handle complex feelings and emotional fear and terror. In therapy, I had to build up my medial prefrontal cortex, my “meditation muscles.” I had to find my way into all the encoded implicit memory laid down in high adrenalin states, safely, with an engaged therapist who tracked my small, small steps, who understood that exquisite pacing, that slower was faster. The same skills that would allow me to find a stable mindfulness practice would allow me to resolve old trauma and eventually, to integrate my split-off Parts. Christine Forner’s recent book, Dissociation, Mindfulness, and Creative Meditations: Trauma-Informed Practices to Facilitate Growth, explores this work. (Routledge, 2017).
David A. Treleaven’s, Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing is also highly recommended. (WW Norton & Company, 2018).
Most of the stigma of disclosing DID is related to mental illness. Some of the stigma is related to speaking openly of the early childhood neglect, abuse and incest that is often associated with developmental trauma. Most abused and neglected children never come to the attention of government or social service authorities.
I have been warned, and I’ve seen first-hand how some people expect a Jekyll and Hyde spectacle when they learn of my dissociative disorder, as if I weren’t any longer the very compartmentalized person they’ve always known. But of course, we need to bring DID out in the open, we need to address the national conversation about sexual abuse survivors and traumatic memory, and we need to demonstrate the reality of healing and integration.
[i] Martin J. Dorahy, et al. “Dissociative identity disorder: An empirical overview.” Australian & New Zealand Journal of Psychiatry. 48(5) (2014): 402-417.
[ii] Constance J. Dalenburg, et al. “Evaluation of the Evidence for the Trauma and Fantasy Models of Dissociation.” Psych. Bulletin. 138, no. 3 (May, 2012): 550-588.
[iii] Karlen Lyons-Ruth, “Dissociation and the Parent-Infant Dialogue: a Longitudinal Perspective From Attachment Research,” J Am Psychoanal Assoc. 51, no. 3 (Sept. 2003): 883-911.
[iv] Bessel van der Kolk, “Developmental Trauma Disorder,” (2005) Psychiatric Annals; Psychology Module 35 no. 5 (2005): 401.
[v] Dorahy, et al., “Dissociative identity disorder,” 402-417.
[vi] Marion F. Solomon and Daniel J. Siegel, Eds., Healing Trauma: attachment, mind, body, and brain. New York: WW Norton & Company, 2003.
[vii] John Briere, “Mindfulness, Insight, and Trauma Therapy,” in Mindfulness and Psychotherapy, ed. Christopher K. Germer et al. (New York: Guilford, 2013), 208-24.
While I was seeing Dr. L, I was also reading everything I could find about dissociation. I wanted to know how “crazy” I was, and alternately, to find evidence that it wasn’t true, that I wasn’t dissociative, maybe I was just very imaginative. The scaffolding of my bibliotherapy is included here, the academic as well as the mindfulness component. In the end, all my reading helped reduce my shame and opened my eyes to the possibility that I wasn’t to blame for what terrorized my child self.
Some of the following is excerpted from end-pages of YOU WILL NEVER BE NORMAL:
Children who stand up to powerful elders who abuse them, particularly when their abusers are their protectors, risk the loss of all they know and all they are. It feels life-threatening, like life will end if they lose their connections to their abusers. Having had the unconscious wherewithal to create alternate “Parts” still fills me with awe; the human mind is breathtaking and I remain staggered by the creativity and practicality of that solution. All the necessary conditions fell into place for me, including a family propensity for denial and dissociation. I thought my childhood was happy, but I couldn’t remember much of my childhood. Ignorance is bliss when survival is at stake. My ignorance bought me time to grow up less disturbed. My distress was far away from me until dissociation interfered with my life many years later.
I cannot imagine raising awareness to such a level that any young child would defy or choose to tell what would result in the extinction of parental attachment. The first best solution to child abuse is prevention. After that, solutions to child abuse can be effectively pursued by adults who work with the wounded among us, children and their adults.
I am convinced that it’s not trauma alone that traumatizes—it’s having no one who is interested or cares about you afterward, that’s what’s especially traumatizing. The therapeutic relationship that unfolded between Dr. L. and me over many years was profound, an integral aspect of piercing my defenses, and it’s a joy to read in You Will Never Be Normal.
The following organizations are excellent resources:
- International Society for the Study of Trauma and Dissociation: ISST-D seeks to advance clinical, scientific, and societal understanding about the prevalence and consequences of chronic trauma and dissociation. It publishes a journal and an online newsletter and presents an annual conference.
- Sidran Institute: Sidran Institute, Traumatic Stress Education and Advocacy, offers resources for survivors, supporters and professionals. Its philosophy of education through collaboration brings great minds together to address the practical, emotional, spiritual and medical needs of trauma survivors. It offers many written resources for survivors and therapists.
- Darkness to light: End child abuse. The five steps to protect our children and the Partners in Protection program.
- Rape, Abuse and Incest National Network: RAINN. The nation’s largest anti-sexual assault organization.
- Erin’s Law: requires that all public schools in each state implement a prevention-oriented child sexual abuse program.
A few books referred to or cited in my bibliotherapy:
- Awakening the dreamer: Clinical journeys. New Jersey: Analytic Press, 2006.
- Standing in the spaces: Essays on clinical process, trauma, and dissociation. New Jersey: Analytic Press, 1998.
- The shadow of the tsunami: and the growth of the relational mind. New York: Routledge, 2011.
- The Wisdom of No Escape. Boston: Shambhala Publications, 1991.
- When Things Fall Apart. Boston: Shambhala Publications, 1997.
- The Places That Scare You. Boston: Shambhala Publications, 2001.
Chu, James A.
- Rebuilding Shattered Lives. Wiley & Sons, 1998.
Courtois, Christine A.
- Healing the Incest Wound. WW Norton & Company, 1988.
Courtois, Christine A. and Ford, Julian D.
- Treating Complex Traumatic Stress Disorders. New York and London: The Guilford Press, 2009.
- Thoughts Without a Thinker. Basic Books, 1995.
- Going to Pieces Without Falling Apart. New York: Broadway Books, 1998.
- Going on Being. New York: Broadway Books, 2001.
Fosha, Diana, Siegel, Daniel J, and Solomon, Marion F.
- The Healing Power of Emotion. WW Norton & Company, 2009.
- Betrayal Trauma. Harvard University Press, Cambridge, MA, 1996.
Freyd, Jennifer and Birrell, Pamela
- Blind to Betrayal. New Jersey: Wiley & Sons, 2013.
• The Experience of Insight. Boston: Shambhala Publications, 1976.
- In Search of the Lost Mother of Infancy. New Jersey: Jason Aronson Inc., 1994.
- Working the Organizing Experience. New Jersey: Jason Aronson Inc., 1994.
- The Search for the Secure Base. Hove and New York: Brunner-Routledge, 2001.
- A Gradual Awakening. New York: Anchor Books, 1979.
- Guided Meditations, Explorations and Healings. New York: Anchor Books, 1991.
Levine, Stephen and Ondrea
- Who Dies? New York: Anchor Books, 1982.
Messler Davies, Jody, and Frawley, Mary Gail
- Treating the Adult Survivor of Childhood Sexual Abuse. Basic Books, 1994.
Napier, Nancy J.
- Getting Through the Day. WW Norton & Company, 1993.
- Dissociative identity disorder. Current Psychosis and Therapeutics Reports (September 2006) 4(3); 112-116.
Saks, Elyn R. and Behnke, Stephen H.
- Jekyll on trial: Multiple Personality Disorder & Criminal Law. New York: New York University Press, 1997.
- Affect Regulation and the Origin of the Self. Lawrence Erlbaum Associates,1994.
- Affect Dysregulation and Disorders of the Self. WW Norton & Company, 2003.
- Affect Regulation and Repair of the Self. WW Norton & Company, 2003.
- Attachment, Trauma and Multiplicity. London and New York: Routledge, 2002.
Solomon, Marion F. and Siegel, Daniel J.
- Healing Trauma. WW Norton & Company, 2003. Plus notes from conferences and Journals.
Ulman, Richard B. and Brothers, Doris
- The Shattered Self. New Jersey: The Analytic Press, 1988.
Van der Hart, Onno, Nijenhuis, Ellert R.S., and Steele, Kathy.
- The Haunted Self. WW Norton & Company, 2006.
Van der Kolk, Bessel
- Traumatic Stress: the Effects of Overwhelming Experience on Mind, Body, and Society. New York: The Guilford Press, 2006. Plus notes from conferences and Journals.