Disorder or Injury?

| By Paul | | Comments (24)

Over a year ago, I began writing here, and trying to come to terms with, what dissociative identity disorder means, see related posts below. I have talked about the reality of dissociative identities. I have also talked about survivors being careful not to think it only means specialness, about there being a time and a place for using the dissociative language, and about personal responsibility.

In Dissociative Identities and Healing, I wrote that holding onto dual views of dissociation, both being an ingenious coping strategy as a child and a disorder as an adult, is a necessary step in healing. My case was simple: that one will not be motivated to change unless he or she sees that what has helped in the past is hurting in the present. I still stand by that basic stance.

However, I would like to shed some new light on that view. Sure, one can say that dissociative identity disorder (or any of the dissociative disorders) or post-traumatic stress disorder (PTSD) are indeed disorders, a term that is used synonymously with mental illness and disease.

But, I offer a few different views, which have helped me, and which you may appreciate.

The first is that the term disorder is not as bad as one may think. Creativity is most often associated with being able to "think outside the box." The proverbial box is all about order. This one helps me a lot. But there is a big caveat. As long as you do not think this means dissociation is only helpful in the present, you can be okay with this. I am just pointing out that not all disorder is bad and putting disorder in context.

If that does not make you feel more comfortable, then consider the thermodynamic quantity of entropy, which is crudely thought of as a measure of disorder in a physical system. All physical systems have a measure of physical disorder and zero entropy can only be achieved at absolute zero, which can only theoretically be achieved. This one helps me a lot, but you may not like science as much as I do.

One arrives at perhaps the "trump card" view by accepting that dissociative coping as children is a common reaction to a physical, emotional or sexual assault. In that sense, all manifestations of dissociative coping and post-trauma stress could be easily viewed as an injury. In sexual abuse lawsuits or criminal suits, the language is all about injury. Injury is often defined as damage done to the structure or function of the body by an outside force. For me, this could not be more valid and this is the view I hold onto most often.

Hold onto any view of dissociation or post-traumatic stress that feels right to you. But it is important to make sure you do not use a more palatable view that serves to provide a reason to put a stop to your healing journey. Whether you call what you live with a disorder or an injury, we must all call upon ourselves to heal. To find peace. To find wellness.

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Kerro said:

Paul, this is a really insightful post. For my own healing, it helped to understand that PTSD is "just a coping mechanism". Sure, there are times it feels like complete craziness, but I'm able to hold the "coping mechanism" idea, which is more compassionate and supportive of myself, and therefore enables healing. I'm really glad you've found a way to view DID that is helpful for your healing, too.

Peace and wellness to you today, and every day.

Paul Author Profile Page replied to Kerro:

Thanks Kerro. There is so much stigma attached to so much, so I figure why do it more to ourselves?

Kerro said:

Paul, I couldn't agree more. :)

Paul Author Profile Page replied to Kerro:

But I do believe that what I said in the post today (and in prior ones) and that is that, for most of us, we cannot simply be satisfied with seeing everything as a coping mechanism. Because I fear that we lose the motivation to change.

Kerro said:

That's true Paul, if you use it as an excuse.

But, for me, it helps me to understand why I react in certain ways, or behave in certain ways in certain situations.

I don't use it as an excuse. I still want to heal. The things I want to change now certainly have their roots in my past - but the healing is about finding better ways to live now in the context of understanding why I coped the way I did.

I hope that makes sense.

Paul Author Profile Page replied to Kerro:

I hear you Kerro. Totally agree!

Nansie said:

Hey Paul,

This really makes me think. When I was a child DID was a coping mechanism and it saved my life. But now as an adult DID becomes a problem in and of itself that I have to find ways to cope with. So the injury occurred (the abuse), the reaction to cope was DID, then DID also became part of the injury or damages and new ways to cope with the DID were formed. What a chain... In therapy I am working on healing from the abuse then discovered the DID and now continue to work to remember all of the abuse, get to know the DID better and the aspects or parts of it and then all the while try to cope or be part of a world that has always been different from me. I can't begin to count all the times I have sat and looked at ppl and wanted to be like that and just be "normal". Normal looks so easy compared to what we go thru. It's like 6 people in my head have to debate on something before a decision can even be made half of the time. When that happens I then dissociate on myself so that I don't have to listen or react to it...does that make any sense to anyone?

It was fun to read this article you wrote..it helps my mind to organize which is hard to do...:)

Paul Author Profile Page replied to Nansie:

Hi Nansie. However it works for you. For me, I see DID as the injury (the wound). Yes, I often rant in therapy how I would like things to be easier and for me to be more normal. But, the more I do in therapy, the more I realize that this is my normal.

Excellent post, as usual. I believe that coping mechanisms are a result of injury that was helpful at one time, but continues in an unhealthy manner as an adult, mostly. Looking at diagnosis as coping mechanisms does take the "label" off some. For me, motivates me to work as changing as something learned can eventually be "unlearned." Where as, a label seems to become an identity without hope. Just my thoughts.


Paul Author Profile Page replied to ClinicallyClueless:

Great points ClinicallyClueless. I do hear you on the label. I often think, and sometimes know, that the label of DID that I have now and have had for a long time, is something that I will carry with me forever, despite the progress I make. That does make me a tad pissed.

castorgirl said:

Why will you carry the label forever?

If you look at the thermodynamic quantity of entropy, the closer to absolute zero you get, the less disorder there is. If you look at the disorder of dissociation, or the injury caused by the abuse; the more you heal, the less obvious that disorder or injury becomes. So why will you always carry the label? Yes, you may always react in certain situations to certain triggers, but the positive coping mechanisms learned through healing will smooth those out. It will become less obvious that there is an injury or disorder.

At what point do we stop carrying the label of the disorder or injury?

Sorry, but your statement that you will forever carry the label of DID is one that I find more defeatist than the label itself. If I can't get to the point of being within the range of "usual" reactions to events, what's the point of going on?


Paul Author Profile Page replied to castorgirl:

Castorgirl/M, I can understand your thinking that I'm being defeatist. I'm not really. Think of it like this: If I see a doctor, they always ask me why I have a scar on my stomach. It's a big scar from surgery I needed after a suicide attempt back in the early 90s. I am used to being asked this question. I could get upset when asked. But I feel like that's a reminder (almost like a tattoo) of where I was and how far I've come. I can't say whether or not those of us with a diagnosis of DID (or any other major psychiatric diagnosis) will carry the label forever. Probably not. But I do know that when we heal, we will know that label still is with us. Because, like the scar, I will know from where I came, and I will not be ashamed of it.

Nansie said:

I am wondering...when we heal does the DID diagnosis get dropped and a note made that we have healed or been "cured"? What happens then...will we always have this coping mechanism and sometimes it will just be quieter than others? Will it just disappear never to return "integration"? Just wondering while we are talking about labels and the lifelong impact of them. Thanks for any info you all can give.

Paul Author Profile Page replied to Nansie:

Nansie, I think these questions are hard to answer. Technically, yes, diagnoses get dropped. How it looks like for each of us will be different. A lot of this is what you say. After I had my 7 or so year absence from mental health (my "cured" years), DID (then called MPD) was never brought up. I'm not even sure my medical doctor got the diagnosis from my mental health people back then, because he always talked about depression at each annual checkup. Maybe he was just trying to make me not feel awkward. Depending on where you live, medical histories may not travel with you very far. With online medical records, I'm not sure how this will change. I get a shiver when I see TV commercials about medical records being so easy to access. I know, longwinded answer that didn't really answer what you asked. But I can't really answer what you asked.

Nansie said:

It's amazing to me Paul cuz diagnosis can follow you forever and many of the professionals out there don't get this stuff. They see this even as a one time diagnosis and that's that....lifelong label. So many still think that DID is like the movie Sybil and don't even realize that was dramatized for tv. I guess there is just very little awareness. Bad enough to go thru all this without then dealing with ppl who don't get it.

Paul Author Profile Page replied to Nansie:

No, Nansie, it does not at all need to be that way. For what it's worth, I actually found the movie Sybil to be quite real-life.

The proverbial box is all about order! Brilliant! I never thought about this in this way, Paul. Thanks you for this post!

Thinking of you.

Paul Author Profile Page replied to marj aka thriver:

Well, I wouldn't say brilliant, but thanks Marj!

OneSurvivor said:

Good vs bad. Helpful vs. hurtful. Needed vs. needing to be discarded. What is DID? As I read you post here I think of how I was so injured growing up... injured to the point of developing DID in order to "survive". I still feel injured.

Injury causing DID in the beginning. DID causing further injury later in life as it no longer fully helps and starts to actually hinder real functionality.

Seriously, my brain feels very non-functioning right now. DID? I don't know. I want to cry. I think the idea of injury touches me deeply. I have never, that I know of, ever used the word "injury" to describe anything that happened to me in regard to DID or even PTSD. Wow!

Injury. I was injured. It caused DID. Is the DID actually an injury in itself? I don't know. It seems more like it was the bandage that was applied to try to keep the injury from getting worse.

Sorry, I don't even know if I am making sense. I want to understand what you wrote, but all I can offer is how it affected me... what I internalized and am trying to share back. I want to cry. What else is new lately?

Take care, Paul. It is good to see you writing again. I will try to do the next art project, but my mind just seems to be doing a lot of swirling lately, making it a challenge to even get ready for the webinar. I feel like such a mess. :-(

Paul Author Profile Page replied to OneSurvivor:

OneSurvivor, As I said on your blog post about this: I think there's not one way to interpret "injury". How I think of it, though, and I said this in my reply to your comment... is that injury is the result of what happens. It's not just the DID. That's only one part of it. It's the damage that individual parts in the system hold, the whole "ball of wax" so to speak, I think. But, again, everyone can and may view this differently. My point in putting it out there was to help people think about what they experience in order to be more at peace with it.

OneSurvivor said:

I hear you, Paul. We are each going to see things a bit differently. I like that you keep putting things out to consider. I like that it oftentimes opens up ways of thinking that I might never have considered before.

David said:

I read this post when you first published it (as indeed I do with nearly all your posts) but it caught my eye again in your sidebar today. It made me think again, as it did the first time, about the ways I consider DID, and the power of language.

Because I have been very clear about being multiple since I was a young child -- and indeed tried to explain it to a therapist as early as age twelve, without success -- I haven't experienced feeling the label stigma quite as much, I think, as those who go into therapy not knowing they are multiple or needing to look at that fact with a therapist's guidance.

This may sound incredibly strange, but -- now that I've had several parts integrate (or "align," as I prefer to call it) and am looking at how my internal experience works differently now vs. before that happened, I am more inclined to think of DID as an organizational principle rather than as a disorder. In taking perhaps an overly broad view of human experience, I notice that certain types of organizations -- whether governmental or social -- evolve in response to crisis; and different types of organizations evolve in peaceful or cooperative circumstances.

I think that for me, the most acute experience of DID was a lot like a wartime civil government ... with heroes, battered civilians, widows, spies, torturers, mad geniuses ... lots of secrets and desperate measures, as well as incredible valor from a select few. Those types of things evolve because they are useful in times of great danger and unrest. But they're unnecessarily complex and even damaging in times of growth or peace.

And so, in different circumstances, it's appropriate to reorganize, in order to respond to what's going on now, in the most effective and life-enhancing way. For me, and the particular way my mind works (which is, I fear, very bureaucratic, at least based on this comment!) the idea of a reorganization or restructuring sounded (and still sounds) much more positive than overcoming a disorder. Even for people who haven't had severe dissociation-causing trauma in their lives ... things change, and they must evolve and reorganize how they think; they must develop emotionally or become stagnant and unhappy. I believe that internal reorganization is something all growth-oriented people do ... for those of us with DID, it's on a larger scale, of course, and it's more difficult. But I still like to think of it that way.

Paul Author Profile Page replied to David:

Thanks David. I can definitely see this point of view. And this post you are commenting on was going to talk about democracy and governments as the framework for how DID can work. I shied away from that because there I was getting a bit political in my writing and I didn't want to go there. Thank you so much for sharing this view.

anothersurvivor said:

I'm shaking. I think I found a comfortable place for me.

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