Multiplicity and Truth
There has been a debate for at least two decades concerning the diagnostic validity of the dissociative disorders, in particular dissociative identity disorder. Anyone who struggles with pathological dissociation has seen this, probably firsthand. On its face it is not hard to appreciate why there is such controversy. Some just dismiss the disorder outright because far out experiences like having such widely varying personality states (often with their own names even) seems implausible. For others, they believe it is either therapist misleading or patient collusion to exaggerate symptoms much like an actor is required to perform for a scene, and there is some historical evidence of this. Many talk about the validity of the experiences, sometimes referred to as the "Swiss cheese" of consciousness, but believe they should be subsumed under other diagnoses.
I talked about this subject a year ago in Is Dissociative Identity Disorder Real? I want to come back to it today.
While I talk about dissociative identity disorder fairly regularly here, I do not generally like to treat it so separately from other forms of dissociation. That is not to say that I do not think dissociative identity disorder is not a valid diagnosis. I absolutely do. For one, I think much of what we have to contend with is similar (though on a different scale) to what many others have to contend with. I think many appreciate that dissociation-like experiences are widespread in the world, if we include things like avoiding difficult situations or being disconnected from our families or not being aware of what we are doing. Of course, most people's experiences do not rise to the level of being diagnosable dissociative disorders. There are billions of people who seek more awareness and deeper connections in their lives, which at its core, is what healing from dissociation is all about. And, while dissociative identity disorder is usually singled out, those who are recovering from childhood sexual abuse and have been diagnosed DD-NOS, PTSD, Complex PTSD, Borderline, or nothing at all also have a challenge to find more wholeness in their lives and heal dissociative tendencies. So, I always try to use language that applies broadly. This is the main reason why I often avoid much of the parlance of the disorder, because the label is much less important than the experience.
Since dissociative identity disorder is an elaboration of what all people experience, this leads to a bit of a "Catch 22." It is a problem because this is the argument many detractors use. But it is also an advantage. Personally, I want to struggle with something that, on a fundamental level, is normal to the human condition. That gives me hope for healing. If dissociative disorders are on a continuum, then I do see healing as finding a way to move down the ladder of that continuum. For me, that makes it all much more manageable. Yes, there are many times when I feel utterly not normal. When I am at my most fragmented. When I have bitter wars inside. When "I" do unsafe things that I would not possibly agree to in any rationale or grounded state.
If we focus on the messages that detractors use, there are usually two outcomes: becoming defensive and succumbing to denial. For me, I find that I start with the former and end up in the latter. But this is dangerous ground. Becoming defensive tends to push one towards a rigid stance that does not appreciate "both sides" or seek a middle ground. And denial can be hugely destabilizing. While some denial is part of the natural healing process, it is not part of the overall solution. I know that firsthand. For several years I was "well enough" to flee therapy, appear well, disavow parts of me and pretend it all did not exist. But I also know that during that time I was not paying attention to what was happening in secret. There was an upside: I ended up quite functional in certain very public areas of my life. But, that came at a severe cost, as I was quite dysfunctional in other areas. For me, that "position" did not stick. It was not in line with what I needed to do for healing. For some people, and I am one of them, multiplicity is very real and part of the fabric of who we are.
I now know I need to have acceptance for the "multiple" way my mind works, though I struggle with this a great deal. This acceptance has helped me change; to be more whole and heal. The goal of good therapy for dissociative disorders is to become more whole. Period. To move from what is more like "Swiss cheese" to what is more like "American cheese." The route is through increase in awareness, which is proportionally difficult to how elaborate the dissociative walls are.
Another issue that is often brought up in any discussion concerning perspectives on multiplicity is Sybil. Sybil defined late 20th century multiplicity. But dissociation is experienced on a continuum. It was a mistake for many therapists in the 80s and 90s to think that everyone was in the Sybil mold. There is vast understanding of a continuum of experience now. Good treatment now does not involve abreaction, regression and purging of memories. That was a lesson learned a long time ago. But rather it is to promote a more whole way of living that holds one's self accountable for actions and teaches grounding and other techniques to quell what are very real, and sometimes extreme, internal conflicts and disparate views of self. And as far as memories go, good treatment does not make them a focus but does not shy away from them when they become an issue. Good treatment works towards containment so that survivors can deal with issues of the past while also learning to navigate through life in the present.
While therapists have a responsibility in the treatment of dissociative disorders, survivors clearly do also. I firmly believe this. Anyone who uses their multiplicity as a means of scapegoating behavior, or puts their whole life in the identity of a multiple, or only identifies as a victim, is putting up an enormous barrier to their own healing and doing themselves a disservice. Survivors (and therapists) need to know there are no guidelines for being multiple. It is recognized that multiple systems are very different for different people. People with any dissociative disorder should not be pushed, by themselves or others, into a belief system that says you have to have X parts, or have this level of trauma, or that you have to have these types of parts, and they have to behave in this sort of way, etc. In other words, we must be driven by our internal truth and not by external pressures.
I believe that if we are guided by truth, we will achieve more clarity. I have found that I have fewer internal conflicts, I am more whole, I am more functional in the world, I am able to feel more, etc., when I accept what I know to be a reality of how things are inside. That is another way of saying I accept my truth. When I do not accept what is real for me then nothings fits together. The bottom line is that everyone has to come to terms with what their reality and their truth is. That acceptance should be respected by others. And that acceptance is the basis for change, growth, and healing.
I will expound upon the subject of truth that I brought up at the end of this post in a subsequent post. Truth is the theme for both the Blog Carnival Against Child Abuse and the Expressive Arts Carnival this month, both hosted here. I welcome writers and artists to submit to both as I think truth is a crucial topic that can benefit from several different perspectives.