Multiplicity and Truth

| By Paul | | Comments (36)

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.

36 Comments


Shen said:

Great points and a needed reminder, I imagine, for many of us. It is frustrating to know that some people do not accept my reality. It is irritating to try and explain it to someone (which has come up for me in coda meetings) and have them just look at you blankly. It might be easier to have an issue that was more widely understood. When I say "bipolar disorder" (which was my first diagnosis) people nod their heads with some level of understanding. Normalizing the condition helps one feel more normal, which is one of the points you make.

It is good to remember that DID is on a continuum. Everyone has some dissociative experiences. The most common one I've heard is when one is driving and suddenly realizes they have not been aware of the last several miles. Possibly they can't remember if they've made the correct turns, and are not sure exactly where they are when they "wake up" to the reality of the moment.

That is very much how DID works in my head. I drift off, often without notice, and wake up minutes or hours (or on a few occasions days) later with no recollection of what has transpired in the interim.

There are times when I know it's coming, when I feel as if I might slip away at any moment. Those are panicky times and I put a lot of pressure on myself to keep it under control - which is not always actually within my control.

Most psychologists accept the concept of the "inner child" and most accept that there are "normal" dissociative states. Most also accept that people will go to great lenths to repress painful memories. So, why is it such a big leap to imagine that the inner child - at various ages - could exist in a more separate way, walled off for self protection from painful experiences?

Paul Author Profile Page replied to Shen:

Thanks Shen. I often struggle with the concept of normalizing the condition. While I think it's ultimately important, it is sometimes viewed as invalidating. It's a delicate balancing act.

Astrid said:

Thanks for posting this. I liked your comment on dissociation being in a way a normal experience. Being reassured of this by my therapist when I first came out about dissociative symptoms (depersonalization at first) helped me to come out about the full-fledged multiplicity that I'm experiencing, which eventually led to a diagnosis of DID.

I was diagnosed in 2010, so I never had to deal with Sybilesque stereotypes. In fact, my diagnosis was purely based on my meeting the threee DSM-IV criteria (different alters that influence behavior and amnesia). I sometimes still question myself based on Sybilesque stereotypes, however.

Paul Author Profile Page replied to Astrid:

Astrid, thank you for taking the time to comment and welcome here! It's always par for the course to question ourselves. It you weren't, that would be a problem. The only thing to pay attention to when normalizing the experiences is that they don't get perceived as invalidating. Thanks again.

tai0316 said:

You wrote this beautifully Paul. It hit on great points and was very balanced. The continuum point is also important. I like that you point out that DID is different for different people. My therapist explained that to me when I was first diagnosed. There may be some general similarities disorder-wise but no one's system or whatever they want to call it, is exactly the same as someone elses. Thank you for writing this.

Paul Author Profile Page replied to tai0316:

Thank you Tai. Balanced, huh? Funny because I feel so UNbalanced! But, really, thank you for your kind words.

Ivory said:

A perfect truth is that people should respect our acceptance. The problem is that they don't. Everyone's a critic and everyone else tries to bend to make them happy. It makes me crazy. Good food for thought, Paul!

Paul Author Profile Page replied to Ivory:

Ivory, I hear you. I like to think of truth as having to do with us alone. Good thing for me to think about for my next post!

persephone said:

Dear Paul,

Thank you for this very interesting post of yours. My first reaction was: If a person is able to write such a distinctive article, he must have a lot of brain, and the multiple part is the intelligent mind's way of solving every day problems. (Or, more severely: hide away from unbeareable traumata).

I am familiar with disorders and I believe that our brain has found an excellent way of keeping mind and body in good balance.

The only problem here is that we lose control of what we are doing and this can be dangerous in certain situations.

I have heard of old cultures in which people with disorders are accepted AND treated as special people.

A good friend of mine, musician and teacher/therapist in meditation, music and transcendence, told me once that people with disorders are the healthy people in society as they reflect the sick society.

To me, this makes a lot of sense.

And from what I have learned in connection with the "sick" is that they are endowed with high intelligence, I conclude: with extraordinary intelligence.

To belong to this category of individuals, is already an outstanding position because the average human being can't follow explanations that might be unusual.

Coming back to the core issue: Society has improved in the sense that anything unusual is being accepted as part of a multiple society.

I have overheard an interview with an M.D. being diagnosed an Autistic. Very interesting. People like this can function quite well when they are aware of the disorder. That is the key to one's own understanding and the chances of healing, if necessary.

There is an artist who due to a criminal action in the 60s was one of the victims of Contergan. He has great difficulty living in his body, because of this drug he was severely damaged as a fetus. This man does not consider himself sick. Well, he is not. He has a fantastic voice, is professor of music, famous, and he is happily married.

The "Truth" is an abstract concept on which we contemplate as long as we live. So we might as well make our contribution to this forum here. I am looking forward to reading the comments of everyone.

Thanks again Paul.

Paul Author Profile Page replied to persephone:

Persephone, I'm not sure if dissociation keeps things in balance. I mean, I think that's one of the main challenges with a dissociative disorder. But if you mean that it keeps your protected from the trauma when it was happening, yeah, I get that. Really, I don't know if I'd feel comfortable being labelled as any more special than the next person. I understand what you are saying, I think. I don't have as kind a view of society as you do. But, yes, I find that if I choose well who I interact with, I can find that compassion and understanding, which for me is important.

Fantastic post Paul, really helpful and interesting. I love that statement at the end about accepting your truth, a very powerful step towards healing. :)

Paul Author Profile Page replied to fromthesamesky:

Thanks SameSky.

Persephone said:

Hi Paul, I forgot to mention the name of the artist; Thomas Quasthoff, Bass Bariton.

Paul Author Profile Page replied to Persephone:

Thanks. I checked him out. Amazing.

castorgirl said:

Paul, I would hate to go up against you on a debate topic that you were passionate about. You have a way of giving your opinion that is subtle and convincing... although I agree with you, so maybe that's why I find it so convincing. I almost wanted to find something to disagree with you about, just to start a debate... all I could find was that New Zealand cheese is much better than American.

I think the debate about DID will continue for as long as it is in the DSM, and probably beyond. I'm glad you mentioned continuums, as I believe that all of the diagnoses you mentioned are on the same continuum. I often tell people that I have PTSD or Complex PTSD to make life easier for myself. In many ways, those diagnoses are the reasons why I'm presenting at the crisis lines - flashbacks, nightmares, insomnia etc.

Thank you for mentioning the way therapy has changed over the years. As you know, I struggle with detractors who are stuck in the 80's and early 90's. I've never experienced the memory seeking or been encouraged to abreact memories, so I'm always a little stunned when they are mentioned.

A great position statement... you categorised it as an intellectual statement, and it is, but it's also so much more than that.

Take care,
CG

Paul Author Profile Page replied to castorgirl:

Yes, CG, you don't want to debate me! Just joking. I think it's safe to say that DID is almost always shared with other diagnoses. This is part of the problem for acceptance. So, yes, a lot of the issues are like what you say, flashbacks, nightmares, etc. I think that's easier for people to wrap their heads around, especially in a crisis situation. Detractors will always be there. I know they sometimes destabilize me. But they also help me to a degree. And, thanks for your help in defining what this category will be. I changed it to simply "Opinion".

Persephone said:

Hi Paul. How do I go about contributing to your hosting next week?

As you have noticed by now, I have found the name of the psychiatrist who healed the student. Since I can't remember the title of the book, I have sent an inquiry to Dr. Solursh.

There are a number of books I have read to traumatizing experiences written by Torey L. Hayden (educational psychologist). Could I mention them in one article?

I am not diagnosed DID, but I had to cope with schizophrenia and paranoia, also with severe damages on children because of their environment. I myself have had a very difficult childhood, thus I am in many ways traumatized. Professional help is necessary, but the healing comes from within.

Truth is as we perceive it. There is no right or wrong.

Please let me know what you think of submitting an article.

Heidi

Paul Author Profile Page replied to Persephone:

Hi Persephone, Are you talking about the Blog Carnival? You need to have a blog in order to submit. It's a sharing resource for bloggers. I'm not sure what you mean when you write about the doctor who helped heal someone with multiple personalities. Healing is very possible. And, as you say, healing comes from within.

Paul Author Profile Page replied to Persephone:

Hi Persephone. I see Torey Hayden has wrote a number of books about children from a "special education" perspective, with uniformly good reviews. I'll check them out.

Kylie said:

This is so well written, as always, Paul. You have an amazing talent at articulating your thoughts in a way which is very easy to follow and understand.

I was really challenged by your comment:

"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."

I agree with you completely on this but it is still challenging to find a balance. I have struggled to accept being DID for many years and it is only in the last couple of years that I have come to realise that it allowed me to survive. Currently my acceptance is a swinging pendulum - on one side I fight my multiplicity, wanting to deny parts and not give them any part in *my* life, which causes huge dysfunction. The other side is becoming so wrapped up in healing and embracing my system that I start to define myself as a multiple and ignore other aspects of my life.

While its not often to these extremes, I do find myself going back and forth. One example would be being understanding with myself when it effects on my studies vs. using it as an excuse for a late assignment. For the most part I truly believe that I don't use it as an excuse though there is part of me that says I am and that I should some how be stronger and just get things done.

It truly is a balancing act.

Thank you for sharing and I look forward to reading your post that expands on the idea of truth. I have been planning on writing something for the blog carnival but I am just not sure if I will get to it or not.

Take gentle care of you

From Kylie

Paul Author Profile Page replied to Kylie:

Kylie, I completely understand the balancing act. It's critical to accept and acknowledge your system and spend time (sometimes a lot of time, sometimes feeling like it's all your time) in healing. But it's important to make the effort to maintain a balance, which you clearly do. For those of us who struggle with these issues, that was not where my comments were directed. I was mainly saying that the more we make an effort to achieve a balance, the greater chance we give ourselves to heal.

Paul Author Profile Page replied to Kylie:

Kylie, I want to make clear my comments about accepting responsibility (or I used the phrase in the blog post "scapegoating"). I am not saying this is common to this community of bloggers at all. But I have seen it elsewhere. All I am saying is that it's one thing to acknowledge that a part of us did something (and we may have very little control over it). What I am saying is that it's important for us to take responsibility for whatever was done. I have heard many times things like "Part X took the pills" and while this is accurate to a point, I think it's also important for the adult parts of us to recognize that Part X is part of the system and for the system to take responsibility for the behavior. It helps, in that way, to not keep the behaviors isolated and helps with healing. Ownership over behaviors is really important.

Kylie replied to Paul:

I do realise that your comments about being a scapegoat were not an attack or accusation. It is something I have actually spent a good deal of time thinking about and considering - your blog just had the right words to help me describe my internal struggles.

For the most part I know that I accept responsibility and that I should not be hard on myself for taking time off uni. But I am currently living on a pension because of the DID and it bothers me I am not doing anything. This is where I begin to question whether I am using DID as an excuse.

I have found that as a community we usually struggle with not giving ourselves a hard time. I recognise this is one way I do that. But I also believe that it means I challenge myself and I am less likely to allow myself to use it as an excuse because I am so aware of the possibility.

Thank you for you comments on my submission this month, they were very encouraging.

As always, take gentle care of you :)

Persephone said:

Hi Paul, thank you for responding. I don't have a blog, can I put the information down or will you do it? Torey L Hayden's books are fantastic; I have read them all. The really good thing about her books is that she is having her very own approach on understanding the problems the pupils have, and she finds a way to heal them. I wonder what she is doing today, if she is still doing research on special cases.

The book that I mentioned earlier, is a story of a student who felt extremely irritated by the fact that besides her student personality there were two more, one being the protector and the other one the destructor. She was healed with the help of Dr. Lionel Solursh. He studied in Toronto, that is how I could find him. He works in the U.S.now. The book, if it is still available, is very good to read, and the actual healing process is fascinating.

Paul Author Profile Page replied to Persephone:

Persephone, You didn't give the title of the book. Hayden wrote a number of them. I want to be careful here because kids do have an innate ability to dissociate, it doesn't mean she had or has dissociative identity disorder.

Paul Author Profile Page replied to Persephone:

Persephone, I forgot to add, it would be best if you don't have a blog to put the information down in the comments.

persephone said:

Hello,Paul,

Coming back to the core issue: Society has improved in the sense that anything unusual is being accepted as part of a multiple society.

What I mean by this is that it is only now that people can live in society no matter how difficult their problem might be.In this respect things have improved,at least this is the case in Europe.

But I know that society as a whole takes much longer to accept changes than individuals.

You are right: Nobody should be labeled.

The more I get into the subject, the more I realize how great the challenges are that people with DID are facing.

Your blog is very helpful, and I am amazed to see how well you handle this. When I first came to this blog, I did not know anything about you, and I was wondering who had initiated this blog. My guess was: Either a therapist or an M.D. Since you are collecting and filtering all inputs,you must have accomplished a fair amount of professional competence. Congratulation on your achievement.

wantstorun said:

Paul,

Thank you for posting this piece. This piece, combined with working on the art carnival, really stirred up some internal work for me/my system. It is tough work, but reading this post and then seeing the submissions has had an impact.

And in a debate - I want you on my team! :o)

wtr

Paul Author Profile Page replied to wantstorun:

Thanks so much WTR!

OneSurvivor said:

I have found my greatest healing and wholeness come when I accept who I am and how I am. For me, the proof is in the pudding, so to speak. If accepting a certain something causes me/helps me/makes it possible for me to move into greater wholeness and healing, then I believe that truly is reality. If it were not reality, then I think it would hinder rather than help.

Dissociation is something everyone does. For many, it is on the scale of simply tuning out people to focus on a book or video. But why is it so hard for some to accept that it can have an extreme on the other end? *shrug*

I find arguing about it to be futile...especially with someone who has made up his/her mind. Some people are open to really looking at both sides. But the ones who are not...it is better for me to not even talk about it with them. It becomes too upsetting and distracts my focus away from what I should be doing.

Good post, Paul.

Paul Author Profile Page replied to OneSurvivor:

I like what you write here OneSurvivor. Acceptance is really hard, though. I honestly think that it's an integral part of what we deal with, and not too much appreciated.

OneSurvivor replied to Paul:

It can be very hard. I was rather shocked when I really got a lot of SRA memories back. But accepting was integral to keeping myself safe...and my son.

anothersurvivor said:

For me with 25 yrs. of a DID [etc.] diagnosis, "truth" has never been a stable entity. It shifts under my feet daily, sometimes moment by moment. The thing I know most surely is that I don't know for sure. To ask another or to consider their view for me- feels dangerous. In addition, they could never know me as I do-and I don't. Is my "truth" to be trusted by me? Sadly right now my doubt speaks the loudest. The "truth" is, this moment is not my reality. I don't know who is speaking and if I will ever get in a word of my own. Today, this minute, healing feels so far away. Have I failed to accept myself as I am? To function at my job I must have all but a single part tightly secured and sectioned off. Is this the truth/a lie; denial/accepting the responsibility I have to others/failing to integrate? Or, is it handling it and balancing, and being true to the moment? You eloquently said,"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". What about when you know it's not reality but a state of delusion and untruth, does one accept the independence of that element and let it be or demand integration? Ethically, am I doing others a disservice or just myself? Truth is etherial, capricious and rhetorical.

Paul Author Profile Page replied to anothersurvivor:

Hi Anothersurvivor. Yes, I certainly get that. For me, I like to think of truth as that unvarnished protected space that I sometimes cannot see or have access to. But that it sits there waiting to be revealed. Of course it FEELS like truth is constantly changing, but for me it's just that it's how I see it changes. I'm sorry healing feels so far away for you. Has it always felt that way? Or can you use the awareness that other times have been better? I would be careful how you label things. "State of delusion" sounds harsh on yourself.

Tracie said:

I love that you said, "But dissociation is experienced on a continuum." that is huge, and often not understood.

There is so much great information in this post. Thank you.

Thanks for saying that DID is different for different people. I am just beginning to get some understanding of it from blogs like yours.

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This page contains a single entry published on February 17, 2011 3:15 PM.

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