Moving Away from the Dissociative Prototype
Dissociative identity disorder (DID) has, for decades, been described in terms of a prototype model which has roots in being called multiple personality disorder. Recent years has seen a realization that dissociation, including more intense dissociation seen in DID or DDNOS, is experienced in a myriad of different ways for different people and at different times.
However, I am not at all convinced that this realization is widely embraced. Clinicians not exposed to many cases of more extreme dissociation or those who try to grasp what dissociation is without prior experience, including those who are newly diagnosed, are often hard pressed to think outside the prototype. While the television series United States of Tara, for example, captures a good deal of what the experience can be of dissociation and switching, it also goes a long way towards reinforcing the well-defined prototype.
I have seen so many, including myself, get caught up in what the DID prototype says we are supposed to be like. That can be a real barrier to healing. It encourages us to deny those experiences that do not fit the prototype and accept those experiences that do fit. That is not to say that we do not have experiences that conform nicely to the prototype. I have seen, and experienced, florid DID which is much like the prototype of Part A knowing nothing about Part B, with self-destructive acting out. DID can really be out of control, but most of the time DID is not like that for most people. And, so, I think it is important to look at all of this from a broader perspective (i.e., that those of us with DID or DDNOS are much more than simply our disorders).
For those of us who experience a wide range of dissociation, we know that the prototype is mostly feature driven and, as such, somewhat superficial. Massive identity shifts are often responses to stress or a trigger. Everyone has reactions to stress and everyone has triggers. With large dissociative walls, our reactions simply tend to be more extreme than most, but they are fundamentally based on the same principles. Complicating matters is that anxiety associated with switching is usually self-perpetuating. Often there is an resulting panic when we realize that we have not been in control of what our body has been doing or have lost time.
In order to heal, our focus needs to become internal and personal. We have to realize that the task is to identify and come to terms with our myriad internal conflicts. When we do that, we are not focusing on the prototype, but rather our own unique experiences and feelings. That is how the barriers can come down, how communication can commence, and how collaborations can ensue. When that happens our experiences become richer. We become more aware. My increased awareness changed everything for me. In many ways it is not even easier, but much harder. I sometimes liked it better when I was not as "co-conscious", when I could just slip away and let someone else take over. Now I am somewhere in between, trying to find my way to a place of healing.
I see DID as a complex network, one that has features of the prototype (parts with rigid barriers), but also has fluidity that allows for barriers to come down and parts to interact in a seamless, dare I say completely normal, way. I have often represented this visually, with parts as circles and lines connecting them. I try to show the reality that the system is not static. That we are not locked into a prototype. That the barriers can come down, but that they can go back up too, and come to some appreciation that DID is really about how we interact with ourselves, no matter how "unconventional" it may seem on the outside.
While DID is unquestionably very challenging, I think it helps to place it in some context. There are far more complex systems on different scales. DID for an individual can be seen as simpler, than say, the community in which you live. Or world governments. Or ecosystems. Or the network of neurons in our brains. Or online social networks. I am constantly trying to reality check my experience of DID with the complexities I know exist in the world. When I am able to do that, my struggles become a bit easier to cope with.
I am not saying that DID is normal. Far from it. But I am saying that when we look at it in a wider context, we make it much easier for us to heal.
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A very intelligent, well written post. Having an awareness is a good first step towards healing. No, DID isn't normal, but having an understanding of your 'own' conflicts & issues is important, rather than following the traditional prototype, after all we are all different, and we all have a different starting point. I wish you well on your continued journey. Thank you for your very enlightening post.
Thank you Louise. And thank you for introducing me to your poetry blog!
Paul, This is interesting. I always keep coming back to the saying of "seeing the forest through the trees". I have alot of trouble with that and then cut myself alot of slack regarding it. I have admitted to myself that I do like being able to shut things down, separate it from myself, and then go on like nothing is wrong. I can pick and choose what I want in my world and what I don't want there. There has been so much safety in that for me for decades now. I don't know if I want to let it go. I know I have broken down walls from the past. I know I have reworked thru pain from the past. I know all that and have worked it through therapy.
The bottom line becomes today's world too. This world is not an easy place to live in. People do careless things. But when it effects us it is instinctive for us to switch instead of face the reality of the pain and intent behind the pain. What is so bad about that? When we have surgeries and things like that they give us pain killers to help us be more comfortable. We have a gift for easing our own emotional pain.
I understand all the theories behind healing and becoming "whole". Someone out there created a definition of being whole, someone who probably never experienced ongoing trauma as a child. Sometimes I get angry about this stuff.
I am wondering how we become "whole" and remain that way and then try to live in today's world which and when at many corners is full of triggers that will re-awaken our instincts to switch? I am skeptical and on the fence and even resentful about some of this stuff lately. I hope it's okay to vent to you? There are very few friends, family and spouses out there that are "safe" people for us and they are so hard to find.
Nansie, The approach you describe can work if personally you are not confused by shifts in awareness and, this is the larger point, if the separation is not leading to self-harming or enabling self-harming. For most people, the number one reason to word towards more awareness is to gain more safety. It does make one angry that we work to become more whole and aware, but then are blindsided (this is what I think you are saying about triggers). If awareness leads to more safety, then there is an objective way to measure progress and that provides a motivation to continue to cultivate awareness. There's no question it can be a painstakingly slow process, and one that continuously forces us to ask why we continue to work at it. Ultimately, each one of us needs to make the decision to increase awareness.
Recently (as in yesterday) I had the fascinating experience of being given Reiki by an enormously gifted woman who is an abuse survivor, and who has been dissociative, though I would say she is now appropriately fluid in her self-relationship...I really hate the word "integrated." Anyway, what struck me was the huge difference between talking to a healer who has been dissociative, vs. one (such as my therapist) who hasn't. What was remarkable to me was the way in which the definition or concept of "normal" immediately shifted in a way that was incredibly freeing. I've never been particularly invested in what DID "should" look like for me, or even in whether I am "normal" compared to the rest of the population. But when I was with this dissociative healer, I really realized that even the most compassionate non-dissociative healer tends to be invested in an idea of what healing is, and what it looks like, and what "normal" is. It really made me wonder whether dissociatives should be healed only by other healed dissociatives...with the definition of "healed" and "normal" being contextualized by those who actually have some idea what the hell we're talking about. Therapists are a lot like anthropologists, you know -- studying the culture, very knowledgeable about it, but not a native, and therefore necessarily limited.
David, Interesting perspective. I have noticed this also. I think one can learn from both. In my case, I have found a therapist who is clearly not an expert on DID or dissociation. And so she is not terribly influenced by what a lot of clinical experts are influenced by.
@ Nansie -- I don't know whether this will help, but just in case...I am very close to being what a therapist would call "integrated," and my experience is that the strengths and coping abilities held in the alters who would emerge in times of stress are still there, it's just that they're more reliable, and I can communicate with them differently. I still have a part of myself who deals with certain types of stress -- the difference is that when that part interacts with the world, the rest of the self actively sits back and watches, instead of going away completely. It's actually kind of cool...like I'm my own best supportive audience. Integration doesn't mean that the facets of self disappear; in a way, it means that they're all visible at the same time.
David, In many ways what you describe for yourself is sort of how I try very hard to be in the present. For me, I have lost sight of integration. That used to be what I thought I was aiming for. But instead I see this place that you describe as being more about collaboration and co-consciousness. And that is okay for me.
In many ways, the prototype feeds into the problems with the language of DID that you've written about previously. In some respects, the prototype gives us a common understanding and language with which to work. But, it has inherent flaws. Just as there would be very few people who would fit the prototype of bi-polar, or schizophrenia, or pretty much any mental health issue; there are few dissociatives who would fit the current dissociative disorder prototype. So while the prototype can help us, in that it gives us a language to help us describe our experiences, it fails when there is an attempt to fit everyone with a dissociative disorder into the box.
In my opinion, this is a fault of the current prototype, and also the way in which it is used by the mental health professionals - as well as the public and media. A person newly diagnosed may feel invalidated by the quite rigid way in which the prototype describes the disorder. If there was more understanding of the spectrum of responses that the dissociative disorders can present with... as well as an understanding that they are an extension of the natural human response, then surely that would benefit us all?
Take care,
CG
CG, That was the main point I was trying to make, that it requires a certain amount of time to grapple with DID in order to arrive at the place where you can appreciate that the prototype is not all that important. For newly diagnosed people, this is a huge stumbling block, which is why I think, as you say, there needs to be a more clear discussion about the spectrum of dissociation, just as there is with "autism spectrum disorders". One solution would just be to classify dissociative problems in that same language, by actually using the term spectrum. Everyone gets what spectrum means. In fact when I talk to parents of autistic kids, they always make some statement about where their kids are on the spectrum. There should be the same for dissociative disorders inculcated into the language.
I obviously wasn't quite with it when I wrote that last comment...
I agree with what you are saying here, and I wonder how much use any of the diagnostic labels are at times. I understand that the rationale for them is to help us identify behaviours and try to establish ways to help as a result; but have manuals such as the DSM become meaningless to the coal face workers? Is it something that the student has to study in order to jump through the degree loop; but then has to almost disregard when they get into the real world situation and realise that nothing is black and white - not even diagnostic criteria.
This is where I see the spectrum being valuable. But would it be a dissociative spectrum, or a trauma spectrum? Even with saying that a spectrum is better, it still has limitations. My niece, depending on which expert you talk to; is considered to be on the Autistic spectrum, Asperger's, or just socially inept.
If nothing else, placing the dissociative disorders on a spectrum, might help ease some of the stereotypes around the diagnoses. Then if they show the Seinfeld episode about world's colliding, we're all set. I like to think that I'm not a mystery, just needing help to find a way to live a full life.
Take care,
CG
CG, I have a good view of the DSM on this. Like anything else, there are more to diagnostic criteria. DID is so misunderstood and in some ways so complicated that I think it's naturally hard to think more broadly. I think doing that requires both experience and open-mindedness. Yes, framing dissociative disorders more formally on a spectrum does have limitations, but I think it would be better than now. For example, I personally would have rather seen the word spectrum placed into the lexicon over the word "complex" (as in complex PTSD).
Like what you've written here. Don't have anything insightful to add right now, but just wanted to say we liked it :o)
Bay. Again, sorry it took me so long to write back. Thank you very much.
Thank you Paul. You have made this so clear for us. I appreciate the intellect you contribute with your blog. I would like to share this perspective with my therapist who I know will appreciate your logic :)
Barbi, Sorry it took me so long to get back. Thank you very much for your kind words.
A good post, thank you. I wish that people I interact with every day could share this perspective - heck, or even my health care provider or my dentist (and their respective staffs).
I watched less than one episode of United States of Tara because it bothered me how much the switching had to be sensationalized to make the television show interesting. I mean, I realize it wasn't meant to be a documentary, but I feel it does more harm to those uneducated about DID than it does good. That's just my opinion ... :-)
wtr
Hi wantstorun. Thank you for your comment. I think a more broad perspective on DID is severely lacking. But there are people out there. I got a lot out of Tara. But in season 3 they are doing things that are way more triggering for me than the first two seasons. I have heard that Tara has been cut and this will be the last season. That will be a blessing for many.
I definitely did not fit the US of Tara model. I believe there are almost as many variations of DID as there are people who have it. Trying to pin it down can be difficult. It was harder to detect with me because I was so atypical. Figuring it out was such a blessing. It explained so much. I refuse to try to fit any particular mold. I am me... simply me.
Paul,
I will push here with my strong opinion borne from a professional perspective and life experience.
DID unrecognized in hands of clinicians harms. "Not familiar" is not an excuse, it is unethical practice. The damage done to undefine DID for a client continues abuse. The detriment of keeping "mental illness" as a tag onto coping skills labels and allows manipulation of that human and their family and their employability. Easier to code and medicate then to practice proper standards of trauma care. Too risky in most practices and HMO's. Consider how many non-white, poor, or incarcerated are not ever going to achieve prototype.