My last post was about memories, the hidden ones that can cause such disruptions. This post will continue with that topic.
Education is the key toward understanding. This does not mean taking courses, writing exams or studying. Understanding is the way forward to helping remove the stigma attached to Mental Health.
Why do I post about stigma so much?
Because the stigma attached to mental health issues is so detrimental to healing and funding. Because it remains a dark issue, one hidden, it becomes a back burner issue when funds are dispersed as well.
As a society we are not stupid, we have the capability for understanding, compassion, to understand the things that occur in minds is how we can reduce stigma, so rather than worsen how someone feels, we can be more helpful. When someone stretches an arm to receive change and we notice scars on their arm we do not ask probing questions or allow that look of horror slip across our face. How no response other than a smile can go so far. By learning more about the illnesses that occur in minds, we can do so much more.
Stigma, as I have often said, goes both ways. Someone suffering often, does not wish to seek help or share their torments with friends and family, where they could receive support and help, because some things are just not understood. Or believed.
So this post goes on, hopefully, to making some more aware of what goes on in some minds.
It is also, somewhat a continuation of my last post about memories. Memories can be fuzzy or clear, real or false, the point though, is they are real to the patient. We are not to judge the memory or question it, but to help the patient cope with the memory and its effects. Some memories are as clear and crisp as the day they were recorded, many are fragments that combine to form a memory.
This is where this post is going.
Hidden memories can be haunting for some. These unconscious roots to the past can set up internal defense mechanisms of denial or dissociation, or more disruptive ones such as redirection/displacement, the list goes on, including aggressive anxiety. It is a long list.
I have, on previous posts, mentioned DID or Dissociative Identity Disorder. This is or was also known as Multiple Personality Disorder, made famous years back with the series Sybil. Memories are very tightly entwined with this disorder and how the patient has coped with trauma, and continues to do so.
Stigma is also a very large part of the trauma associated with DID. For many just can’t comprehend how this can be, or flat out disbelieve it. How does this make someone suffering with it, feel or why would they want to talk to others about it?
So before we dip back into memories again, an education on DID is in order. This is how we begin to understand. This is not going to be in massive depth, first just an understanding.
DID is a breakdown of memories and identities, this begins with Dissociation. During trauma, mostly as I said childhood trauma, the mind disconnects from reality. It is a form of self protection from a horrible experience that very often, the child mind, can not cope with nor understand. The memories of these events may not be recorded or may be hidden and protected from being revealed. It is likened to self hypnosis. Patients with DID are in fact easier to enter into a hypnotic state during a therapy session.
DID starts with childhood trauma for the most part, it is rare for adult trauma to instigate DID, but keep in mind terrible trauma, especially one that is ongoing has a terrible impact on the mind. This dissociation can cause a splitting of the personality, forming identities, different personalities that can take control of the persons actions, behaviours. These different identities can be very different in all respects, age, gender, experience, knowledge and even pets.
The different personalities or identities that coexist are known as alters, alternate personality states. The goal in therapy is to unite all the alters to integrate the personality. This is not always possible though, or desired, alters will sometimes fight to keep their identity , so then the goal becomes to have the alters live in harmony. They are also called parts as they are all a part of the whole. They can vary in number from a few to a few hundred. The entire collection of parts, is known as the system.
These parts may be known or may not be, the person may be unaware when one takes control/fronts or that this part even exists. When a different part takes control, this is known as switching. When switching occurs the host may or may not be aware of the switch or that they are not in control, sometimes they must wait for the part to give control back to them. The change may be subtle, someone observing may not even notice it. They may not be aware of what transpired when they were not fronting.
Someone with DID is very likely to have memory loss or partial memory loss. Not just from when they were not fronting, but from their past. It is possible that a part has that memory that is missing, they may be protecting the system from this memory. Some parts may be created to protect those with the memories, to keep them from being viewed. Some of these memories may just not exist. When they dissociated, to protect themselves, the memories may not have been recorded.
To further complicate, many other disorders will coexist, most often P.T.S.D. . Misdiagnosis is quite common as well. Someone with DID will have mood swings, so a bipolar diagnosis may result. As an example Borderline personality disorder can coexist and is often a diagnosis as these two disorders are a sort of cousin. Treatment in some areas is similar for the two disorders, in some areas it is quite different.
Treatment for DID is mostly therapy, medications can help with some issues though. Therapy can be quite successful but over a long process. The goal is to unite all the parts, to unify them, but some do not wish to unify their alters, so the goal then is to have them work together. This begins with stabilizing. Making the system safe, safe from self harm, eating disorders and suicide. Some therapy to enhance their self schema may also occur. Childhood trauma has a way of diminishing the schema.
Therapy may help the identities become aware of each other, to work out issues the parts have, set the parts up so they work as a team. To encourage the parts to help each other. Establishing trust between the therapist and the patient. Trust is always important, but perhaps even more so with a patient with DID. This is when skills can be taught, tools provided so the patient can self help. To manage anger, to cope with flash backs, anxiety, panic attacks, hypervigilance. The parts need to understand that if they harm themselves, they harm all of the parts, mostly they do not wish to do this. Much anger may be encountered. This is defensive anger, anger at how they were treated, not believed or protective, to avoid more pain.
When the system is safe the treatment, the inspection of memories can begin. This does not mean though, that this treatment is finished, making the parts feel safe is ongoing, more so as new parts may emerge or become more vocal. In my last post I asked if we want to visit memories, some we don’t. The exploration of memories needs to be accompanied by a strict set of rules, which ones are accessed, which parts will view them, how deep we will go. The release may break a dam, going slow is very important. The dam may break well after the session, as memories that were hidden, come to light. This is why the first part of treatment is to provide tools, to help cope with this information, the view into the past. This is when the parts holding the memories will be visited. Often younger parts, some that may not even be able to talk, other parts may help by saying she feels this now, she is angry, she is crying. She doesn’t want to look at that… This is when the patient learns to cope with shame, horror, revulsion, grief… rage.
Uniting fragmented or dissociated memories is done by revisiting them. Different parts may hold different memories or different pieces of the same disjointed memory, unifying them to bring clarity in this controlled environment can bring peace or to make the memory something that can be dealt with rather than haunting. These events are in the past, they are not going to harm the patient now. This is a slow process though and is not each session, working with the parts is important too. As the memories are united some parts may start to fade to be unified with other parts, they become less fractured. This event is known as a fusion. Learning to cope with the memories, to forgive.
Exploration of memories can be therapeutic and dangerous. Hypnosis is often used as it is calming. DBT skills may also be taught so the patient can cope with the raw emotions they encounter. Some memories may be difficult to bear, difficult to access. EMDR can be used, but must be done with great care. The goal is not to release everything all at once, to break the dam. Team therapy can be effective, some parts may get along with a different team member/therapist.
EMDR is Eye Movement Desensitization and Reprocessing, this therapy is effective when dealing with trauma. When memories are evoked with this therapy, they often lose their aversion to the memory, it becomes less haunting.
Exploring memories may be necessary as some parts may insist on this so they can be at peace. Some memories though, may just be intense feelings that need to be addressed, the memory may not be there. Some memories will be vivid, learning calming techniques such as mindfulness before they are addressed can assist with this process.
So, back to memories, in my last post I said, we may not always want to revisit them. With a person living with DID however, this retrieval is important. Some parts, that hold these memories will not rest until they are released, just as some parts try to stop the release of those memories, they do not wish to relive them, so conflict emerges between the parts. Therapy is a slow process, a careful process, trust is so important, and caring.