Monday, August 29, 2011

What's it like to switch?

Q: What's it like to switch? - David

A: I have never seen a tv show, movie, or book that has resonated with how it feels for me to live with Dissociative Identity Disorder as much as Quantum Leap. I had to be like Sam Beckett trying to figure out the missing pieces, while preventing people from realizing I was someone else, and trying to figure out what tasks had to be done before I leapt out of there.

An alter is inside, minding their own business, maybe even sleeping. Then, usually without warning, unless they were intentionally trying to take over control of the body, they find themselves out. Being out means you are in control of the body, and you may or may not have access to the other people inside the body. But as a survivor of abuse you know that your life depends upon maintaining the secret of the abuse. That also means hiding the secret that your body holds more than one...

So you find yourself out, surrounded by people and places you may have never seen before. Maybe doing activities you've never done before. Minutes, hours, days, or even weeks may have passed since the last time you were out. All you really know is your own personal past, and your own personal skills. Sure, the previous alter may have known how to drive, but do you? Do you even know where you are driving to? Do you pull over and wait, or are you going to be stuck out for so long that waiting is pointless?

Usually alters can hear at least one other alter who is still inside, and sometimes they can communicate to each other. This may be an alter who can offer help and guidance, like Al does in Quantum Leap. Or maybe they can can go ask others that theynhave access to that your don't, like Ziggy the Computer in Quantum Leap or the staff back in the lab that Sam can't talk to.

Since we honestly believed hiding our existence was the only way to survive, we did not develop very obvious external differences, like you often see in movies or tv shows. My access to clothes, jewelry, makeup, etc was the same regardless of who was out. We viewed the body as a car: no matter who gets in to drive, the car is still the same; how they choose to drive may be very different though. I have graceful alters, and I have klutzes. I have alters who feel fat and slow, and alters who feel skinny and fast in the same body.

The biggest change some people notice is my mood and language shifts, and that my beliefs or point of view may change depending on who is out. For example, I don't curse often. A frequently out part of me, however, curses like a sailor, and with much comfort! But my skills also change. My boys know how to build things and are mechanically inclined than me. Some of my people are very socially comfortable whereas I am quiet and introverted. Some have religious or spiritual knowledge while others do not. One knows Spanish, one knows American Sign Language, one doesn't know how to speak.

There are times when you want to leave being in control up to someone else. When I have a lot of physical pain, I want someone better equipped to deal with it to be out. Sometimes you don't want to give up control, but are forced to. Either one of administrators of my system shuts the whole body down, or they can force a replacement out. This is good for dealing with alters who are self-destructive and putting the body at risk, or who are having a panic attack or otherwise not functioning well. And sometimes someone else just wants the control because they want the control. They have people to talk to, things to do, or just cabin fever from being inside too long. This can be the worst shift.

When I am out, and someone else demands to be out, and I don't want to let them do that, I have to fight. I have to fight to keep focus on where i am and what I am doing. I have to fight to shut their voice or images out of my head that they are distracting me with. They may turn up the volume to drown out my own thoughts. It may give me a headache because were both fighting for the same mental resources. Some of them used to be able to cause physical pain (muscle spasms, migraines, IBS, stabbing pains, dizziness, nausea, feeling cold or hot). Luckily since the body know does that all on it's own, no one uses that tool anymore because now they've been on the receiving end.

I had a grad school profess assume I was ADD/ADHD because in class I would fight to stay out for the lecture. My ways of doing that usually involved a LOT of foot tapping or leg bouncing because the constant physical sensation and exertion helped me keep others away. I was also a prolific doodler and almost frequent gum chewer for the same reasons.

Then there are times when you've had enough and you want to go back inside. Sometimes no one else wants to deal with what you're dealing with either, and you get abandoned and locked out. Sometimes alters would resort to self-injury or cutting to force someone else to come out to protect the body. Other times the system can't seem to make a switch happen (stress, inner turmoil, no one wants to be out, they can't afford to let the person who is out to come back inside yet), in which case we usually escaped to sleep. So, once again, like Sam Beckett, sometimes it's time to leap, and sometimes it isn't.

Sunday, August 28, 2011

When did you first know you were Multiple?

Q. When did you first know you were Multiple? - Marcy

A: I was diagnosed with Dissociative Identity Disorder in the summer of 1996. I was already aware that I was Multiple before the official diagnosis got applied, but there was still something oddly heavy, scary, and final about having a Psychologist and a Psychiatrist confirm it (when I hadn't told them my suspicion).

It's hard to answer the question of "When did you first know you were Multiple?" Who, exactly, are you asking? Because some of us inside knew almost two decades before others inside found out! But there is also the complication that when you are a young kid, you think you are normal because you don't have a lot of reference points yet to compare with. And that's especially true when talking about trying to figure out if your brain works the same as everyone else.

As far as we can tell, I became a We at age two or three. "How do you know your memory is from that age? That's an awfully long time ago!" yes, it is an awfully long time ago for most of us. But some of my parts are frozen in time, and that's not far away from their perspective. The way I'm able to age most of my memories though is because my family moved every year or two, so I can figure out the years based on what house I'm remembering. I've also verified details and memories of houses and ages with my mom, and the records she has of our moves.

Anyway, we continued to make alters to help deal with new challenges (moving, school, church, friends, continued abuse, different abusers, etc.) until the abuse stopped at age 14. I, Selah, didn't meet the others until college. I was created to go to school, and protected from knowing about the others so I wouldn't also have to know about the abuse. When they began to make themselves known to me, I felt like my world was being ripped apart, like I was being shredded apart. I began to question everything, and I trusted nothing, especially not them.

I knew we were different from our peers early in life, before school even started. Mostly because I understood my father's threats that the abuse was a secret that had to be protected at all costs. I withdrew from my peers because it was the easiest way to protect the secret. We knew being Multiple was something we had to hide by the time we were 6 or 7. Which is why Selah got created, because we needed a unified appearance and memory for learning for school.

Things began to unravel in college. That's when it became painfully obvious to me, Selah, that there were others sharing my life and my body. And they started to really show me the holes in my memory and daily life. I remember my mom came to visit me in college and a lady came up to me and asked how I was doing and what I was up to, normal chit chat for someone who knows you. But I didn't know her. She asked who I was with and I had to figure out how to introduce my mother to a stranger who seemed to know me. I was mortified. My mom caught on and helped introduce herself, then later asked me what happened. I told her the truth: I had no idea who that lady was. I speculated that she had me mistaken for someone else.

Later that night I got shown of memory that I had been in a writing class with that woman earlier that year. But I didn't remember the class either! It was a month long semester in January where my college offered unusual classes, and the more I tried to think about it the more I realized I didn't remember January! I asked my best friend about the class casually, and she had taken the class with me. Oh vey.

Another stark slap in the face was when I found myself in second year college Spanish one day and realized I didn't understand a single word! The alter who had learned Spanish had decided that she was no longer going to be in class. I was confused, ashamed, and mostly pissed. How was I suppose to pass a class in a foreign language that I never learned?!

Good times ;-)

So, we began to unravel and start tearing down the internal amnesia in 1993, with Selah really finding out starting in 1994. Recovery really started for us because we were finally away from the father for the first time. It was finally safe to feel and remember again. But it also became necessary to get Selah to know because we knew we had to confront the father before he had the chance to abuse grandkids that were hitting the "right ages" for them to be at risk of sexual abuse. We did confront him in 1995, which really opened the floodgates for even more alters and memories to come out of the closet for all insiders to face. That's when recovery became a real life or death deal, one we weren't always sure we'd survive. But we knew that to avoid recovery was an absolute one-way ticket to suicide.

Friday, August 26, 2011

DID without abuse history?

Q: Is it possible to have DID if I haven't been abused? - Anon

A: Yes, for two reasons. First of all, since a critical part of Dissociative Identity Disorder is amnesia, it is possible that not all alters know about the abuse. Secondly, a lot of things can be traumatic enough to cause DID without necessarily being something you would call abuse, if you're only using that term to mean physical or sexual abuse. Severe and recurrent trauma can be caused by abuse (physical, sexual, verbal/emotional), extreme neglect (isolation, imprisonment, withholding or inaccessible food/water, etc.), or significant acts of violence that carry a significant risk to health or life (natural disasters, wars, refugee camps, etc.). But while research shows a very strong link, with the expectation of a causual relationship, between early childhood abuse or trauma and DID, the clinical diagnostic criteria for Dissociative Identity Disorder does not require a trauma history.

A few people with Dissociative Identity Disorder do claim that they have no memories of abuse, and feel that they have adequate knowledge of their internal system for them to be able to rule out that the abuse memories are simply blocked by amnesia. Some believe that they simply created their system because they were very bright, creative, or imaginative enough to create the DID.

Clinically this is unexpected. I would encourage someone who has symptoms of severe dissociation, with no reasonable memories of trauma to explain their symptoms, and who has thoroughly explored this issue in counseling, to seek a full evaluation to also rule out medical or neurobiological conditions that may be underlying their condition (ie, tumors, seizures, brain injury, etc). I would also want to rule out other mental illnesses that can have dissociation symptoms such as Bipolar, Borderline, Schizophrenia, and Schizoaffective disorders.

Sunday, August 21, 2011

How do I get to know the others inside?

Q. How do I get to know the others inside? - Cheryl

A: With time, patience, acceptance, and by not forcing them to be known. Think of it like meeting a new person in real life. If you approach them directly, start asking personal questions, demand they explain their presence, seem angry or scared that they are there, etc., they are going to blow you off, leave, or get angry.

Most people with Dissociative Identity Disorder seem to start their internal communication through writing or drawing. I'd recommend a diary or notebook. Write letters to them and invite them to write you back. But keep writing even if they don't respond. Chances are they are listening and seeing if you're safe and to make sure you're really ready to meet them. Sometimes having pens and pencils of different colors and even thickness (for young ones) help others inside be willing to share their writing or drawings back.

Once people start communicating, it can be helpful to start making a family tree or system map of your insiders. Most people want to know if that alter has a name, an age, a gender, and when they were created or what job they have inside. As you fill in the details you'll also start to know more about their likes, dislikes, temperament, etc. And can add that to the family map. A spreadsheet can be a good tool because you can sort by age, genders, etc. And it's easy to add in new people or new information as it becomes available.

Just take your time. This isn't a fast process for most people. Many alters have spent years in hiding from insiders and outsiders, so it's going to take time to build up their trust in you and their trust in their safety.

A new iPhone app we like is UFace which gives us the ability to draw faces of what people look like inside even though we have no real drawing ability!

Reparenting young alters?

Q. What about young alters who want to go through re-parenting in therapy before they agree to age or integrate? - Angela

A: I am not a fan of outsiders reparenting alters. Too many counseling clients have become overly enmeshed or dependent upon counselors and other professionals who thought reparenting was a great idea. We have seen a few Dissociative Identity Disorder autobiographies that showcase this style, and failure, of treatment.

I believe insiders have the ability, the responsibility, and the skills to reparent younger alters. Most systems even have these older, wiser, calmer alters already created. They are there for a reason! Use them for that! I don't think we create these caretakers and protectors by accident.

I fear that depending on an outsider to reparent leaves alters too open for more hurt, abuse, abandonment, and even a slower recovery. Why? Because an outsider is never with you 24/7. An outsider will always lose patience with your needs sometimes because of their own needs and stressful life. An outsider will either start to resent your needs, or will become attached to the role of caretaker or special friend and may not want you to recover because they want to maintain that role. They may not even realize they are sabotaging your recovery, because they really usually do want to help you by giving you comfort and support. But it's a fine line between support and enabling.

So reparent from within. You have the resources. Plus reparenting inside helps the whole system learn how to take care of themselves, the body, and even how to nurture other relationships in their lives. That way both the reparent and the reparented grow from the process.

Appropriate to share therapy notes?

Q. My therapist feels its not appropriate to share her notes and findings and theories on me with me, for fear it could inhibit progress. Is that right? - Rowan

A: Usually this is a real risk. Being a counselor, I know it's very hard sometimes to know how much to tell a client, and when. I also have to figure out if it's helpful to share that information, for the client, rather than just sharing clinical tidbits or jargon that makes sense to only me.

When working with someone who might have Dissociative Identity Disorder, this is a very complicated process. If the therapist tells too much, too soon, then people in the system may feel like the therapist "knows too much" (unsafe), "told my secrets" (untrustworthy), or worse "doesn't know what they are talking about!" (disconnected, not listening, not a good counselor, making up illnesses, pushing medications, etc.). The reactions from clients could be firing the therapist, refusing to seek outside help from referral sources (like medications), increased self-harm or suicidal thoughts, or severe loss of progress and trust in the counseling relationship.

Counselors should be able to tell you some basics, like what is my current diagnosis, are we making progress, are we a good fit, do we have an agreed upon set of boundaries or rules that both sides feel comfortable with, is medication an option or even recommended, are there other types of treatment or self-care things I can be doing to help my recovery?

I also don't like to share my notes because they are hard to read (handwriting), hard to understand (usually fragments or phrases that make sense to me), or are required but not therapeutically required (i.e., required by insurance companies for billing). I may also choose to leave out certain things from a chart because they are highly private and I don't think they are specific to the treatment, but I want to protect my client's confidentiality. For example, if I'm working with a client for anxiety that appears to be related mostly to a medical condition, I may opt to leave out the fact that my client discussed their homosexual lifestyle one session because it isn't directly related to our focus and therefore should remain private from anyone else who may read that chart. I want to be a counselor, not an informant.