One could get discouraged at the state of affairs in psychiatry for treating DID, but please don’t.
While there are many negatives to consider, 15 years into my retirement as a psychiatrist working in one of the major cities in North America, there are some positives as well.
One negative is that there appears to be an ever-increasing emphasis on the use of medication to treat psychiatric disorders. This is based on a reductionist approach in psychiatry which presumes that every disorder has an organic and/or genetic basis. The result for DID patients is that they are often not even offered treatment, or even the acknowledgement that they are suffering from a legitimate defined psychiatric disorder.
The positive is that there are more (though not enough) therapists willing to work with DID patients. I believe this is a result of more public reporting and sometimes dialogue both about the extent of early childhood abuse as well as DID. This comes often from the bravery of those with DID writing books and blogs, as well as conferences organized by and for the DID community. Just as important, there is much more peer support than ever before. That peer support can be invaluable to those with DID that have no therapist and may simply need warmth, human empathy, to help them during a particularly difficult time.
Another negative, of which I am quite ashamed, is the failure of the profession to help veterans of the Gulf and Afghanistan wars along with their families, to get them the right kind of support/treatment for their PTSD. While I had limited experience treating veterans or their families, I am confident that psychotherapy conducted in a way which limits the risk of re-traumatization is a safer path to healing than focusing primarily on medication, or on medication alone. Further, the benefits of giving non-pharmaceutical tools to spouses of DID individuals to help the entire family deal with the consequences of PTSD would likely benefit spouses, children and the families of veterans.
The positive is, again, peer support – a critical component for veterans that is often part of military discipline – and the willingness for the military to acknowledge the ongoing impact of PTSD. While that is from a military perspective, it is a societal acknowledgement of dissociation – a key component to PTSD. This has led to at least some acknowledgement of the dissociation issues that those with DID confront as a result of their own Complex PTSD.
Another positive is that DID patients have been able to bring information to their own therapists in a safe way. They are able to bring books, articles and blog posts that allow them to say something to their therapist(s) along the lines of “This is like what I go/am going/have gone through.” Sometimes it is less re-traumatizing to give the therapist something written in a blog or book, or in a peer support group, rather than try to express it directly oneself. This is likely the case when the patient is not fully confident in their therapeutic alliance. It can allow for that alliance to develop further as well as to give the therapist another pathway to help their patient.
I have received many communications from individuals with DID that have used my books and blog posting in those circumstances and for those purposes. I am honored by their trust.
