As my readers know, I am not happy with the short term news cycle attention that is generally given to early childhood trauma. The negativity expressed toward,dissociative diagnoses in general, and DID in particular are very unhelpful. I think it is important to note that in some circles of psychiatry, dissociation is now much higher on psychiatrists’ index of suspicion. This is primarily due to the Herculean efforts of veterans with wartime related PTSD and their families.
The dissociation that veterans with PTSD experience, and the difficulties their families deal with upon their return from service, forced the Veterans Administration to look at dissociation and PTSD. Why? Because there were government, military and family advocates forcing the issue. This brought an understanding of the frightening levels and intensity of PTSD with which veterans were returning.
There recently appears to be the beginnings of a change beyond the military-related PTSD community. It is instructive to consider some of the reasons why that is happening. In capitalist societies, opportunities to make money are often the primary drivers of health care. Simply put, this is why the pharmaceutical industry successfully sought to control mental health care education, with the extreme focus on chemical treatments for psychiatric disorders. The potential change is, as is often the case, heralded by marketing professionals.
I having been seeing many many ads for trauma courses targeting therapists. Yesterday, I saw one ad promoting a well-known trauma psychiatrist/author using the following language: “…an industry leader in studying and treating trauma.” I am not mentioning this to criticize that psychiatrist. I am confident his work has helped many many trauma survivors. I am merely pointing out that once trauma counseling is see as an “industry”, it is clear that there is an understanding once trauma counseling is an industry, there is money to be made in it – just as in any other industry. I remain concerned that the term “trauma informed” is being applied in all directions and throughout society – hence the idea that it is an industry definitely is taking shape.
I am not denigrating considering the impact of trauma throughout segments of society. Rather, I think it is important to retain the distinction and understanding of early childhood trauma, with its consequences, from older individuals that experience trauma, with those consequences, and one-time trauma survivors, with those consequences, and refugee trauma survivors, with those consequences. There is a common thread throughout all of these, which is the lack of the experience of safety which one had before being traumatized. But, the etiology, consequences and treatment may differ in various ways.
People participating in any trauma training need to be focused on stability, insight and compassion – not just the technique being promoted. With stability, insight and compassion, one will not see any technique as immutably applicable in all treatment. Without stability, insight and compassion, you will be like a hammer seeing the whole world as a nail to hit. Engendering stability insight and compassion must be the foundation.. This means that it is important to attract people that desire to help others, rather than people that are simply acquiring a credential to bill patients.
Mental health professionals, individually and collectively, need a forceful push to recognize how misdiagnosed as well as improperly treated Dissociative Identity Disorder causes a massive waste of societal resources in addition to the ongoing suffering of the patient(s) and families. DID still remains erroneously viewed by many professionals and lay people as a rare disorder, or worse, a controversial disorder. This continues to happen even as undisputed world statistics tell us its prevalence rate is 1% irrespective of the social or cultural background. Schizophrenia, which is not seen as particularly rare or controversial, has a worldwide rate of point 32% of the population – 1/3 of the rate of DID!
We know that early childhood trauma based DID, a complex form of PTSD unrelated to wartime service, has been generally ignored since the beginning of psychiatry. I think that the reason is that there has never been a groundswell of support from advocates of those with DID forcing the issue. Why? It is likely based on the fact that early childhood trauma is usually connected with sexual and physical abuse by family members and close friends of the family. It is rooted in heinous conduct people don’t want others to know has happened in their family and the perpetrator us likely in the family – so family members unit usually don’t want to confront or identify to police or mental health authorities.
It is grossly negligent that our mental health system fails to support a DID sufferer when they are finally able to gather enough strength to seek therapy. But, therapists use excuses to avoid taking them as patients, such as lack of experience – or even having doubt about the validity of DID as a diagnostic classification – despite its presence for decades in the DSM. It often takes months years for them to find a therapist that will accept them for therapy.
Perhaps too many psychiatrists prefer to craft a diagnosis from the DSM5 that offers a proposed solution that entails medication rather than the effort required for genuine psychotherapy. For instance, quickly prescribing medication for depression rather than first seeking to uncovering the root cause of the depression.
DID patients are commonly labelled as depressed and prescribed antidepressants. Then, when he/she does not get better because the diagnosis fails to consider dissociative symptomology, the usual course is to increase the medicine or change to a “better” antidepressant. The doctor reviewing the case of someone without improvement should be reviewing the diagnosis. In reality this is not done.
It is far easier to increase the dosage of medications, than to adopt a new approach. How often does a psychiatrist have the courage to say that the patient is suffering from dissociative disorder and requires intensive psychotherapy instead of continuing the same medication but at a higher dose? According to the textbook by Putnam published in 1989, the average time for a DID patient to reach the correct diagnosis is 6 years. From the social media I have seen, it remains the same. So, if you are living in the USA, write to your senator, in Canada and the UK, your MP. Unless you express yourselves out loud, repeatedly and unflinchingly, no one is going to hear you. Having your spouse/SO do the shouting may be the more effective approach. Hence another reason for considering including the spouse/SO in the therapeutic journey.
The power of kindness, of compassion, is not anecdotal. It is woven throughout our human history. Even those therapists focused primarily on psycho-active treatment should try to include kindness and compassion, even if it is just 5 minutes of actually listening to their patients about their difficulties, before dismissing such inclusion as a waste of billable time.
