Language has power. Whether you examine it from the point of view of ordinary communication, advertising, or threats, words and how we use them have tremendous impact – some of which is intentional and some of which isn’t. This is because the words are chosen based on the experience of the speaker/writer while the impact of the words is based on the experience of the listener/reader. For those with DID, words are tied intimately to the body language of the abuser. For people without DID, they often fail to understand the power that words have to trigger retraumatization – because they fail to understand the physicality, violence and/or threats of violence, that accompanied those words.
Given that a word may have one meaning to one person and be experienced quite differently by another, I want to look at the use of the terms illness and injury in DID. I had not thought about this before, but in a DID Facebook group, one member defined himself as injured, not ill. In considering the refusal to consider himself ill, going against most therapeutic models, he was quite clear: he had been injured. He advised me that this distinction came from a therapist at Del Amo’s National Treatment (Trauma) Center. I believe this critical distinction is both accurate and subtle.
Illness and injury are often used as synonyms. Conventionally speaking, this is not usually a big deal but while they can sometimes be used interchangeably, they are not exactly the same. An illness is something that people understand to be bacterial, viral and, at least subconsciously in almost every circumstance, potentially infectious. An injury is something that is the result of some external force exerted on a person, whether deriving from a fall, a chemical, or something done by one person to another. This is not something that people, even subconsciously, generally view as potentially infectious.
The truth is that the trauma of child abuse is not an illness that arises due to a microscopic life form such as a bacteria or virus invading one’s body. Those attack one at a cellular level. The body’s defenses rise to fight the illness, sometimes successfully on its own as in a common cold, and sometimes successfully with medicines.
Child abuse is an external force – physical, psychological or, often, both – that attacks and injures the child as an entire individual. In situations of child abuse, there is no cellular defense that can rise to fight the abuser. In the case of trauma resulting in DID, the mind’s defenses rise in the form of multiplicity to survive the external force of the abuser.
When someone breaks a child’s arm, the broken arm is classified as an injury. If the bone protrudes from the break and becomes infected, the infection would be considered an illness but the broken bone would continue to be classified as an injury. In fact, the root of the illness (the infection) was the injury. We must keep this distinction in mind when examining the etiology and resultant manifestation of DID.
Characterizing DID as an injury, rather than an illness, has the potential to benefit those with DID as it is a more accurate classification of the source of DID. Thinking of DID as an illness implies, conventionally speaking, that one needs rest, medicine and homemade chicken soup. But, no patient with DID got it because someone sneezed near them in a crowded bus, or because they ate at a restaurant where the chef didn’t wash his hands before cooking. No patient got DID because they stepped on a rusty nail. Patients manifest DID as a result of very real injuries that unrelated to the microbial world.
This re-characterization may enable those with DID, and those without it that engage them – whether therapists, family, friends – to see them the same way one would see a person who has a broken leg. That person, perhaps with a cast, needs extra help. They need to be protected from anything or anyone banging into the broken leg intentionally (an abuser continuing the abuse) or by accident (a non-abuser unaware of interpersonal triggers). Just as a bone takes time to knit as part of the healing process, DID takes time to process the trauma as part of its healing process. Let us understand the injury so that we – patient, therapist and supporters – understand the importance of protecting both the mind and body during the course of healing.
