Part 3 Healing Past Trauma.
Just knowing that trauma is frequently the real issue underlying their individual issues does not mean that there are easy solutions for trauma survivors. Trauma is not something that one can easily elicit and heal. The first step is to avoid quick solutions that seek temporary symptomatic relief and allows one to confuse symptomatic relief with actual healing.
[1] Do not jump to a quick diagnosis of anxiety and depression as the reason why many are dysfunctional and disabled. This drive to immediately diagnose a patient is a mistake and dangerous.
Why? It cuts off considering other potential causes that should be on your index of suspicion. Your training should have included the fact that anxiety and depression are not necessarily the disorder. Rather, they can be mere manifestations of the underlying pain and suffering from past trauma.
As therapists, we cannot simply ask, “Did you experience trauma when you were little?” and expect an accurate response. But this question is something for therapists to keep in mind. The answer requires patience and human contact to elicit. But no clarifying answer will be put forward unless and until a genuine therapeutic alliance is established.
Without the time and effort needed to establish a genuine therapeutic alliance, it is no wonder that a person suffering from unresolved early childhood trauma gets diagnosed with an anxiety disorder, panic and/or depression. Diagnosing those symptoms as a disorder is not appropriate without exploring whether they are a disorder or merely symptoms of a different disorder – such as DID. Do not confuse symptoms which are mere descriptions of how the patient feels because while descriptive, they do not clarify the etiology. Giving the patient pills to relieve these symptoms without confirming the etiology is like giving aspirin to lower a fever without checking to see if there is an underlying infection in need of antibiotic treatment.
[2] The mind, confronted with something uncontrollable, terrifying, and overwhelming, seeks escape from the experience. When one cannot escape the situation, the mind can fracture so that while part of it remains trapped with the body in the experience, part continues as if the experience is happening elsewhere, to someone else. It is why the natural (and likely solely available) defense of dissociation kicks in.
Repeated psychological trauma results in this becoming a habit to cope with the ongoing trauma pattern. Typically, the split off part says, “This is not happening to me. It is only happening to someone else so it is no concern of mine.” This should be understood to be an uncontrollable response that encourages, if not solidifies, the creation of alters as well as the amnestic barriers that are the hallmarks of DID.
[3] Very often the clinician compares their own life experiences with those they hear from the client. While understandable in some contexts, there is an enormous therapeutic danger in concluding that what the client experienced was “no big deal.” It is made easier then the therapist believes that the description they have been given by their patient is accurate both as to content and depth. With that, they fall prey to their own misguided assumptions.
No trauma patient would describe their original trauma(s) in the kind of detail that would overcome such an assumption without a firm and deep therapeutic alliance. It may simply too terrifying to describe. The risk of re-traumatization is too great to try to demand such a thing from a patient.
I will point out from my own experience. Having treated one particular patient for many months, details of an early traumatic experience exploded out of the patient one session. The details still leave me overwhelmed and speechless when I think about that patient. When you are so privileged, through the trust of a genuine deep therapeutic alliance such that your patient is able to share their experience with such immediacy, it jolts you to get a true glimpse of the depth of their trauma experience. It is also why I warn therapists of the very real impact of vicarious trauma, of the need to care for oneself when treating individuals with such intense childhood trauma.
[4] No two experiences are the same.
Different people react to distress differently. Some are remarkably resilient and are able to bounce back. Others are crushed under its weight. Sometimes having a sympathetic bystander helps to ease the pain of feeling hopelessly alone. At the same time, two soldiers pinned down in a fox hole by gun fire may result in only one having severe PTSD decades later, while the other is able to move on.
This is particularly noteworthy as it is sometimes the case that a victim who feels supported and loved by a caretaker can recover from almost any psychological trauma. With a loving caretaker, many of them can survive the trauma without permanent damage. When an infant, toddler or small child is abused by the caretaker, without support he/she will feel utterly vulnerable and alone – because they are! It is both simplistic and callous to say that what a patient experienced as trauma is commonplace and should not produce irreparable damage. The extent of damage depends on many other factors, including the repetition of the trauma itself or of a like trauma.
[5] Clinicians often have the outmoded belief that the past should be forgotten. They say that it is only with one’s eyes facing forward to the future, can one start taking the next step forward. This is a very common belief, and I have come across well qualified teachers and people of responsible position who utter this view. While it may be helpful for people moving past ordinary setbacks, it ignores the fact that trauma, particularly repeated trauma, often leaves the victim with symptoms, without accessible explicit memory, and no understanding of how to work with the trauma and its effects.
Dissociation is a hallmark of many trauma victims. They may have hazy memories or even complete amnesia. This is why it is said that trauma leaves us with symptoms rather than memories. When trauma survivors are triggered, regardless of the clarity or accessibility of their memory, their nervous system literally re-experiences the trauma. This re-traumatization that further undermines even a tentative feeling of safety.
[6] Dissociation is a phenomenon that stretches on a spectrum from normality to abnormality. Dr. David Spiegel, author of Dissociation: Culture, Mind, and Body, once said, “I certainly hope my surgeon can dissociate when he operates on me.” Why would he say that? Well, one hopes one’s surgeon will concentrate on the operation rather than being distracted by some unpleasant domestic upheaval at home. Concentration itself often involves dissociation.
This mixing of normal and abnormal dissociation has confused many clinicians who have a simplistic black and white view of dissociation. Dissociation in the DID patient is the creation of amnestic barriers between parts of the fractured self. It arises to wall off unacceptable and immensely painful past experiences of trauma and abuse. Dissociation is an effective response to trauma that is embedded in the human mind. It should be clear that DID is not controversial. The only thing controversial is why therapists hold on to a mistaken view of the dissociative pathology in DID.
[7] For therapists, particularly psychiatrists, who say that they have never seen a case of DID, I suggest that they are wrong. According to studies, schizophrenia has about the same incidence in the population as DID. In my own practice, looking back at my early years as a psychiatrist, there were most certainly DID cases that I missed. I believe I missed them at the time because my training included the guidance that DID was so rare I would likely never see it in my practice. So, for many years, DID was not included in my index of suspicion despite the presentation of dissociative symptoms in patients.
Putnam, author of the first text book on MPD wrote, “We (Putnam et al., 1986) found the median length of time in treatment with the therapist who made the diagnosis of MPD was 6 months after initial presentation, with a number of cases continuing for several years before a diagnosis was made.” These psychiatrists with a special interest in MPD (now termed DID) and who still took an average of 6 months to come to their diagnosis.
It is no wonder so many psychiatrists say that they have never seen a case of DID. They have likely indeed seen DID but simply didn’t recognize what they were seeing!
