DID continues to cause so much controversy, and remains a hot topic among mental health workers. In my opinion, this is for two reasons. The first reason is pretty clear. It is that some famous professors and heads of universities deny even the notion of DID. They continue to denigrate the diagnosis, claiming that it is based on unscientific misunderstandings.
They argue against accepting it even as a possible diagnosis. They assert that it should be removed from the DSM diagnostic formulations. This is despite several studies that show it is statistically as common as schizophrenia – a diagnostic formulation that no one disputes.
A colorblind person may argue with you that there is no such thing as “red.” They believe it doesn’t exist because they don’t see it. They can only understand “red” as a concept because it is something they cannot perceive. They are not lying, they simply cannot distinguish and identify what people without colorblindness see as “red.” In that same way, some famous university professors and heads of their psychiatric departments irresponsibly conclude that because they have never identified a case of DID in their exalted and long careers, that such a thing does not exist. Their conclusion really comes from their blindness to DID as a clinician.
The second reason is simple: DID continues to come up because it is a correct diagnostic formulation. The question then becomes, “Why is schizophrenia an acceptable diagnostic formulation and DID is not?” I suspect it is because the etiology is quite different: The root cause of DID is ongoing horrific early childhood abuse.
This means that the incidence of DID is connected to the incidence of early childhood abuse. To acknowledge the statistical studies of DID shines an uncompromising and embarrassing light on psychiatrists’ (and society’s) blindness to early childhood abuse.
Some wish to deny DID because one cannot measure or prove the existence of DID with a laboratory test. But, that is true of many psychiatric disorders. The fact is that if you are open to hearing a patient’s early childhood history of abuse, even ordinary levels of empathy reveal the internal reality of a traumatized individual. Applying the balm of that empathy opens doors that a patient would otherwise keep locked shut.
If you are not open to hearing a patient’s early childhood history of abuse, which they are already trying to keep locked up from themselves, ask yourself why they would reveal anything to a therapist that is predisposed to denying their experience. The result is that ever since the case of Anna O, a patient of Breuer whose case study was described by Freud and includes indications of DID symptoms, there have been numerous cases of DID mistakenly identified as disorders under other diagnostic labels.
A key myth that needs to be overcome by therapists treating DID is the view that alters are pathological mental deviations to be eliminated. Instead, alters should be seen for what they are; an integral part of a whole system. It is not for the therapist to choose alters to accept and alters to reject. In fact, the problem for the host personality is often the internal conflict resulting from accepting and rejecting the other parts.
As I have said repeatedly, alters hold the keys to healing. The job of a therapist is to help the client to understand what drives the alters, and to invite them to participate in the whole system without undue conflict. This can be accomplished by engaging such alter(s) by first listening with empathy to what they need to say, and second by speaking to them with respect, with kindness. In this way you encourage them slowly to understand that they are not only a part of a whole system, but play(ed) a significant role in the system’s survival of the original cycles of abuse.
A surgeon, seeing something pathological, can treat problems through excision, or incision and drainage, like treating a tumor or an abscess. In DID treatment, healing is by inclusion not denial, suppression or excision. It is a bad for a therapist to think like a surgeon.
Alters may have originally been deemed by the individual showing up for therapy as undesirable, unworkable, a nuisance, or some other kind of problem. But they are not going to be eliminated by cutting them out like a tumor or draining them like an abscess. All of the alters, but particularly the “difficult” ones, are pointing out the therapeutic path to follow if only we therapists will truly listen.
Perhaps a better way for people who don’t understand DID to get a small glimpse of it is to look at “normal” people with a conventional unitary personality. Consider a judge at work putting on his wig in an English court. There, he behaves with dignity, representing the law of the land or the imperial crown (in England). He projects a very particular powerful persona. If that same individual was raised by an alcoholic parent, once he leaves the court, he might sloppily carouse with friends at a bar – projecting quite the opposite of his persona as a judge.
In another non-courtroom circumstance, that same person may try to learn to ski because they want to accompany other friends already skilled in the sport. But, if that judge had broken a leg skiing when they were young, they might become quite frightened, quite hesitant and even paralyzed, getting on the chairlift for the first time in decades. In fact, he might look somewhat like a frightened child. Only a person who knows or suspects that long-ago injury might be able to help him overcome the paralysis of the current moment – or tell him it is ok that he doesn’t get on the lift. This example includes the paralysis that can some with a traumatic trigger to a past event.
It is the same person, with the same name and picture on the driver’s license. But depending on the context, he may behave with a completely different persona in each different circumstance. This is somewhat how a system, with host and alters, feels. The difference is usually that the individual with DID is often not capable of choosing what face to project in the event of a triggering event.
Alters are best incorporated into the whole in the operational sense, not in the sense of integration. I see no harm in their individuality so long as they all work toward common goals with minimal internal clashes.
