For most people, and for many therapists encountering DID patients, the first question that comes to mind is whether or not to take the reported memories of abuse to be truth or fantasy. But, there is an even more fundamental question that is at the heart of the matter: Why is that the first question for so many people, whether they are trained as therapists or not?
In my experience, it is because most people simply don’t want to believe that another human being would do something so evil to an infant, to a toddler or to any small child. People don’t even want to believe such things when it is adults doing evil to adults. This is clearly shown by the disbelief during World War II of the initial reports of the concentration camps, of the genocide in Rwanda, and of the Cultural Revolution in China – among other horrific events. And so, people continue to suspend belief, and such horrors continue without protest, until the evidence overwhelms the bias against looking at the evil of which human beings are capable. The same is true with child abuse.
The raw unvarnished truth is that the abuse of children, physical and sexual, happens. The raw unvarnished truth is that such evil has happened in the past, is happening in the present and in all likelihood will happen in the future. The terrible consequences echo throughout the life of the child with ramifications in future generations in that family and for all of society. This is clear for anyone to see, if they are willing to actually look at the abuse and its cascading effects.
Consider the inclusion of fantasy as part of that first question arising when one hears a tale of abuse. To the abused individual, the use of the word fantasy, whether it is said out loud or is expressed in the subtext of a therapist’s body language, can only sound offensive and demeaning. But still worse, it is a confirmation of the ongoing fear ingrained by their abuser that no one will believe them that such things happened.
It usually takes months of waiting to see a specialist, after perhaps years of gathering the courage to tell a doctor one’s innermost private and excruciating history of early sexual abuse. How would you feel if you were finally able to disclose even a hint of the trauma, and then consider how you would feel if the person you are looking to for healing and support, the person in authority evaluating your trauma history, is hesitating as they consider whether or not your memory is some kind of fantasy. It is important to know that they are generally not hesitating because they think you are lying. That is a second step. They hesitate because they simply don’t believe that another human being, particularly a parent or close family friend, could or would do such a thing.
But, no therapist can establish a genuine therapeutic alliance with a patient if they cannot listen deeply to such trauma material, remaining present without judgment. This means keeping one’s own mind stable without doing an on-the-spot calculus concerning the details of the patient’s recounting of abuse. Forget the calculus, you will get the truth of the trauma far more directly and accurately by remaining fully present and grounded for the patient. In that way you can see the totality of the context, presented verbally as well as in body language. The assessment needs to be about whether or not there has been trauma is the point, not the details.
My advice to therapists is to sit still and project genuine empathy, empathy based on understanding that any individual talking about being abused has experienced trauma. As with any memory, traumatic memory does not need to be 100% accurate in its detail because it will be accurate in its context.
Look at an ordinary memory, for example my memory of my childhood bedroom. I remember it as being quite large. There is no doubt that if I were to walk into that bedroom today, it would appear to be quite small. But no one would challenge my memory of that bedroom as being fantasy. It would be taken for granted that when I was a small child (the context of the memory), I would definitely have experienced it as much larger than I would experience it as an adult.
So, when listening to a patient’s memory of trauma, particularly a flashback of trauma, don’t be stuck on proving or disproving “fantasy.” To proceed with therapy, it is enough to know that there was trauma that is reaching into the present and trapping the patient in its past.
The use of the word fantasy can be traced back to the very beginning of psychoanalytic theory. When Freud formulated his theory of neurosis by the end of the 19th century in Vienna, he had already encountered many patients who talked about early sexual experiences with their fathers. He privately wrote to a friend that it was a highly significant discovery, like discovering the source of the Nile. The discovery suggested, for the first time, that there was a causal link between hysteria and early childhood sexual molestation.
When Freud delivered his first lecture on this causal connection, the academic and medical authorities were quite unreceptive to this discovery. He explicitly used the terms incest, rape and gross sexual abuse in describing the experiences related to him by his patients. Krafft-Ebing, then one of the most prominent physicians of the time who was senior to Freud both in age and professional stature, described Freud as “spinning a fairy tale.”
Having felt the ice-cold response to his discovery, Freud then changed his theory and used the term “fantasy” to describe the recounted sexual experiences he heard from his patients. He then postulated that it was a kind of wishful thinking that infant girls had for their father.
There have been many explanations for this change in his view: Was it beyond his imagination to believe that these molestations in fact took place? Unlikely, as his original presentation was quite explicitly about molestation, not imagination. Did he change his words and his mind to ensure the survival of psychiatry in the harsh intransigent academic world of Heidelberg and Vienna which at that time was the center of science and medicine in the Western world, or perhaps as a way to preserve his own reputation in order to be able to continue his work? Possibly. Was he afraid to force a confrontation with leading lights of society whose daughters told him of having been abused, a confrontation he might easily lose? Quite possible given that this is something that continues to happen up to this very day, when people are terrified to confront abusers that are leading lights of today’s society.
Regardless of why he changed the theory, and whether or not he then reverted to his original view, his use of the terms “seduction” and “fantasy” enabled society and the abusers to infer participatory intent in the abused children instead of forcing an acknowledgment that the abuse was exactly what it was – rape, incest, and assault, just as he had originally characterized it.*
Later, much later, psychiatrists like Judith Hermann, in her extremely clear and invaluable book “Father-Daughter Incest” published in 1980, elaborated the truly sinister aspects of such early childhood sexual abuse experience.
Today, we should correctly appreciate Freud’s discovery of the link between hysteria and the psychological experience of a patient’s childhood. At that time, it was well beyond of the imagination of others. People were then, and many still are, stuck on searching a biological root for the phenomenon which, in Freud’s time, was called hysteria. There are still psychiatrists obsessively denying the impact of early childhood abuse on adult patients as they search for a biological cause of the mental phenomenon that results, whether it be deemed hysteria, DID, PTSD or other diagnoses.
Based on my clinical experience, the odds are that Freud’s patients were indeed victims of incest, sexual assault and abuse. As the studies and news reports continue to highlight the ongoing patterns of molestation across religious, cultural and ethnic lines, it is a phenomenal disservice to patients to presume as a therapist that there is a burden of proof a patient must meet before the therapist is willing to try to establish a therapeutic alliance. The moment such a burden is placed on the patient, the ground for a therapeutic alliance is likely poisoned.
Sit still, be kind, project empathy. A patient will experience anything else as the therapist assigning himself the role of judge and jury. Remember that no memory is foolproof, no memory is incontrovertibly accurate in all details. But also remember that the heart of the matter, the energy of the memory, is accurate in context. Don’t fear acknowledging the context; sit still and listen deeply.
* “Assault on Truth” by Jeffrey Masson (1984) has some convincing alternative explanations of Freud’s views on abuse as well as the development and possible repudiation of the seduction theory.
