Dissociation

Excerpted from Compton's Interactive Encyclopedia

The unconscious is like a great holding area or reservoir of unprocessed events. Anything we don't or can't assimilate consciously goes there. The unconscious holds irrelevant things such as images of strangers we see on the street. It also holds important things that need to be brought into conscious awareness but may be too big to fit our existing system (conscious mind). There are times when people are unable to fully assimilate the significance of an overwhelming experience such as a car accident. One of the passengers calmly calls an ambulance, administers first aid, and reroutes oncoming traffic. Once the ambulance arrives, she falls apart and cries hysterically. In order to take care of the immediate priorities, she dissociated her feelings and emotions temporarily. The dissociation allowed her to break up the oversized experience into manageable pieces. These were assimilated as soon as it was safe to do so. If the accident survivor didn't assimilate the dissociated part of her experience, she would probably suffer the PTSD symptoms.

Children are commonly seen to dissociate---not because of trauma, but because every time they get a new type of experience, they have to modify or expand their faculties in order to assimilate it. In the meantime, the experience is dissociated and held in the unconscious. There, they "play with it," using their imagination until they work out a way to make a fit. Children go through a very high rate of new experiences and may frequently dissociate as a normal response to an unfamiliar event. They are continually modifying and expanding their system, or conscious mind. This is the process of growth and learning. As they mature, children may dissociate less and less, because there are fewer and fewer experiences that don't fit their conscious system.

Children rely extensively on adults for interpretation. Their developing comprehension is largely fashioned after that of their parents or caregivers. If caregivers are emotionally damaged, their own skewed view of the world is imposed upon their children.

Unresolved issues in the parents' unconscious are misinterpreted for the child. This is a common phenomenon known as projection. For example, if parents feel shame but cannot admit it, they may deny it, separate themselves from it, disown it, dissociate from it, and project it onto their children. They then condemn their children as being shameful. In psychology this is described as retaliatory defense. In other words, the shame the parents have within themselves but cannot accept is expressed by shaming the children. In fact, the less parents are able to accept the "monster" within themselves, the more readily they are able to see it in their children.

Emotionally troubled parents frequently reinforce skewed interpretations with abuse. If the abuse is extreme, as practiced by destructive families, a child's conscious world becomes overwhelmed. The extreme abuse is dissociated into the unconscious, but it cannot be made to fit, even in a misinformed way. The trauma remains dissociated. To survive, children tap into extraordinary coping skills, fashioned from within their own unconscious.

Clinical (Amnestic) Dissociation

Our instinctive reactions to an assault are fight or flight. However, neither works when children are abused by sadistic adults. The only option left is to freeze, and take flight through the mind. A common initial coping mechanism is to escape the body. It is the beginning of clinical (amnestic) dissociation, which allows a shutting out of an unbearable reality. It is held unassimilated---in effect, frozen in time. A dissociated experience can be split up to store the emotions separate from bodily sensations, and the sensations separate from the knowledge of an event. In dissociating an experience, children split off a part of their self to hold the trauma. In some cases the dissociated aspects of self, immediately or over time, form their own and separate sense of self.

A dissociated identity, like a dissociated experience, can hold the entire event or parts of it. Alters may hold only a bodily feeling, only an emotion, or only the knowledge. One hundred abusive/traumatic incidents may be held by one identity or by one hundred or more identities. It may be helpful to think of each identity as holding an abusive experience. In this context, taken together, the identities hold a person's overwhelming traumas and express a survivor's entire life story.

When the abuse is over, the original self "returns" and resumes "normal" life, having no/little awareness of what has just transpired. If severely abused children were forced to experience the trauma they just lived through, they would probably NOT survive.

Some children maintain a complete split between their everyday life and the abusive episodes. They may be seen smiling when posing for family photographs. Perpetrators often use such photographs to prove there is nothing bad going on.

As abused children grow, their problems typically begin to mount. The load on their unconscious becomes increasingly great, and they feel overwhelmed. As some identities stay out more and more, they may begin to take over and operate in the child's day-to-day world. If the abuse continues or increases, the original self may stay out less and less and, in time, stop coming out at all. The survivor is then functioning through identities who "switch" to cope with day-to-day life.

In the November/December 1992 issue of The Sciences Magazine, Dr. Frank W. Putnam writes the following about survivors with dissociated identities. "The (presenting) personality is almost never the (survivor's) original personality---the identity that developed between birth and the experience of trauma. That self usually lives dormant and emerges only after extensive psychotherapy."

Amnestic dissociation may be used for other purposes as well. Some identities are created to protect fragile, delicate, or creative and expressive parts of the child. An example is how the cult can manipulate dissociation to have a child create identities to serve their purposes. Fear and resistance are typical initial survivor responses to learning about dissociated parts or selves. Multiplicity can feel frightening if a survivor doesn't know what it is. Dissociated experiences/identities are frequently greeted with awe. It's natural to fear the unknown. How ever, once survivors understand the ingenuity of their own system, most develop admiration and respect for it. They no longer see it as awful but awesome.

There's a saying that "necessity is the mother of invention." Pushed beyond normal limits, people have discovered extraordinary abilities. These abilities are in evidence by survivors who used their powers of the mind to survive. We as multiples are introducing the world to new realms of possibilities that have yet to be fully understood. With knowing and understanding comes appreciation. Regardless of an identity's name, description, or personality, its main and common purpose is always to protect the child. Alters can manage extraordinary feats in their determination to keep the child safe. Sometimes these feats are beyond the range of normal human experience or comprehension.

Initially for survival, and later for managing day-to-day life, some survivors have developed extraordinary coping skills. Although these abilities may be wonderful in some respects, they have come at an exhorbitant price. While no two survivors are alike, some of the more commonly observed abilities in multiples are perfect memory, ability to heal unusually fast, ability to tolerate extreme levels of pain, and ability to self-anesthetize. By "switching," some survivors are also able to work almost continually with minimal rest. Some report the ability to perceive paranormally.

Each identity within the same person may have unique neurological and physiological responses. For example, some identities may require glasses, while others have perfect vision: some identities are allergic to smoke, while others may be chain smokers: some identities are almost deaf, while others have exceptionally good hearing: different alters within one person will register unique electroencephalogram, electrocardiograph, blood pressure, and pulse readings. Alters may have different allergies and different ailments and unique responses to medications. One identity may be diagnosed with an ailment, but a different identity may be "out" when the medication is taken. In this case, the original alter isn't helped, and the receiving alter may have unfavorable side effects. Prescribing medication to survivors who are multiple should be done with special care and extra monitoring.

In the same way that alters protected the child, once survivors get to know their inner parts, most develop a strong reciprocal protectiveness and appreciation of them.

Clinical Diagnosis

Aftereffects of trauma are still being researched, and diagnostic terminology continues to evolve. Some existing terms are being retired and new terms are being proposed. In keeping with evolving trends and thinking, we will use the term post-traumatic reactions to indicate the overall condition; and the terms post-traumatic fear, dissociative experience, and dissociative identity to indicate the most prevalent reactions. Professionals are recognizing that post-traumatic reactions exist on a continuum, and many survivors use more than one coping strategy to survive. Trying to arrive at an exact diagnosis using existing terminology can be complex. It is sometimes more confusing than helpful to try to find the right "label."

The current list of specific diagnosis includes but is not limited to PTSD, also know as Post-Traumatic Stress Syndrome (PTSS); various dissociative disorders, which include Depersonalization Disorder, Dissociative Fugue, Dissociative Amnesia, and Dissociative Disorder-Not Otherwise Specified (DD-NOS); Dissociative Identity Disorder (DID), formally referred to as Multiple Personality Disorder (MPD); and catatonia or catalepsy. Regardless of which way or ways a child splits, the mechanism of repression and dissociation and therefore the basic approaches to treatment are the same. Recognizing this, the current trend among professionals is to group survivor post-traumatic reactions under a single umbrella that may soon get its own name.

Survivors have mixed reactions to the proposed changes. Many survivors have difficulties with change because there are so many selves affected, and each self has a unique reaction. Some worked a long time to accept and feel comfortable with the term multiple personality and so may be reluctant to change. Others prefer the term dissociative identity because it describes the coping strategy rather than the symptom. Some survivors also feel that it sounds less extreme than multiple personality, which has often been given sensationalized treatment in the media. The terms dissociative identity and dissociative experience help to desensationalize and normalize the survivor experience.

Avoiding Misdiagnosis

The most frequent misdiagnosis is identifying secondary symptoms as the primary problem. Because most survivors are not aware of their traumatic past, they rarely seek help for post-traumatic reactions. However, the aftereffects of trauma often include a variety of symptoms, which survivors usually identify as "the problem." Related secondary diagnosis' include depression, physical ailments, chemical dependency, and eating disorders.

The symptoms of unintegrated trauma are very similar to and therefore often confused with various personality or mental disorders. Common misdiagnoses may include: paranoid schizophrenic, borderline personality, bipolar personality, anxiety disorder, attention deficit disorder, clinical depression, and psychosis. While these conditions may be present in survivors, they, too, are often secondary, not primary, problems.

The list of physical problems identified as primary rather than secondary diagnosis is almost endless. Survivors may be diagnosed with or without corroborative test results. A common, although certainly not an exhaustive, list of misdiagnoses may include temporal lobe epilepsy, allergies, thyroid problems, dyslexia, genital problems, digestive and elimination tract disorders, chronic infections, skin disorders, and asthma.

Although it is important to treat all symptoms, treating the secondary diagnoses alone without addressing their traumatic source will not yeild satisfactory results over the long term. Unless a physician or therapist has made a point of learning the signs and symptoms of unintegrated trauma, survivors may remain undiagnosed or misdiagnosed for long periods of time. A recent study showed that it took an average of seven years before a person with dissociated identity was properly diagnosed. The best indicator of possible misdiagnosis, physical or psychological, is unresponsiveness to treatment.

Further articles of interest:

• Coping with PTSD by Joe Ruzek, Ph.D.

• PTSD in Children and Adolescents - a National Center for PTSD fact sheet