THE CURRENT EPIDEMIC of dissociation is a senseless one. Here is an illness that can be treated and cured and yet is so widely undetected or misdiagnosed that the waste, in terms of both human dysfunction and money misspent on inappropriate health care, is tragic. This book is a first step toward ending these unnecessary losses.
The three in-depth case histories have shown how a dissociative disorder often underlies a presenting problem and, because it is not recognized or treated, reaches a point where the patient needs to be hospitalized or suffers some other serious consequence. The first case history patient, Nancy L., had been treated for attention-deficit hyperactivity disorder for nine years before she broke down completely. She was taken to an emergency room in a crisis state and was spared hospitalization only because her psychiatrist suspected a dissociative disorder and referred her for a SCID-D that resulted in a diagnosis of DID and appropriate treatment. The second case history patient, Linda Α., had received therapy for a long history of anxiety and panic attacks. Not until a violent overreaction to a police incident almost landed her in jail was she diagnosed with DDNOS and for the first time treated successfully for her dissociative tendencies associated with being raped in adolescence. Jean W., the third case history patient, had been treated for anxiety and drug and alcohol problems earlier in her life and wound up in the ER with a severe panic attack at the age of forty. Had her real illness, DID, not been diagnosed and treated, in all likelihood she eventually would have found herself in the ER again.
Stories like this abound. One of my DID patients, a first-time mother in her late twenties and wife of a physician, was given electroshock therapy over my objections for what her husband thought was postpartum depression. The shock treatments worsened her condition and caused a six-month setback with uncontrollable flashbacks of a gang rape she suffered when she was a young schoolgirl. And then there was Dorene, who was written off as “crazy” by her own daughter for seventeen years because she thought intruders were breaking into her home and moving her personal belongings around. Originally misdiagnosed as having a paranoid disorder, she was finally referred to me for a SCID-D that confirmed my earlier suspicions of DID. Now in her sixties Dorene is being treated at the clinic by a therapist who has been advised of her dissociative disorder, and she is finally receiving the therapy she needs.
A wrong diagnosis can result in keeping a person immobilized—remaining in therapy for years and years without being able to make appreciable progress. Antidepressant and antianxiety drugs can help the person function in a going-through-the-motions state of chronic depersonalization—a kind of permanent “stuckness”—but the ability to engage fully in nurturant relationships and in the development of one’s own talents will be seriously compromised.
Meredith, the woman mentioned in the chapter on the four C’s of treatment as an example of someone who had a distorted belief about gender and developed a male alter, fell victim to this predicament. At the age of thirty-eight, after ten years of treatment with a psychiatrist, she had two master’s degrees in biology and was working at a dead-end job, was still living with her parents, and had never been intimate with a man. Concerned about her lack of progress, she volunteered to participate in my field study on dissociation. The SCID-D revealed that Meredith had severe dissociative symptoms that started in her childhood. She had a little boy, Donny, inside her who went to an imaginary psychiatrist because he kept cutting himself. Meredith herself wasn’t a cutter, but Donny was. Her real psychiatrist, a kindly man who didn’t believe in dissociative disorders, dismissed Donny as simply a figment of her vivid imagination.
When Meredith’s psychiatrist retired, I began seeing her regularly. I discovered that although Meredith hadn’t been sexually abused, the emotional abuse she’d suffered had severely impaired her sense of self. Her mother constantly flailed away at her for being fat and homely—actually she was a bit overweight, but had a cute face and sweet demeanor—and forced her to be her nursemaid for a variety of ailments, terrifying young Meredith by screaming in pain whenever she attended her. Her mother was also one of those people who believed that boys could do everything, but girls could not, and gave her brother free rein while holding her back. As a consequence Meredith developed Donny, a blond-haired, good-looking little boy who was self-assured at times but who also had a great deal of pent-up rage and aggression that he turned upon himself by being a cutter. He was an elaborate invention that protected Meredith from self-mutilation and severe depression.
From the start Meredith’s alter, Donny, a child who was afraid to be on his own, became an integral part of therapy. By learning how to comfort Donny and other childlike parts of herself, Meredith was able to overcome her terror of living on her own as an adult. Within six months of treatment—after ten years of being immovably stuck—she was able to move out of her parents’ home into her own apartment, enter a doctoral program in her field, make many friends, and begin navigating the possibility of an intimate relationship with a man.
One of the most tragic and common clinical mistakes is misdiagnosis of a person with DID as a schizophrenic. People with DID perceive the voices of alters as internal phenomena and are oriented in reality, whereas schizophrenics are out of touch with reality and may hear voices of others—CIA agents, for example—perceived as emanating from outside sources and invading their brains. Silencing a multiple’s separate parts with antipsychotic medication instead of working to integrate them can reduce a person whose illness has a good rate of recovery to a nonfunctioning zombie. One such woman, among countless others, a skilled nurse who had DID. was so badly mistreated as a schizophrenic that she stopped working, lost her house, and ended up totally incapacitated in a psychiatric institution.
By contrast, Albert, a mild-mannered man in his early fifties, entered a clinic near me with a diagnosis of schizophrenia, and I was called in to consult on the whopping dose of four different antipsychotic medications that he’d been taking for twenty years. Albert said his doctor had prescribed these drugs for him to get rid of an angry man he had inside of him—someone he called Son-of-a-Bitch—who drove him out of control whenever he came out. I evaluated Albert and, on the basis of my findings, told him that he was not schizophrenic and that I would work with him in a different way. The objective was slowly to reduce the medications he’d become psychologically dependent on after so many years by learning more about Son-of-a-Bitch instead of trying to get rid of him.
The first step, I told Albert, was to begin to refer to the man inside him in a much more respectful way if he didn’t want this angry person to cause such havoc when he came out. I suggested that he consider a different name for Son-of-a-Bitch and sent him home in the care of a social worker. Two weeks later I saw Albert, and the name he’d come up with was Bad Temper. That was an improvement, I acknowledged, but it still wasn’t completely respectful. Albert thought for a moment and said, “Okay, how about Temper?” I told him that was much better.
Albert continued therapy with the social worker, learning more about Temper. When I saw him several months later, the name had changed once again. It had become Mr. Temper. A year later, after several reductions in Albert’s medications, his social worker told me that Mr. Temper no longer existed separately within him.
The rapidness of this progression was remarkable, but the treatment probably worked so well for Albert because it was such a radical departure from the grossly incorrect treatment he’d had. His case shows how we can prevent the tragic waste of life of many creative people with DID by teaching them how to communicate with their different sides and integrate them instead of trying to suppress them with drugs alone. Research has shown that patients spend seven to ten years or more in ineffective treatment, often shunted haplessly from one therapist to another until their dissociative disorders are correctly diagnosed. This is a fate that you can prevent for yourself or a loved one simply by asking to have the SCID-D assessment done.
In addition to sparing needless human suffering, proper diagnosis and treatment of dissociative disorders can prevent a shameful waste of public money. A 1984 study revealed that 47 percent of patients with inaccurate diagnoses required hospitalization before their DID was discovered, compared with only 19 percent who needed to be hospitalized during treatment after an accurate diagnosis. The average cost of a two-week psychiatric hospitalization is fifteen thousand dollars. Since misdiagnosed people may require several hospitalizations, it is easy to see that taxpayer-supported hospitalizations and insurance costs could be greatly reduced by early diagnosis and proper treatment.
As an informed individual you have the power to prevent these unnecessary human and financial losses. Now you can identify dissociative symptoms, whether in yourself or someone you love, and seek out a professional who is qualified to make an accurate diagnosis and provide the care that can make the difference between bare subsistence and a life abundantly lived.
Beyond that, you can help put an end to our current epidemic of dissociation by striking a blow at its root cause—the inexcusably high incidence of childhood abuse and trauma in our society. The sexual, physical, and emotional abuse of helpless children by those entrusted with their care is an evil that no one should turn away from any longer. We cannot continue to tolerate a system that protects abusers and denies or downplays the mistreatment of children. We collude in this atrocity by our silence or skepticism. Decency demands that we speak out for all those mute survivors whose childhood, a time that should be filled with happy memories to cherish in the mind’s eye, is instead a shameful secret that they dare not see at all. Our disconnection from the truth, like theirs, is waiting to be healed.
