![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Dinah on June 13, 2003, at 20:54:45
And am getting such mixed messages. I've read books that seem very rational and calm about the idea of dissociation. For example "The Myth of Sanity". Books like these seem to destigmatize the idea and remove the tabloid TV sort of sensationalism.
I've also read books by "experts" in the field that seem a bit odd. I've heard that some of these "experts" have had their licenses revoked and have suffered some hefty lawsuit losses.
And I've read some skeptics literature that says that units all over the country are being closed among tons of lawsuits. And that the new and latest treatment is to ignore any (for want of a better word) alters that present themselves. Which seems to me like a rather unkind tactic to take with a patient. It seems to imply disbelief. And I know that when I am faced with any disapproval of a mental health professional about something, I just don't talk about it with them. So I, for example, only mention my self injury to my psychiatrist in passing, if at all. Because his reaction is to ignore my mention of it. (I guess his idea is to not reinforce it). So the conclusion that these doctors reach - that ignoring the "alter" causes the patient to drop that symptom - seems like a faulty conclusion.
In short, I am vastly confused. There doesn't seem to be any professional consensus on the subject at all. And some of the experts scare me as much as the skeptics.
And while I don't meet the requirements for DID, I probably could be considered DDNOS, depending on the diagnostician I suppose. The whole thing makes me feel a bit ashamed about my experiences. For every single thing I tell my therapist, I retract three. :) He never makes me feel ashamed when I'm with him, and so I freely disclose. But afterwards I remember what I've read and feel embarassed and ashamed.
Why is there so little consensus on this subject? Haven't any studies been done? It seems to be even more amorphous than most areas in psychiatry. Do more therapists and psychiatrists believe in it or disbelieve? What is the self, and how divided is the normal self? Because most people do seem to believe that everyone has different aspects of themselves. When does division cease to be normal, and start to be pathological? How much is metaphor? Is amnesia the key component?
All my research on the subject fails to bring a consensus answer to these questions. It's frustrating.
Posted by deirdrehbrt on June 13, 2003, at 23:59:52
In reply to Been reading up on DID/MPD, posted by Dinah on June 13, 2003, at 20:54:45
I haven't seen agreement on the subject even from patients. I suppose that there is a huge variability in the condition, and that the difference in treatment comes from the researchers trying to pidgeon-hole the entire group of patients.
My therapist believes that each alter is keeping something crucial to the health of the whole. It needs to be explored. I haven't read a whole lot though, and I'm still learning. I guess that as things progress, I might actually develop my own viewpoint rather than adopting my therapist's.
Posted by Dinah on June 14, 2003, at 3:05:32
In reply to Re: Been reading up on DID/MPD, posted by deirdrehbrt on June 13, 2003, at 23:59:52
You are probably far wiser than I. I always want to pin things down. Find *the* answer. And so I probably read far too many things and from the therapist's perspective.
So far the only thing I've read that's helped is "The Myth of Sanity" since parts of that book really fit what I experience.
The rest of the literature either frightens me or makes me feel ashamed. I worry obsessively over whether my therapist is laughing at me. Or I do when I'm not with him. I don't feel laughter or disdain from him when I'm with him.
I just have that darn obsessive need to understand. It served me well with my OCD, but less well with my dissociative traits. :(
Perhaps I should just stop reading. Stop looking for the magic key. Start trusting my therapist a bit more instead of trying to guess where he's going with me, or what his motivations for each sentence are. Nawwwwwww. Don't think I can do that. Somewhere out there must be that magic key that will make everything make sense. :)
Posted by judy1 on June 14, 2003, at 11:05:18
In reply to Been reading up on DID/MPD, posted by Dinah on June 13, 2003, at 20:54:45
Dinah, I did some major reading too when I got the DD-NOS dx, so I understand the disagreements out there. My own shrink and therapist disagree with each other about DID, but my therapist has a lot more experience in this field, so I tend to listen to her. Yes, I think 'losing time' is a huge component, and personally the scariest for me. As far as SI, my therapist accepts it as my coping skill until I get others, she just wants me to remain safe and has provided me with names of sympathetic docs if I need stitches. We usually discuss it for a few minutes, like did I do it and if so when and how I felt. That is usually an indication that we need to back off in therapy, so it's important for her to know.
I truly don't understand you feeling shame, it's like any diagnosis- I mean I wouldn't wear a t-shirt proclaiming it :-), I just accept it and do what I have to to deal with it. Is this a personal thing on your part? Or does your doc's refusal to talk about certain things bring it about. I know I was frustrated with my own pdoc's outlook- like does DID exist or not- but I insisted he speak with my therapist and I feel he's a lot more open now You just have so many years invested with this doc and he has helped you, I think it's worth the effort to try and educate him more (if you think that's the problem). take care, judy
Posted by Dinah on June 14, 2003, at 11:24:16
In reply to Re: Been reading up on DID/MPD » Dinah, posted by judy1 on June 14, 2003, at 11:05:18
Oh, I don't want to give the wrong impression. My therapist is very accepting. He's worked with DID patients back when they were MPD patients in his prior job. He's pretty calm about anything I bring up. Way back at the beginning of our therapy, I got the feeling he didn't want to open that can of worms, so I talked around things for a long time. But I finally told him how uncomfortable it made me, and I guess it had been long enough that he wasn't afraid of creating an iatrogenic phenomenom, because he started being more accepting. Now he accepts what I tell him as being a true representation of what I experience. And he certainly wouldn't refuse to speak to me as whatever ego state I was in.
My pdoc is a different story. Based on his reaction to simple things like SI and suicidal ideation, I get the distinct feeling he would be a skeptic of dissociation. I don't know for sure because nothing could induce me to tell him about it. I tentatively started to tell him one day that I had problems with dissociation, and got no further than that before he had offered me an antipsychotic. I clammed up and haven't brought it up, and won't bring it up.
It's the literature that makes me feel ashamed. I guess I should never have done any reading. :(
Posted by deirdrehbrt on June 14, 2003, at 21:13:04
In reply to Re: Been reading up on DID/MPD » judy1, posted by Dinah on June 14, 2003, at 11:24:16
I think that the hard part about working with someone is trusting them to understand the degree and qualities of dissociation which we experience. Everyone is capable of deep dissociation, but most don't do it automatically when threatened or injured.
I suppose that it would be helpful if we could demonstrate by means of an injury that we can't feel, or some other tangible means for them to examine. I'm sure that most of us have experienced illness or injury that brought about questions from doctors or acquaintances as to how we were able to walk / function / handle the pain without being incapacitated by it.
The real problem is when we let these professionals who disbelieve our dx influence our own thinking. If our diagnosis isn't real, how can we be sure that the events that caused this defense mechanism actually occured? If dissociation is supposed to be caused by trauma or abuse, and if our dissociation is doubted by the professional we look to for help, then might we not begin to doubt that trauma or abuse?
I suppose that I'm fortunate in that I have a therapist who has worked with DID clients before. It was a psychiatrist who I trust who first recognized that I dissociate. The P-doc that I'm seeing now doesn't doubt DID. The greatest degree of doubt regarding my diagnosis has come from me. Part of that doubt is because I don't want to recognize the amount of abuse that I experienced.
I guess that what I am suggesting is that the most important people who need to believe is us. With that, we will be able to find the therapists who can help us. It is much more difficult though for those who haven't yet been diagnosed, and might be filled with fear because of the stigma, urban legend, and mis-information surrounding dissociative disorders.
I hope I'm making sense, but I'm real tired right now.
Dee.
Posted by Dinah on June 15, 2003, at 9:19:32
In reply to Re: Been reading up on DID/MPD, posted by deirdrehbrt on June 14, 2003, at 21:13:04
> It is much more difficult though for those who haven't yet been diagnosed, and might be filled with fear because of the stigma, urban legend, and mis-information surrounding dissociative disorders.
> I hope I'm making sense, but I'm real tired right now.
> Dee.You're making perfect sense, because that describes my fear precisely. I wish they would hash it out behind closed doors and come out with a consensus.
I have to confess that I was quite upset when I read that the new treatment was to ignore ego states. But then I realized that the practitioners who did that were so smug that they were right, because the patient quit telling them about it. When the truth is that I would quit telling them too. I would just hide my experience because I wouldn't want to deal with their disapproval. That wouldn't make the experience go away. And hopefully I'd find a new therapist.
Also the negative appraisals of patients by experts (for example, Paul McHugh) who seem to see the diagnosis as something only experienced by people with extreme dramatic and attention seeking behaviors put such a stigma on the whole thing.
But I *know* I'm not like that. I'm willing to admit that I might be wrong in how I organize and interpret my experiences. I'm willing to admit that. Goodness only knows I have no idea of how to interpret my experience. But whether I'm right or wrong, my way of interpreting my experience does not automatically link me with a lot of other personality characteristics. It's kind of like self injury. When you self injure, many diagnosticians automatically assume a lot of other things about you. And it's just not necessarily true. At least in one case, it stems more from an inhibited expression of emotion rather than a florid dramatic expression of it.
I'm really sorry, Dee, that you have so much abuse history to haunt you. That's something at least that I don't have to contend with. It must make things so much worse for you.
I hope this discussion doesn't upset you. I am just so frustrated with the lack of consensus. And so shamed by the views of some practitioners in the mental health community. And the fact that my therapist isn't one of them doesn't seem to help that shame enough.
Posted by judy1 on June 15, 2003, at 13:52:03
In reply to Re: Been reading up on DID/MPD, posted by deirdrehbrt on June 14, 2003, at 21:13:04
"The greatest degree of doubt regarding my diagnosis has come from me. Part of that doubt is because I don't want to recognize the amount of abuse that I experienced."
I couldn't agree more with that statement. My denial knows no limits at times and has really hindered any recovery I might have. As sympathetic as my shrink and therapist has been, I have stopped and restarted therapy so many times I've actually lost count. The simple truth is the more I speak about anything that has to do with my past (and I mean even discussing symptoms like flashbacks or dissociation), the worse I feel. And it's also the reason I go months w/o seeing either of my docs. I have absolutely no clue how to remedy it- I can't spend an hour discussing the weather.
Take care, judy
Posted by Dissociative Jane on June 16, 2003, at 17:16:51
In reply to Been reading up on DID/MPD, posted by Dinah on June 13, 2003, at 20:54:45
> And am getting such mixed messages. I've read books that seem very rational and calm about the idea of dissociation. For example "The Myth of Sanity". Books like these seem to destigmatize the idea and remove the tabloid TV sort of sensationalism.
>
> I've also read books by "experts" in the field that seem a bit odd. I've heard that some of these "experts" have had their licenses revoked and have suffered some hefty lawsuit losses.
>
> And I've read some skeptics literature that says that units all over the country are being closed among tons of lawsuits. And that the new and latest treatment is to ignore any (for want of a better word) alters that present themselves. Which seems to me like a rather unkind tactic to take with a patient. It seems to imply disbelief. And I know that when I am faced with any disapproval of a mental health professional about something, I just don't talk about it with them. So I, for example, only mention my self injury to my psychiatrist in passing, if at all. Because his reaction is to ignore my mention of it. (I guess his idea is to not reinforce it). So the conclusion that these doctors reach - that ignoring the "alter" causes the patient to drop that symptom - seems like a faulty conclusion.
>
> In short, I am vastly confused. There doesn't seem to be any professional consensus on the subject at all. And some of the experts scare me as much as the skeptics.
>
> And while I don't meet the requirements for DID, I probably could be considered DDNOS, depending on the diagnostician I suppose. The whole thing makes me feel a bit ashamed about my experiences. For every single thing I tell my therapist, I retract three. :) He never makes me feel ashamed when I'm with him, and so I freely disclose. But afterwards I remember what I've read and feel embarassed and ashamed.
>
> Why is there so little consensus on this subject? Haven't any studies been done? It seems to be even more amorphous than most areas in psychiatry. Do more therapists and psychiatrists believe in it or disbelieve? What is the self, and how divided is the normal self? Because most people do seem to believe that everyone has different aspects of themselves. When does division cease to be normal, and start to be pathological? How much is metaphor? Is amnesia the key component?
>
> All my research on the subject fails to bring a consensus answer to these questions. It's frustrating.Do you have a diagnosis?
Posted by Dinah on June 16, 2003, at 17:42:47
In reply to Re: Been reading up on DID/MPD...Dinah, posted by Dissociative Jane on June 16, 2003, at 17:16:51
I have only officially been diagnosed with Obsessive Compulsive Disorder and Cyclothymia. My therapist, who says he isn't authorized to diagnose, says if he would say DDNOS if he were authorized. I don't mention this to my psychiatrist. It's not a medication issue, and I don't think he'd care for it very much.
Posted by Dissociative Jane on June 16, 2003, at 18:59:19
In reply to Re: Been reading up on DID/MPD...Dinah » Dissociative Jane, posted by Dinah on June 16, 2003, at 17:42:47
> I have only officially been diagnosed with Obsessive Compulsive Disorder and Cyclothymia. My therapist, who says he isn't authorized to diagnose, says if he would say DDNOS if he were authorized. I don't mention this to my psychiatrist. It's not a medication issue, and I don't think he'd care for it very much.
This is so interesting to me. My original dx when I began therapy was major depression by my p doc and therapist. My pdoc however brought up "dissociation" with me one day and said I need to work with my therapist about this. my therapist and pdoc are within the same practice and have discussed my case. It was during my last appt with my pdoc (2 months ago) when he actually wrote the DSM codes 1. Major depression
2. DID. I didn't recognize the code # so I looked it up and found that the code was for DID.
Anyway, I'm just trying to feel well.
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.