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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by alexandra_k on March 27, 2005, at 16:56:13
aka:
System Indeterminacy and Interpretive Constraints.
Am trying to adapt this for a seminar.
Comments, suggestions, criticisms etc etc most welcome :-)Dissociative Identity Disorder (DID) has generated a great deal of controversy within and across the disciplines of psychology, psychiatry, and philosophy. Within mainstream psychology and psychiatry two dominant theories of DID have emerged as providing an account of etiology, a conceptualization of alters, and a proposed course of treatment. While accepting one of the positions on a single aspect of the disorder (such as etiology) does not logically commit one to that same theories position on another aspect of the disorder (such as treatment), theorists typically consider that one is forced to choose between these two ‘rival accounts’ taken as package deals. I shall begin with a summary of these received views before I go on to offer an alternative conceptualization of the alters that are the distinctive feature of this diagnosis.
1.1 The Post-Traumatic Model
The post-traumatic account originated from the work of theorists / clinicians in the 1980’s. Braun, Kluft, Putnam, C*ons (go go automated asterisking heh heh), and Bliss are cited by Ross (1989 p. 50) as important figures in re-establishing clinical interest in DID (formerly Multiple Personality Disorder) as a legitimate phenomenon. These theorists have gone on to write seminal work on the disorder in the form of papers and treatment manuals. While there are points of difference in emphasis and detail between supporters, there seems to be a general consensus on an overall view that has come to be known as the Post-Traumatic account. Gleaves, (1996 pp. 42-59) has recently written in defense of this account and I will focus largely on Gleaves rendering as he writes in clear opposition to the alternative theory and he seems to be fairly representative of the Post-Traumatic line.
According to the Post-Traumatic model alters originate in childhood when individuals with a diathesis for dissociation encounter severe, repeated trauma (Gleaves, 1996 p.2). The child is thought to dissociate aspects of their experience from conscious awareness as a protective coping strategy. If the experiences were accessible to consciousness, or impinged on the child’s consciousness then their functioning would be severely impaired. As an example, an abused child may need to dissociate from abuse in order to behave trustingly to an abuser at other times in order to ensure that primary needs, such as those for food and shelter are met (Gleaves, 1996 p. 2). Because the strategy is successful (in that in enables the child to cope) the dissociation is reinforced. Because of the extreme and repetitive nature of the abuse the child comes to dissociate more often, and in these times their behavior is governed by these alternative states.
It is a distinctive and defining feature of the disorder that these states develop an internal consistency and coherence of their own (DSM IV-TR, 2000 p.529). Alternative identities are thought to function to ‘contain memories’ of different kinds of experiences, and to act in ways believed to be required for the benefit of the child. One alter may be a passive and helpless recipient of abuse with access to distressing memories. Another may take responsibility for deriving pleasure from the abuse so as to behave in a manner that pleases abusers. Another may come out to ‘fight back’ by taking active steps to use force to protect the child’s body. Because different alters have different protective functions they have access to different memories, emotions, and goals; and thus they behave in distinctively different ways.
On this account alters are conceptualized as dissociated aspects, fragments, or parts of the greater self that is their summation. Dissociation is thought to be a highly creative and adaptive strategy that enables a child to deal with child-hood abuse that they otherwise cannot escape. It is thought to become maladaptive when it continues once the abuse has stopped, and the behavior of alters causes distress to the ‘main personality’, or alter who presents for treatment. The goal of treatment is the integration or fusion of these dissociated aspects into one largely integrated and consistent self of the sort exhibited by individuals without the disorder.
Posted by alexandra_k on March 27, 2005, at 21:26:14
In reply to Dissociative Identity Disorder, posted by alexandra_k on March 27, 2005, at 16:56:13
Just to give the above section its title.
Now. In order to observe the three post rule somebody will need to post me a response in order for me to be able to continue ;-)
Posted by sunny10 on March 28, 2005, at 7:57:27
In reply to (i) The Post-Traumatic Model, posted by alexandra_k on March 27, 2005, at 21:26:14
so what do they call it when a person disassociates but does not create alters???
Just kind of loses reality from time to time....or does that even happen?
I'm asking because there have been times of trauma that I remember, but others who were there remember it differently... is one of us disassociating?!?! And how much does perception have to do with disassociation?
I can't remember any "memories" from childhood at all. I have pictures, and I've been told stories about the pictures, but I have no memories at all...
But I don't have any alter personalities... I guess what I'm asking is whether it is possible to be considered DID without multiple personalities.
Posted by alexandra_k on March 28, 2005, at 15:43:08
In reply to Re: (i) The Post-Traumatic Model, posted by sunny10 on March 28, 2005, at 7:57:27
You can use dissociation as a coping strategy without developing alters. There are a range of dissociative disorders. Dissociative Identity Disorder is just one of them. It is a defining feature of DID that there are alters, yes. But other dissociative disorders don't require that.
Posted by sunny10 on March 29, 2005, at 9:45:27
In reply to Re: (i) The Post-Traumatic Model » sunny10, posted by alexandra_k on March 28, 2005, at 15:43:08
thanks!
Posted by Pfinstegg on April 1, 2005, at 19:35:49
In reply to Re: (i) The Post-Traumatic Model » alexandra_k, posted by sunny10 on March 29, 2005, at 9:45:27
Very interesting discussion- and it sounds like an excellent thesis! Just to add to the range of what dissociative disorders are thought to be by some therapists now, they can range from a pretty mild ego state disorder, with sudden mood changes, representing the feelings of child-parts who have been traumatized at some time in the past, and continue to have their own responses to present situations, without knowledge of time having passed, towards more and more definitely dissociated "selves", which may be given separate names, and perhaps be separate enough to "lose time". The cause is always the same- trauma of some kind- whether neglect, physical or sexual abuse- or all of them. It really is considered to be a very resourceful and intelligent response to trauma which is too much to bear.
Speaking first hand, as someone with an ego state disorder, treatment is difficult, as, when you begin to explore what these below-consciousness states actually are, you feel much more pain and distress than when you had all the parts separated. I have young parts coming more to life, and into therapy, who hurt so badly that I sometimes think I can't bear it. That's where having a really good therapist helps- he/she understands that, and is so skilled at giving these separated parts a new experience of empathy, warmth and careful listening. I don't know how they have the ability to do it, as so many parts flash in and out of one's feeling and awareness so quickly. But they do know how, and your traumatized parts know that, so they increasingly dare to share their feelings and experiences. At first, they just share extraordinary amounts of pain, and new details of horrible experiences, but even that is better than having it inside you, and unconscious, or only partly conscious. I can't say much more right now, as I don't feel I have healed too much yet. Somehow, I believe I will, though. I told my therapist today that, even though things are hurting an awful lot now, I'm so glad I'm no longer trying to skim along the surface of a personality with such pain separated and hidden underneath. He gazed at me so kindly and tenderly; I knew how deeply he understood- more than any words he could ever have said.
Posted by alexandra_k on April 2, 2005, at 3:25:04
In reply to Re: The Post-Traumatic Model, posted by Pfinstegg on April 1, 2005, at 19:35:49
(((Pfinstegg)))
It has to get better.
I think I know what you mean about it being better to deal with it instead of just ignoring it all the time. I know its gotta hurt, but maybe it has to sometimes for people to be able to move on from that.
Posted by Pfinstegg on April 2, 2005, at 19:32:50
In reply to Re: The Post-Traumatic Model » Pfinstegg, posted by alexandra_k on April 2, 2005, at 3:25:04
Thank you, (((alexandra-)))! I really appreciate your kind wishes, as you have the understanding that comes from sharing the same kind of problems and challenges that I do. I have been following your very resourceful struggles to find a good therapist, and do hope the recent encouraging developments turn out to be real ones. I do think liking the sound of her voice is VERY promising! It goes straight to that right hemisphere and limbic system which probably contain the dissociative systems. Does that accord with how you think of it?
Posted by alexandra_k on April 2, 2005, at 21:08:42
In reply to Re: The Post-Traumatic Model » alexandra_k, posted by Pfinstegg on April 2, 2005, at 19:32:50
> Thank you, (((alexandra-)))! I really appreciate your kind wishes
You are welcome. I really appreciate yours too.
>I have been following your very resourceful struggles to find a good therapist, and do hope the recent encouraging developments turn out to be real ones.
Yeah. It is sounding promising. P-doc needs to get a proposal together and check I can't get alternative funding (which I am pretty sure I can't). He thinks that will take two weeks. Their only other objection was that funding me to have external treatment might be setting precedent for all those other people out there who could get better treatment from an external source. I think I managed to dispose of that by saying that at least those other people are getting some kind of treatment within the service but in my case there isn't anyone with some experience who is willing to treat me.
>I do think liking the sound of her voice is VERY promising!
Yeah. Me too :-)
I started to panic a bit that I might meet her and we might not click at all. But I did like the sound of her voice. She sounded really nice and sensitive and I really hope I can work with her.>It goes straight to that right hemisphere and limbic system which probably contain the dissociative systems. Does that accord with how you think of it?
I don't know.
I would like to learn more about neurology - I really don't know to much... I am not sure on the neuro-physiology of it all...You are more into that - right??
Posted by Pfinstegg on April 2, 2005, at 22:13:41
In reply to Re: The Post-Traumatic Model » Pfinstegg, posted by alexandra_k on April 2, 2005, at 21:08:42
I'm trying to learn more about it. The whole field is just exploding because of things like functional MRI's. This is all talked about with so much excitement at conferences and seminars but not a whole lot is published yet. When and if the studies are completed and validated, there will be a lot of amazing stuff published. But the hints of new information are already causing a lot of experienced therapists to rethink how they practice. The knowledge of the importance of the right hemisphere as the container of unconscious memories, traumas, and also joyful and meaningful relationships and experiences has caused a lot of therapists to put a much bigger stress on the importance of a feeling of a "good fit", and on how the tone of a therapist's voice, and the expressions on his/her face contribute to new emotional experiences and learning which can bring about healing. There's a much greater respect and awareness that all the non-verbal parts of interpersonal relationships are terribly important. Putting it all into words is probably only the last step. My therapist has been working with me in these ways- it is a very powerful experience. often very moving. As we go along. the words become less important, and the feelings much more so. He wants me to remember and feel again fully the things which made me ill. Then I get- or the traumatized part of me gets-a chance to know that things are different now. He is not going to hurt me. Even though I'm often afraid that I'll be too much, and that he'll want to get rid of me, I also know he never will. When I get angry, he remains calm but intensely interested in what made me mad. I can count on him looking at me with a warm, really loving, gaze, never failing to listen intently and letting me know that understanding me is his most important function.
Well, you know I do tend to go on about this, but I hope you find someone who can do this with you. It helps so much. I've been doing it for two years, and am amazed at how intense and painful it has proved to be. It's hard for me to think of myself as being really better yet, but HE thinks I am! And, strange as it may seem to say this, I look different. My husband says that my eyes are no longer so sad, and that I look "cuter"!. And somehow my hair is starting to look pretty, having been a disaster area despite monumental hairdressing efforts- my clothes are mysteriously prettier too!
Posted by alexandra_k on April 3, 2005, at 1:08:20
In reply to Re: The Post-Traumatic Model » alexandra_k, posted by Pfinstegg on April 2, 2005, at 22:13:41
:-)
I started really missing one of my old t's the other night. Really cried hard. I really didn't want her to go - but at the same time I realised that she needed to do what was best for her (and she turned down a job with the service to go to another region).
I didn't get very upset in our last meeting. I didn't want to make her feel bad.
But it really really hurt.
And I am still waiting...
We will see...
Posted by Pfinstegg on April 3, 2005, at 11:42:03
In reply to Re: The Post-Traumatic Model » Pfinstegg, posted by alexandra_k on April 3, 2005, at 1:08:20
I hope you will be working very soon with someone with whom you can share all that pain and eventually gain some comfort and solace. Even though they are very painful, all those feelings are so healthy and natural, and give you so much to work with. Think of the opposite- feeling indifferent and detached- that's so much worse. None of us can do these things quickly (think of Dinah, Daisy and me- and probably most everyone else). I was noticing that there is a funding time-limit. Is that renewable if you have found a good working partner? It would be so good not to have another premature termination.
Posted by alexandra_k on April 3, 2005, at 21:18:02
In reply to Re: The Post-Traumatic Model » alexandra_k, posted by Pfinstegg on April 3, 2005, at 11:42:03
Yeah, there is a time limit. P-doc was going to ask for 6 months. That was hard. I didn't think that was nearly enough time. t said one year. I was very pleased with her for trying to get more time out of them. Really pleased.
That is ok. I will probably be out of the country before that year is up anyways. But it should take me to the end of my time here.
I want to start with her NOW. It is so hard for me to think that she is there and I really really want to see her and she is willing to work with me but I still need to wait... It is so hard. But I need to be patient.
Patience.
AAAAAARGH.
This is the end of the thread.
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