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Dissociative Identity Disorder: Triumph Over Life’s Greatest Challenges Dr. Jerry Mungadze  Introduction
For a young child, life is viewed in simplistic terms. A loving family, a safe
environment, food and shelter, playing with friends, and not getting sick too
much, may be all a child is concerned about.
However, this simplistic view is sometimes disrupted by unfortunate experiences
which take away these very needs. The child may be traumatized or suffer
maltreatment. The child may encounter a natural illness that goes beyond what
the child can handle psychologically. The child may develop a learning
disability or other conditions that may cause them to isolate and withdraw and
retreat to an internal world where the child can create a safe world where
things are exactly the way they want it to be. In that world the child may
develop imaginary play mates.
Children naturally do this through their wonderful imagination. But when you
add, challenges as mentioned above, these imaginary playmates become the child’s
way of surviving and in certain cases the child learns to triumph over the
challenges in life through these internal friends, helpers, protectors, and
special achievers. Depending on what the child faces growing up, the responses
to these situations color the thoughts, feeling, and behaviors, of these
internal playmates, some may have negative thoughts, feelings, and behaviors,
but some will be positive and helpful and propel the child to levels otherwise
not possible if the child had not used this genius way of coping.
Most people with dissociative identity disorder go on for years being
functional, and successful in what ever they do. In fact their coping mechanism
(the D.I.D.), or (M.P.D., or multiple personality disorder as it was called in
the old days), makes it possible for them to be successful. Those who become
aware of this in later years are able to see in retrospect how the D.I.D. helped
them through the years. They will also be able to see where the D.I.D. may have
caused them problems. This is the reason why people end up seeking treatment
because the coping mechanism may fail or develop problems.
There are possibly a lot of successful people in all walks of life including
show business who use this very coping mechanism to achieve what they have
achieved and for them they don’t see this as a negative and bad thing. If the
coping mechanism starts to give them problems, they may never go to seek help
because all that is ever talked about is how bad, crazy and bizarre D.I.D. is.
Negative View of D.I.D.
Most people are familiar with D.I.D. or M.P.D. through the Hollywood version of
it. Sybil, The Three Faces of Eve, Many Minds of Billy, The Many Lives of Trudy
Chase, and many other movies about D.I.D.. No wonder people with D.I.D. don’t
want to admit it. Who wants to be seen as crazy and out of control? Most people
with D.I.D. are normal people with normal jobs in your community. They could be
your pastor, your teacher, your lawyer, your congressman, your police officer,
your favorite movie star, or your professional athlete, or your therapist.
They are not running around screaming, pulling their hair out and fighting with
people, as depicted in the Hollywood movies.
Clinical View of D.I.D.
The clinical view of D.I.D. is based on the (DSM) Diagnostic Statistical Manual
which is the diagnostic authority on mental disorders. The focus in the DSM is
on the pathology rather than adaptation. However, the clinical literature in the
field does address the adaptation qualities that allow some D.I.D. people to
function reasonably well. But, even in the clinical literature a lot of
attention is still focused on the pathological aspects. It is important that
adaptation be considered a big part of the overall view of D.I.D. because
adaptation is the coping mechanism of the disorder that allows people with DID
to go on with their lives just like everyone else.
It is also important at this juncture to mention that the symptoms of D.I.D.
mentioned in this paper do not apply to everyone who has D.I.D. And a lot of
these symptoms are not always expressed outwardly to where everyone sees them
(See Table I.). This is the reason why people wonder why they did not see the
D.I.D. in their loved ones. Research indicates that only 20% of those diagnosed
with D.I.D. have obvious symptoms leaving 80% with hard to detect symptoms.
Research also indicates that most people diagnosed with D.I.D. are not eager to
get the diagnosis contrary to the notion that they are trying to get attention.
Research also indicates that D.I.D. is a childhood disorder developed in
childhood contrary to the notion that therapists create it in their adult
clients .
Table I
Skepticism About The Diagnosis
The skepticism in the general public is understandable given the difficult
nature of diagnosing the disorder. However the skepticism among mental health
professionals is both confusing and disturbing to people diagnosed with the
disorder. D.I.D. has been in the DSM since 1980, it would appear that there
should not be any discussion about its validity since its inclusion in the DSM.
It would make sense if the skepticism was really about "who" has D.I.D. instead
of its existence. This level of skepticism is disturbing because it’s the same
as the President of South Africa, who declared that HIV and Aids does not exist
in his Country, even with thousands of his people dying from it. He angered the
international community with this level of skepticism.
This level of skepticism is disturbing also because research indicates that the
skeptics tend to treat their other mental health professionals who believe in
the diagnosis unprofessionally, and with disrespect instead of disagreeing
agreeably.
A lot of the skepticism focuses on the many different treatment approaches used
by many different mental health professionals. Anyone who is an expert in the
field knows that over the 28 year history of D.I.D. treatment, there have been
treatments that were bad, ineffective and at times unethical that professionals
and lay people have used. A lot of the controversy about the treatment centered
around memory. The memory issue is too big to discuss here but it needs to be
mentioned that people have difficulty believing some of the things D.I.D.
patients disclose as memories from the past.
Every day the news papers are filled with horror stories of abuse; A child being
thrown into the fireplace headfirst, babies being born, dismembered and left in
garbage cans. Children being killed at the hands of live in, common law spouses.
There was a story in the news, of a 4 year old child, whose mother had a live in
boy friend who took the child, tied him by his feet, hung him upside down in a
closet for months, until the poor young child died. when they found him, he was
malnourished, his pelvic and collar bones were broken, and he had head injuries,
amongst many others. The boyfriend convinced the mother that the child was evil,
and that he must be punished. The mother did nothing to stop the boyfriend.
There have been children found living in small, hidden rooms. Most of them are
girls, and they were sexually abused daily. Sometimes, these very children live.
They are called "survivors" for a reason. Why then does the American population
doubt the possibility of child abuse in this Country? Although there are several
explanations for the memory debate, the point to make about the diagnosis is
that memory discrepancies validate the existence of the disorder rather than
invalidate it.
Current Treatment Approaches
Dissociative disorders are among the most researched disorders and the majority
of the research is focused on treatment and a better understanding of them and
other trauma related disorders such as Post Traumatic Stress Disorder (PTSD),
and Acute Stress Disorder (ASD).
Dissociative identity disorder, or D.I.D. which is the most severe of all
dissociative disorders, is sometimes confused with Post Traumatic Stress
Disorder. Although they are both trauma based, they are not the same. People
with D.I.D. may have PTSD symptoms but people with PTSD do not have D.I.D.. Many
people with PTSD may experience some dissociation but not enough to meet the DSM
criteria for D.I.D.. PTSD can be developed at any age through the life
developmental cycle but D.I.D. can only be developed in childhood.
There is a professional organization, the “ISSTS”, “The International Society
for The Study of Traumatic Stress”, that focuses on the treatment of traumatic
stress disorders such as PTSD, Acute Stress Disorder (ASD), including combat
stress, and anxiety experienced by a percentage of men and women in combat.
The Vietnam war brought the awareness of PTSD to the world and now the Iraq and
Afghanistan wars are bringing both PTSD and ASD to the world. Although D.I.D.
and PTSD share certain symptoms (see TABLE 2), they are not the same.
Table 2:
Most mental health professionals who are keeping up with current trends in
treatment are aware of the need to use evidence based treatments. The
international Society for the Study of Trauma and Dissociation (ISSTD), which is
arguably an authority in the field, has treatment guidelines that serve as the
standard of care. There is nothing bizarre or unusual about these treatment
guidelines. Most of us who are members of the ISSTD abide by them.
The focus on treatment is basically summarized in three phases.
Phase one, includes helping the D.I.D. client stabilize what ever acute symptoms
or crisis that brings them to treatment. These crises are usually caused by the
breakdown of that genius coping mechanism. This stabilization also targets
improving the clients quality of life which includes functional ability and or
managing negative thoughts, behaviors, and feelings if needed.
Phase Two, includes dealing with presenting memories of what ever caused the
D.I.D.. This includes helping clients deal with flashbacks, body memories, and
other mental and emotional issues that arise due to the traumas that may have
caused the D.I.D. or in cases of Post Traumatic Stress Disorder the PTSD.
Phase Three, includes dealing with beliefs, thoughts and behaviors resulting
from the traumas that may have caused the D.I.D.. At this phase as the client
begins to resolve these issues, they rely less and less on dissociating and
begin using healthy ways of coping and eventually the dissociation represented
by the different personalities will be replaced by a unified presentation of
life and the person goes on with their life dealing with life’s problems like
everyone else.
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