March 23, 2010
So here we go again.
The second season of the Showtime series “United States of Tara” starring the Emmy Award winner Toni Collette has begun.
The first season was full of controversial episodes, and most of the survivor population with dissociative identity disorder was disappointed and angered by the series. Even though some of the best-known trauma psychiatrists were allegedly acting as advisors for the show, there were still far too many inaccuracies and misrepresentations for the comfort level of real DID survivors. (Maybe next time, Showtime, executive producer Steven Speilberg, or writer Diablo Cody should speak more with clinical therapists that treat dissociative clients on a long-term basis. If you ask me, therapists know more about the clinical realities of DID than psychiatrists anyway, but that’s a whole different rant.)
The first episode starts with Tara tossing out the clothing and personal items that belonged to her formerly recognized four or five insiders. Tara had ended the first season in the hospital, and had apparently done so well in her brief hospital stay, that it had been three whole months since her insiders had surfaced. She was sure they were all gone. She was already saying goodbye to them – more like good riddance to them – and her family gathered around the charitable donations dumpster to make crass comments toward the inside parts.
Oh dear. What a way to start the season. Fifty-one seconds into the show and my eyes are popping out with enough material for a blog post. (Dare I even watch the rest of the episode?!) Yeeesh!
So this very first minute of the show brought up some of my very biggest complaints about the way some mental health professionals and hospital programs treat DID / MPD.
One of the most devastating techniques that treatment providers can use with dissociative survivors is to push the whole integration idea. To push the idea that insiders need to not be allowed out, or need to be silenced, or need to be pushed to the back, is damaging to the person as a whole. Integration is not anywhere near the cure-all or ideal goal it is professed to be, and frankly, expecting dissociative clients to having these “alleged integrations” too fast is absolutely harmful.
I have seen too this happen far too many times. This is not good treatment for dissociative identity disorder!!
You cannot go into a hospital program and walk back out, a few weeks later, as an integrated multiple. This is NOT possible. I don’t care how much this is advertised as possible, it is not. It is complete farce, and it will not work.
Sure, you can temporarily push your insiders back into hiding. Or, your insiders can push you out to the front and rebuild the dissociative wall behind you so that you are completely separated from your system. You might think you are alone. You might think you are “integrated”. But you are just separated from your insiders. In fact, you are more dissociated than ever because now you have a complete dissociative block between you and the rest of your selves.
This is not helpful.
Unfortunately, there are hospital programs or therapists that encourage this kind of treatment.
It doesn’t work. It won’t stick. Those inside parts are not gone. They might be hidden, but they absolutely are not gone. And this new or encouraged separation will just cause problems down the road. I’d bet money on that.
I realize that many of you may want to push your insiders back in, or make them shut up, or make them go away, because you believe that your life would be easier and more manageable if they were gone. I can understand the concept that having one personality is easier than having a dozen or two (or three) personalities. I get that.
But it’s still not a good idea.
The various parts of you were created for a reason, and they hold valuable pieces of your life, your history, your emotions, your skills, your abilities, your memories, your talents, your energy, etc. They represent years of your life, and it takes all of you together to make the whole picture – and as appealing as it might be to think that three weeks in the hospital can solve everything with a quick integration, this is an illusion and a lie. Genuine integration, if it is actually desired and if it is actually going to be successful, requires years of work. The various selves to work through all the things that caused them to be separated in the first place – and that just takes time.
It is a cruel trick for hospitals to sell this approach as something they can achieve for the client – because the hospital won’t be there six months or a year down the road, when the apparent “integration” falls apart and the devastated client is left feeling at fault. And it is compounding the wrong for Showtime to present this approach as something that actually happens.
The other problem in this first minute of United States of Tara is the negative way that Tara and her family are speaking about her insiders. Where is their kindness and compassion? Why such blatant disrespect? Where is the appreciation for what those insiders did for her?
EVEN IF I believed in sudden or quick integration as a general theory (which I most definitely do not), I would still say to Tara and her family members that their “good riddance, you big pains in the butt” attitude was an obvious indication of why this particular attempt at integration was not going to work.
Clearly, there were still plenty of issues left unresolved. Clearly, Tara and her family harbored resentment, irritation, and bitterness toward her insiders. The insiders did not integrate because there was acceptance, understanding, and blending of their roles. These insiders were clearly not wanted, not liked, not understood, not appreciated. They were hated. And if Tara is still hating on her insiders, then she is still hating herself. This is not the kind of foundation from which any kind of healthy progress is made.
You cannot integrate your insiders if you hate them.
You cannot make them go away, just because you hate them.
I suppose you can pretend they do not exist because you don’t like what they did. But that will not help you to get better.
I suppose you can act like they are not real because you don’t want them. But that will not help you to get better.
Hating on your insiders, in any way, shape, or form, is not conducive to good treatment.
Hating your yourself, in any way, shape, or form, is not conducive to good treatment.
Your insiders are still parts of you, now and for always.
As far as I am concerned, neglecting your insiders is a form of self-abuse. Neglect is neglect, and if you are not working hard to appropriately meet the needs of your insiders, you are carrying out of form of neglect.
It is so very important to develop positive acceptance and understanding with your insiders. It is imperative to the success of your healing, and one of foundations of your treatment, to be kind, gentle, and compassionate to your inside parts. Build positive teamwork. Build good cooperation. Build good internal communication skills. Become friends with each other. You and your insiders really have to be able to get along and work things out together in order for your healing to progress.
Somehow Tara forgot to do this, and somehow her hospital program forgot it as well.
She can pretend that shoving her insiders away, or pretending they don’t exist, is a wonderful option for her.
But it really will not work.
Later in the previews, it becomes clear that Tara starts realizing she is switching again. (She calls in transitioning. What a bulky word, but ok – it’s a transition from one self to another.) So yes, she clearly switches from one part to another. That’s no surprise.
Someone on her treatment team should have told her months ago that that her “they are gone” approach wasn’t going to work.
Because it didn’t.
Kathy Broady LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
February 28, 2009
This week, the readers here have posted a wide variety of reactions to the idea that being multiple could have benefits. If you haven’t yet read all the comments on that blog, please do so. They are very interesting.
When people have DID/MPD, they have experienced life as a multiple since their childhood. It is their norm – basically the only way of life they know. Multiples typically have not experienced life any other way other than being multiple, even if they didn’t realize they were as split as they are. Sure, one or two of the host personalities may not have a strong personal connection to what it’s like to be multiple, and many of them can deny the existence of the internal others to some degree, but the internal system as a whole would have been there for nearly your whole life.
And frankly, many DID’ers that are newly diagnosed just haven’t realized how much they have been switching their whole lives long. But just because they haven’t recognized their dissociative abilities doesn’t mean that they haven’t been living their life as a very active multiple, switching, possibly losing time, and putting amnesiac walls around anything that is too uncomfortable for them.
So what if you are dissociative and you really really detest being a multiple personality? What if you can’t stand being DID/MPD, and you hate it, and you despise it, and you make sure that everyone in your system knows it, and that everyone in your treatment support team knows it too?
- How does that affect how your internal system views you?
- Will they feel loved and accepted?
- Will you feel good about yourself?
For sake of argument here, let’s be sure to separate the fact of being dissociative as being very different from being traumatized and abused. I will clearly and adamantly acknowledge that no young child likes the trauma and abuse that happens as the first step in the process of creating various alter personalities. I am not proposing that the road to becoming DID is a pleasant one. It clearly is not. The very idea of being forced to become a multiple is horrifically tragic in itself. Any trauma, abuse, neglect, violence, horror, pain, that you’ve gone through is too high a price for anyone to pay.
Often the fact of being multiple becomes inextricably entangled with the fact of having been abused. The multiplicity comes to represent all the pain and fear and wrongness of the abuse, and rejection of the multiplicity is part and parcel of rejecting the reality of the painful past that caused it.
But how do those feelings of adamant rejection affect your healing?
One of the ways to treat and understand multiplicity is to join in, to some degree, with the idea that the alter personalities are their own individual people. Of course they are all connected to the same one person, but you can balance that out with also seeing each of the insiders as their own unique person. How would an outside person feel if they were treated the same way your insiders are being treated?
If your internal parts know that you hate the fact that you are multiple, might they begin to internalize that feeling as if you hate them? I would think so.
How would you feel if you were repeatedly told that you were disliked and unwanted and despised? Remember, your insiders don’t have to be told these things in actual words. They are connected to you, and they will know how you genuinely feel about them, whether or not you make a point of telling them. They will be able to feel how much you don’t like them. You will not be able to hide this fact from them.
How would you feel, if day after day after day, the people that you lived with refused to speak to you? Or to acknowledge you? Or to care about you? Would you feel cooperative? Would you want to be friendly and helpful? At what point would you lose your patience and tolerance? How might you act when that happened?
In this context, if you have Dissociative Identity Disorder, and you also firmly believe that multiplicity in itself is a horrible way of life, that strong pervasive belief will negatively affect your treatment progress and your healing. How could it not? Your insiders are aching for acceptance and kindness and comfort no less than you are – and constant rejection can and will make them continue to act out in resentment and anger and desperation. Nobody else’s acceptance will ever mean as much to them as the acceptance of their own group – their own self – and if that is perpetually withheld from them, then both they and you will be at a self-created stalemate in your healing.
Because the flip side of treating your insiders like individual people is remembering that they are the same person as you.
If you are repeatedly telling yourself that you hate the way you are, what does that do for your self-image and self worth?
If you believe that the way you are is not ok, not good enough, not right, not acceptable, not normal, then you are reinforcing a lot of negative beliefs of yourself – and it is a short road from having a low self-esteem to have a ton of self-hatred.
- What if hating your multiplicity is a version of hating yourself?
- What if accepting your multiplicity is a version of accepting yourself?
Multiplicity is simply what it is – the fact of having more than one personality / “person” in your head. In my opinion, it does not have to be a bad thing. The trauma and the abuse were devastatingly bad – absolutely. The dissociative walls can really cause problems in the current day, even if they were initially helpful. The PTSD, anxiety, depression, and other emotional fallout can be debilitating at times.
But the multiplicity – just the multiplicity… does it have to be bad to share your life with others?
Again I ask….
Is accepting your multiplicity “as is” a version of accepting yourself?
Kathy Broady LCSW
January 17, 2009
This blog is a continuation of the initial article posted on December 31, 2008, “25 Ways to Avoid Self-Injury and Prevent Self-Harm.”
If you are feeling pressured to get past the “heat of the moment” and you need some ideas of how to do this safely, try using a handful of the following ideas. These ideas will not help solve your self-injury issue on a long-term basis, but they could help you to get through the actual moments when you are feeling at the highest risk. Safe distractions that also provide some element of emotional expression are a good balance.
- Find a brick wall (or any kind of strong wall with no windows), and kick a soccer ball against the wall. Consciously put the anger you are feeling into the ball as you kick it. The cracking sound of the ball smacking the wall can be satisfying as well. The louder the better!
- Use handfuls of ice, ice packs, or cool cloths to soothe and calm yourself. Some people may find warm cloths or heated warm towels more comforting. Changing a physical sensation in your body and concentrating on that may help to calm your frayed nerves.
- Put your anger into something useful — be more assertive with utility companies that aren’t doing their job, or tackle other external household issue that need a more aggressive approach. I’m not necessarily promoting being rude to someone who doesn’t deserve it, but you might be able to constructively resolve an existing problem with your added energy and intensity.
- Color or draw. Small, repetitive movements are soothing and calming, and you might learn something from your picture. The others inside might tell what they are upset about through the drawing that is made.
- Dance out your feelings. Use strong energetic body movements to release the adrenaline and to wear yourself out. Pick music that fits your mood. Sing along if you can – the voice release is good too.
- Write a long letter to your abuser(s). At this point, write these letters with plans to NOT send them. The point is not to set up a confrontation. Let your focus be on expressing your feelings about what they did to you. Write the things that you might never have the courage to actually say to them in real life. When you are finished, you can read the letters out loud repeatedly. Use intensity in your voice. Let yourself say the words with emotional honesty and genuine expression.
- Get obsessed with some safe activity — for example, do in-depth research on a particular subject on the internet, pull every weed from your yard, wash every dish in your cupboards, pace 10,000 steps, etc.
- Count those annoying little doodads on the ceiling, and when you lose count - which you will – start over.
- Do puzzles (the harder the better). There are lots of free online jigsaw puzzle sites if you do not have any actual puzzles in your home.
- Practice relaxation, yoga, and deep breathing exercises. Take long, slow, deep breaths. Inhale deeply and slowly, hold for a few counts, then release your breath slowly. Do this until you can feel yourself calm down.
- Play video games, and take your aggression out on beating the game, or smashing and bashing the other “enemy” characters in the games. Time away “in another world” can help release the pressure you are feeling right now in your world.
- Clean out your fridge or freezer, scrub it, making it clean and organized. This same idea can be applied to closets, or drawers, or bookshelves, etc. Getting involved with a complicated household task will give you another focus, a place to put your energy, and a positive sense of accomplishment when you are finished.
- Alphabetize your books, CD’s, Videos, DVDs, etc.
- Hammer nails into a piece of lumber or old tree stumps until you are exhausted. Watch your fingers – the idea is to NOT do any self-injury! The physical movement will be helpful, the noise will be satisfying, and if you speak about your anger and upset while you are banging away, you will be expressing your feelings at the same time.
- Wash your vehicle, your outside windows, your driveway, your floors, etc. The physical movement helps, and the accomplished feeling of being clean afterwards can help lift your mood.
- Go sit in the waiting room of a hospital, and read a book or magazines, and sip on coffee. You do not have to talk to doctors or any of the hospital staff – people will assume you are there waiting for someone who has an appointment. Just being in a calm, safe place can help.
- Take the time to groom your pets and give them treats. Try teaching your dog a new trick.
- Do something for yourself that makes you feel pretty, such as brushing your hair, doing your nails, getting your hair cut, coloring your hair, wearing perfume, etc. When you feel lousy, try doing the OPPOSITE of that by doing something that helps you feel pretty.
- Make something creative. You might have to pre-plan this, or have some options available just around the house. Finish a paint-by-number picture, work on needlepoint or sewing projects, try beading, learn how to make your own jewelry, etc. Getting creative will help distract you and put you in a better frame of mind.
- Do a collage. It is amazing what comes out in pictures, and you might not have realized what was going on in the background. The collage might explain it to you.
- Do acronym writing exercises. These might help you uncover why you are feeling so terrible while expressing some of the pain. Expression often eases the pain.
- Hold a frozen orange. Feel the coldness. Look closely at the frost on it. Hold the frozen orange where you wish to SI. Scratch the orange, smell the aroma. Look at bright orange color. Count the little dots in the orange peel. As you feel better, allow yourself to eat the orange and throw the peelings away.
- Throw water balloons at a fence, a wall, or a tree and watch them explode. As you throw each water balloon, make a comment about something you are upset about. Use your body and your voice to express your feelings.
- Build a model car or airplane or create something that takes a lot of detailed mental focus.
- Go to the library or book stores where it’s fairly quiet, but people are around. Make a list of 100 books you would like to read at some point in time. Or pick five books from each aisle that you would be willing to read. You can browse for hours, and no one would think anything of it. The same kind of book browsing could happen at online book sites as well.
Stay busy – do things over and over from these lists until you feel safe enough to manage your self-injury impulses. Sometimes just getting past the peak time will be enough to keep you safe.
The more you work on emotional expression in an ongoing way without allowing it to build up to a critical numbing point, the better. One of the biggest keys to resolving self-injury issues is to increase your emotional endurance. The more you can sit with your feelings, the less you will have to hurt yourself to numb them away.
Kathy Broady LCSW
December 27, 2008
Thanks for coming back and reading more of the Discussing Dissociation blog. It’s exciting to see the number of site viewers growing each week – I think you all must be spreading the news! I appreciate all of you who have already become regular readers, and thanks for telling your friends.
As a follow-up to yesterday’s post about giving- making- creating- providing new and positive experiences for your internal child parts, I want to encourage all the multiples here to expand that idea to include your whole system on an even wider scale. This idea applies to non-multiples too, of course, but since we are “discussing dissociation” here, I’m going to write about these idea within the context of DID / MPD.
I have found that most dissociative trauma survivors have a fair bit of trouble understanding how to be genuinely kind to their inside people. It is very similar to being nice, and kind, and accepting towards outside people, but the effort gets directed to your own insiders instead of outside people.
I could explore the many different reasons for this. Is it because your family treated you so poorly? Were you so hideously neglected that taking care of yourself is truly a skill you have yet to learn? Is it because you truly believe you don’t deserve anything nice? Is it that you are full of self-hatred that you won’t be kind to yourself? Is that you are so angry at anyone (everyone?) that it is easier or essential to take it out on yourself? I don’t know. I’ll leave those questions with you to think about.
For now, I want to focus on what kind things you actually do for your internal system.
- What do you do to be nice to your inside people? What did you do this week?
- What do you do to show the others in your system appreciation and kindness?
- What do you do to encourage them through the hard parts of therapy work?
Think about all the different kinds of things you can do for your people on the inside. Your internal world — your internal landscape — is totally your own world. It belongs to you and only you and your internal system. You and your insiders control that inner world. You all can truly make a huge impact by doing nice, kind, gentle, supportive, and comforting things for each other in there on that level. Even if you can’t afford to buy things in the external world, you can do things for free on the inside worlds. Your inner world can be a true haven and a place that is comfortable and “just right”.
When you can see the others inside, and when you listen to them, and pay attention to each other, you will be able to recognize their needs and then do something about it to make their day better. Taking better care of your insiders will have a huge impact on your life, your system work, your healing process, and your external world.
One of the biggest keys to your overall healing depends on how YOU all treat your own system and internal parts. Do you support each other inside? Do you take the time to be kind to each other inside? Do you comfort each other inside? What do you do to help each other inside? Do you treat each other with respect? Are you trustworthy with each other?
For those that are DID, I believe that one of the most significant therapy goals is doing INTERNAL self care. Look at your others inside — share blankets and stuffies with them. Give them hugs, sit quietly with them. Meet their needs, clean up the messes, give them clean clothes to wear, and a quiet safe place to rest. If your inside world stays chaotic and unkept, neglected or dangerous, then how on earth are you going to feel safe or ok in the outside world? Start by addressing things in your own world, and let it ripple out from there.
The more folks learn to be there for their own selves, the less they will depend on their therapist, or spouse, or any other outside person to “take care” of them. The more you can take care of your own selves, the less it matters if someone else is busy or away for a few days. The more you take care of your own selves, the more you will feel GOOD about yourself and your ability to handle life.
Here are more questions to think about:
- What is the nicest thing that someone in your system could do for you?
- What are some of the most meaningful things you could do for them?
- How do you show the hurting ones that you have compassion for them?
- How do you show your little ones that you will protect them and keep them safe?
- What kinds of things can you do for your insiders to show them that you will help to take care of them and tend to their needs?
- How does your system respond when you are kind and attentive to them vs. being neglectful and angry towards them?
This is an important topic — your thoughts and/or comments are welcome.
Kathy Broady LCSW