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principal caretaker. The dissociation of the experience serves an
obvious purpose; it blocks out painful or shaming experiences,
memories, or "states of mind." If you are overwhelmed by a bad
experience, avoiding it or repressing it or detaching from it is one way
to escape. In this situation, you mentally create another reality. Early
in childhood, this avoiding or "tuning out" or "spacing out" can become
a habit, potentially a very unhealthy one. Sometimes when people
dissociate they feel like they are observing themselves from outside
their bodies or they may feel depersonalized (like a robot) or sense
others as being mechanical and/or the environment as unreal. While
these are unusual mental adjustments to intense trauma, all of us
"tune out" parts of our experience at times, e.g., we might fantasize to
escape a boring lecture. And, we all have many different states of
mind, jolly and optimistic sometimes, crabby at other times. The old
label of Multiple Personality has been discarded by therapists because
the term implies more than one or several complete and independent
personalities. It is better to think of ourselves as having only one
personality, even though our total personality may be complicated and
split into different states of mind. These different states, some called
alternate personalities or "alters," are frequently in conflict with each
other but they are still part of the person's total personality, not a
separate person. The experience of DID has been described in detail
by victims (Cohen, Giller, & Lynn, 1991). Several articles are here:
10% of all psychiatric patients have DID. Heated controversies have
centered on how often DID occurs and on the extent to which some
therapists may subtly suggest to the patient that he/she has multiple
personalities, thus, facilitating the development of another disabling
disorder.
What are the treatments for these unhealthy reactions to trauma?
Both insight therapists and cognitive-behavioral therapists would
provide a safe, supportive treatment setting and then gently
encourage the patient to talk about their traumatic experiences, to
gradually re-experience without undue stress the life events that
previously caused them stress and lead to dissociation. Proceeding too
quickly may "re-traumatize" the patient. For the insight therapist, the
goal is to make sense of your reactions to the trauma. This means
helping the patient learn about how stress, fears and reactions to
trauma, including dissociation, are developed and how the
unwanted/unhealthy reactions can be reduced. Of course, eventually
the PTSD and DID patients must not only face the past but also learn
to cope (avoid panicking) with current life stresses.
DID patients need to reduce their dread of their dissociated states.
By gradually exploring each dissociated part and discussing their
feelings about it, they become familiar and more comfortable with all
their "states of mind." Resolving the different views and desires among
these parts or states of mind ("alters"), a process called integration, is
an important but not easy task, usually requiring the help of a
therapist. The current approach of insight therapists is to avoid a
catharsis or abreaction (a reliving) of the traumatic experience.
