Sunday, July 26, 2009

A New Book on DID

I am half-way through a new book (2009) on the treatment of a single case of DID: Switching Time, by Richard Baer. He is a psychiatrist who practices what he calls “psychoanalytically informed psychotherapy.” Psychoanalysis seems to be helpful in the treatment of DID, although it is probably not the most efficient treatment approach. One problem is that it is so slow. The most famous of all DID cases is that of Sybil, whose treatment by psychiatrist Cornelia Wilbur is described by Flora Schreiber in 1976. Treatment lasted in that case 11 years at an average of four sessions a week. If you think of it in terms of the usual once-a-week therapy sessions held by most psychotherapists, Cornelia Wilbur treated Sybil for the equivalent of 44 years. That’s a lot of therapy.

In the case of Richard Baer, he diagnosed his patient in the first year of treatment but didn’t share that diagnosis with his patient. It wasn’t until four years had passed that he actually began to work with any of the 17 subpersonalities, or alters, who made up the whole person. In the sixth year of treatment they have still not done any trauma resolution work, save letting alters know that the primary perpetrator, the patient’s father, died during the fifth year of treatment. Still, there continues to be progress, if slow progress. I will write more when I have finished the book. A final note: this psychiatrist, like so many under-informed psychiatrists, believes DID to be a rare condition. Actually, it is not rare at all. Probably about one percent of the adult population of the United States suffers a major dissociative disorder, including DID. For more information on this see The International Society for the Study of Trauma and Dissociation website, http://www.isst-d.org/.

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http://www.counselinglasvegas.net/

Sunday, July 19, 2009

Restructuring Memories in Parts Therapy

One of the techniques we use in Parts Therapy is that of restructuring memories, most commonly by helping a client to visualize rescuing a remembered child part from a painful memory scene and taking the child to a safe place. This sort of intervention has a long history in psychology. In 1889 Pierre Janet described his work with a patient named Marie, in which among other things he cured her of her hysterical blindness in the left eye. The blindness was linked to Marie’s memory of being forced to sleep at the age of 6 with another child who had a terrible case of impetigo on the left side of her face, after which Marie developed impetigo in exactly the same portions of her own face. The long term effect was that Marie developed blindness in her left eye and numbness of the left side of her face. Janet used hypnosis to retrieve the traumatic memory of sleeping with the diseased girl. He convinced the remembered child self that the other girl was not ill and guided the child self in being comfortable with her bedmate, even caressing “without fear the imaginary child.” Most of the work we do in Parts Therapy is much less complex than that of Janet, and hypnosis is not a necessary ingredient.

http://www.lasvegaspsychotherapy.com/
http://www.counselinglasvegas.net/

Sunday, July 12, 2009

The Diagnosis of Herschel Walker's DID

I raised doubts in my previous blog about the diagnosis of Dissociative Identity Disorder for Herschel Walker, based upon the first three chapters of his book, “Breaking Free” (2008). Having now finished the book I am still in doubt about the legitimacy of this diagnosis. It seems to be based largely on the presence of alters: Walker talks about the Indifferent Dare-devil, the Warrior, the Sentry, the Judge, and others. But everyone has alters. I usually use the terms, ego states, parts, or subpersonalities, but they are the same as alters. In order to avoid arguments with other professionals who do not understand this, I usually go along with reserving the alter term for persons with DID. However, It is circular reasoning to say that the subpersonality of a DID person is an alter, and it is the presence of alters that qualifies someone for the diagnosis of DID. The DSM IV criteria require, in addition to the presence of alters, that there be autonomous switching between alters, and that there be significant amnesia for what happens when an alter switches into control.

It is because autonomous switching and amnesia are largely absent that I doubt the diagnosis of DID. There are exceptions. Walker describes dislocating his shoulder during a Sugar Bowl football game and insisting that his coaches put it back into its socket on the sidelines. He says he had no pain during the procedure and that he did not remember the process. Additionally, he had a wisdom tooth removed without anesthesia and felt no pain during the surgery. Evidently, a subpersonality switched into control in these special cases and blocked the pain from Walker’s consciousness. But is this amnesia enough to qualify for a diagnosis of DID? I don’t think so. I believe that the ability to block pain for short periods of time is not rare, and although it is dissociative, those who intentionally make use of this ability do not qualify as DID. Walker also describes amnesia for long drives between work and home. This is also a fairly common occurrence in the larger society. It is often referred to as the result of “highway hypnosis.”

So does/did Walker have DID? Maybe; but based upon what he says in his book, I doubt it. I think his symptoms fall short of diagnostic. Clearly, though, he is significantly dissociative. I would say the symptoms warrant a diagnosis of DDNOS (Dissociative Disorder Not Otherwise Specified), a diagnostic category specifically reserved for people whose symptoms fall short of DID. It is actually a close call as to whether Walker has a dissociative disorder at all. Although he is dissociative, the diagnosis of a “disorder” requires that the condition be distressing to the person or to others in relationships with him. In Walker’s book he generally describes the benefits of being dissociative, but he does eventually say that he sometimes feels shame for being that way. That appears to be enough to qualify him for a “disorder.”

www.lasvegaspsychotherapy.com
www.counselinglasvegas.net

Sunday, July 5, 2009

Normal Multiplicity Versus Dissociative Identity Disorder

I just bought and read the first three chapters of Herschel Walker’s, “Breaking Free: My Life with Dissociative Identity Disorder.” Walker is a Hall of Fame football player whose book, because of his fame, has the potential to normalize having dissociative disorders. So far, however, I am not even sure that his diagnosis is correct. In the “Prologue” he describes the overwhelming rage he felt when a Mercedes salesman failed to deliver his new car where and when he said he would. Walker drove to where the car had actually been delivered, fighting off his murderous impulse to kill the salesman when he arrived at the car’s location. As he drove he heard two opposing voices, one telling him to shoot the man, and the other telling him that would be wrong. He did not lose awareness of who he was and where he was going. This is not Dissociative Identity Disorder (DID). In order to fit the diagnosis of DID, Walker would have had to have amnesia for all of part of the incident, and there would have to have been a dissociated alter personality who took control of his consciousness during the experience.

Hearing voices is not in itself sufficient to qualify as a mental disorder. In fact, up to 20 percent of the population hears voices at one time or another. But the crucial missing evidence may appear later in the book. In his first chapter Walker suggests that what separates DID from other dissociative disorders is the creation of alter personalities. This is a common misconception shared with many professionals. Those of you who have read other of my blogs will know that having subpersonalities is normal. We only begin to call these subpersonalities “alters” when the subpersonality takes executive control and the person has amnesia for the time when the subpersonality was in control. I will follow up on this question when I have read more of the book.

www.lasvegaspsychotherapy.com
www.counselinglasvegas.net