However, we find it pretty unnerving to look back at this text and realize that at one time this was the only type of information on multiplicity available on line. Of particular note are Kluft's interrogation techniques. Multiples and abuse survivors alike, in bulletin boards and later on the internet, took it seriously, passed it around, and apparently felt that this kind of behavior on the part of therapists was justified.
This was originally provided by the Love Galaxy, Home of VBBS Health Net,
which offered many files on multiple personality and health issues.
PRODIGY(R) interactive personal service 11/21/92 9:27 PM
SUPPORT GROUPS
TOPIC: SEXUAL ABUSE
TIME: 11/20 2:56 PM
TO: ALL
FROM: CALLIE GOBLE (TDMK17A)
SUBJECT: MPD REPRINTS
Diagnostic Signs of MPD
DISSOCIATIVE INTERVIEWING: 60% of multiples will not do or say
anything that suggests MPD unless subjected to a detailed, subtle, and
sophisticated dissociative inquiry. Never accept "No" for an answer.
Denial, forgetting and minimization produce many false "no's" to
questions regarding dissociative experiences. If you have any reason
to suspect MPD, keep the issue open in your mind despite the patient's
initial "No's" to crucial diagnostic questions. Said differently, it
often takes several or even a good many therapy sessions before
sufficient information is acquired to strengthen (and finally confirm)
a diagnosis of MPD.
AMNESIA: Virtually all multiples have periods of amnesia (losses of
time) but (i) may deny them (ii) may be genuinely unaware of them.
Remember 80% of multiples have no knowledge that other personalities
exist. Finally, some multiple confabulate. They report made up
memories which cover their amnestic lapses - - and they believe these
confabulations. Losses of time, blackouts, Called a "liar" as a child,
blamed for things he "did not do", finding that the rest of the class
seemed to have been taught something that the patient had not been
taught. Discovery of items among one's possessions that cannot be
accounted for parents or friends report behavior or events which the
patient does not recall Does not recall a large chunk of childhood;
Zero memory for one or more years. For example, "I don't remember
anything before age 8."
CO-PRESENCE PHENOMENA: (Schneiderian first rank symptoms) are often an
important guide to diagnosing MPD. These symptoms are accidental or
deliberate impingements, by alters inside, on the personality who is
"out":
Voices arguing: usually about the patient
Voices commenting on one's actions: typically, a helper or persecutor
Influences playing on the body: often, somatic memory of abuse/trauma
Thought withdrawal: going blank, often in mid sentence
Thought insertion: alien or surprising thoughts are imposed or
"happen"
"Made" feelings: surges of feeling out of the blue that are not owned.
"Made" impulses: strong impulses to action that are not felt to be
one's own.
"Made" violational acts: feels controlled, "I watched myself do it"
MOOD SHIFTS: Most of the time, MPD looks like mood shifts rather than
personality changes. "Moody" -- sudden mood swings observed or
reported by patient or others
Brought to you without permission by:
THE TEACHER & Nikki 10/22 09:48 pm
"MEMORY" PROBLEMS: Many forms of apparent forgetting that are actually
the result of activity of alter personalities. Little forgettings
(e.g. lighting a cigarette while another is still burning in the
ashtray; going to bring in the mail or newspaper when he/she has
already brought it in) Peculiar forgettings (e.g. learning school
material and then TOTALLY forgetting it the next day.)
NOTE: This is an extremely common MPD experience.
Makes written notes to him or herself because he/she too often forgets
what he/she has done or needs to do
Headaches that do not respond to pain relievers
Spontaneous trance states
Staring as if in thought
Like watching a movie and may talk to self
Dissociative experiences
May admit to fearing that he or she is going crazy
Visual hallucinations, visions
Unexplained pain or other conversion symptoms
Marked differences in manner, voice, language, or dress
Changes of handwriting
Says he or she wants to know "why" he/she did something (e.g. an
episode of acting out)
Does not like mirrors.
Avoids going to the dentist
NOTE: The more of the above items that characterize the patient, the
more likely it is that she/he is multiple. Early in the diagnostic
process, a patient who is multiple, may score positive on only 3 or 4
items. Generally, this score will increase with time as the patients'
dissociative process becomes increasingly visible. Some patients,
however, will have a score of 10 or more right from the beginning. In
any event, diagnosis ultimately depends on establishing unmistakable
contact with one or more alter personalities. As Rick Kluft is fond of
saying, "The opera ain't over until the fat lady sings".
Of course this is brought to you without permission
courtesy of:
THE TEACHER & Nikki @ 10/22 09:42 pm
Part 1 of 4. General MPD Info
MPD Education....Multiple personality disorder is about pain.
Nothing else. Just pain - physical pain, emotional pain, total
helplessness, terror, traumatic humiliation, and overwhelming rage.
MPD is the desperate and creative solution of the traumatized
child. It is a crude, powerful and wonderful means of survival for
children who are repeatedly terrified, abused or trapped in
inescapable pain. MPD arises in childhood, mostly ages 3-9. There is
juvenile diabetes and there is adult onset diabetes, but there is no
adult onset MPD. Only children have sufficient flexibility (and
vulnerability) to respond to trauma by breaking their still coalescing
self into different, dissociated parts.
It used to be thought that MPD was an exotic form of hysteria, an
elaborate means of escaping responsibility for dealing with life. It
is not; it is usually an effort to "escape" from child abuse. It is
often thought that MPD is a sham: a bizarre form of play acting that
is perpetrated by manipulative, attention-seeking individuals. It is
not; MPD is a "disorder of hiddenness" wherein 80-90% of MPD patients
do not have a clue that they are multiple. Most know that there is
something wrong with them; many fear that they are crazy - but few
know that they are multiple.
It is sometimes thought that MPD is the last refuge of a
criminal, a deceptive effort to provide an insanity defense so that
the criminal can evade responsibility for his or her crimes. Far from
it, most multiples don't know that they are multiple. Moreover, once
the diagnosis is made, the typical MPD patient consumes months denying
the diagnosis and insisting that the therapist has a very vivid
imagination. A recent study of convicted criminals (felons, murderers,
etc.) who were diagnosed after being imprisoned, found that none of
them wished to make use of their diagnosis in order to seek a new
trial or to ameliorate their existing sentence.
Finally, MPD is frequently misunderstood by the question, "Isn't
MPD just an exaggeration of the different parts of our personality;
aren't we all really multiple?" This is an enticing question. Yes, we
all have different parts to our personalities. No, MPD is not "just an
exaggeration" of these parts. Why? At least 6 reasons: 1) Because we
all don't have dissociative disorder; 2) Because we all do not have
amnesia for what we are doing when a different part of our personality
comes to the fore; 3) We all don't suffer from severe and chronic
child abuse or trauma; 4) Because the raison d'etre of the different
sides of out personality is not to hide from ourselves information or
feelings about trauma; 5) Because we all do not have high
hypnotizability; and 6) Because we all do not develop post-traumatic
stress disorder when we begin to pay attention to our parts.
How many parts are there? The typical female multiple has about
19 alter personalities; male multiples tend to have less than half of
that. The number of alters is explained by 3 factors:
a) the severity of the trauma,
b) the chronicity of the trauma, and
c) the degree of vulnerability of the child.
Thus, a male multiple who was sexually abused a half dozen times
by a distant relative from ages 7-10 is going to have far fewer alters
than a female multiple who was severely physically, sexually, and
emotionally abused by both parents from infancy to age 16. The latter
patient, in fact, could easily wind up with 30-50+ alters.
How could a person have so many different personalities? How
would you tell the difference among them? The answers to these
questions require a clarification of several points.
First, MPD is a misleading term; Dissociated Self Disorder would
probably be better. There is but one self that is dissociated into
multiple parts. MPD tends to be understood (incorrectly) to mean
multiple self disorder; in fact, there is only one self - however,
divided or dissociated it may be.
Second, there are usually only 3-6 alters who are particularly
active (i.e., assuming full executive control) on any given day. The
rest of the alters are relatively quiet (or even dormant for long
periods of time).
Third, THERE IS NO REQUIREMENT THAT DIFFERENT PERSONALITIES BE
VISIBLY DIFFERENT TO AN OBSERVER. It is only necessary that each alter
fulfill the basic function of an alter personality; to protect the
host personality from the knowledge and experience of trauma. This
task is accomplished by means of dissociative barriers or walls of
amnesia. Thus, a multiple could conceivably have dozens of alters that
look just the same, but who nevertheless serve the function of walling
off the trauma from the host (and dispersing it among different
alters).
Nikki & The Researcher 10/23 08:12 pm
The answers to the above questions can now be more easily
understood in light of the basic task of an alter personality. If the
raison d'etre of alters is to sequester trauma from the host so that
she or he is able to continue to function without becoming
overwhelmed, then as many alters will be produced as are necessary.
Accordingly, when an alter becomes overwhelmed, additional alters may
be produced to help contain the trauma. It is not required that these
new alters look different, nor is it necessary that they all be active
at one time; it is only necessary that they do their job (of
controlling the trauma).
The typical alters that are found in a person with MPD include 1)
a depressed, depleted host, 2) a strong, angry, protector, 3) a scared
and hurt child, 4) a helper, 5) an embittered internal persecutor who
blames and persecutes one or more of the alters for the abuse that has
been suffered. While there may be other types of alters in any given
MPD individual, most of them will be variations on the themes of these
5 alters.
How common is MPD? Although all data are not in, the best
estimate of the prevalence of MPD is that it approximates that of
schizophrenia (about 1% of the general population). This estimate
would translate into at least 2,000,000 cases in the U.S. alone. Why
so many? Because MPD is directly linked to the prevalence of child
abuse. And, unfortunately, child abuse is all too common.
How impaired is a person with MPD? The range of impairment across
different persons with MPD is best analogized to that of alcoholism.
Impairment due to alcoholism ranges from skid row bums to high-
functioning senators, congressmen, and corporate executives.
Impairment also varies in any given alcoholic from one period of time
to another (as function of binges, patterns of drinking, life
stresses, and so on). It is much the same with MPD. There are some
multiples who are chronic, state hospital mental patients, others who
undergo recurrent hospitalization due to self-destructive behavior,
and many more who raise children, hold jobs and may even be high-
functioning professionals such as lawyers, physicians, or
psychotherapists.
There are 3 major factors that account for whether a multiple is
low-functioning or high-functioning; personality traits, post-
traumatic stress disorder, and experiences of criticism or rejection.
Despite having many "personalities", every multiple, as a whole, has a
personality (just like the rest of us). Thus, to the extent that a
multiple has counterproductive traits (i.e. irresponsibility, rampant
denial and avoidance, strong narcissism, entitlement, masochism,
addiction to interpersonal control, psychopathy, etc) then that person
will be impaired in his or her functioning as a competent and
responsible adult. The character traits of multiple not only typify
how they deal with daily life, but ALSO HOW ALTERS DEAL WITH ONE
ANOTHER.
Lower functioning multiples may have alters who are struggling
with one another for dominance, competing for attention, stealing from
one another, refusing to take responsibility for the mess that they
just made, grabbing control whenever they want (no matter what it
interrupts -job, relationships, child care, financial solvency, etc)
and so on. Such negative character traits are the single biggest
determinant of frequent crises or chronic dysfunctionality; they are
also unquestionably the largest hindrance to the therapeutic treatment
of MPD.
The 2nd major factor that affects daily functioning in persons
with MPD is post-traumatic stress disorder (PTSD) (flashbacks,
intrusive memories, nightmares). Individuals with MPD also tend to
have PTSD. To the extent that a person is troubled with recurrent,
intrusive re-experiencing (visual, auditory, or somatic) of trauma, he
or she may also have depression,loss of concentration, suicidality,
substance abuse, panic attacks, self-mutilation, etc. An upsurge in
PTSD symptoms (i.e., flashbacks about a significant trauma) is one of
the 2 most common causes of sudden crises, decline in functioning, or
psychiatric hospitalization for a multiple. The 2nd most common cause
of sudden crisis in persons with MPD (and the 3rd major factor that
affects their daily functioning) is an experience of rejection or
emotional abuse and rejection as children. As a consequence, most
alters are highly (and often catastrophically) reactive to current
life experiences that are reminiscent of parental criticism or
rejection. Such current life experiences trigger crippling emotional
flashbacks and intensely negative thoughts to self-loathing,
hopelessness, and perhaps even self-injury or suicidality.
For many observers, MPD is a fascinating, exotic, and weird
phenomenon. For the patient, it is confusing, unpleasant, sometimes
terrifying, and always a source of the unexpected.
The treatment of MPD is excruciatingly uncomfortable for the
patient. The disassociated trauma and memory must be faced,
experienced, metabolized, and integrated into the patients view of
him- or herself. Similarly, the nature of one's parents, one's life,
and the day to day world must be re-thought. As each alter personality
metabolizes his or her trauma, then that alter can yield its
separateness and reintegrate (because that alter is no longer needed
to contain undigested trauma). Recovery from MPD and childhood trauma
is a long and arduous process of mourning during which fear, hurt,
rage, and shame must all be digested. Recovery usually takes about 5
years.
This appears to be one of three notes on therapy posted by Nikki,
Researcher and Teacher about therapeutic vs spontaneous abreactions.
Facts about Spontaneous & Therapeutic Abreactions:
1. Trauma and Dissociation - During a traumatic experience some
people automatically enter an altered state of consciousness that
protects them from the full impact of the trauma. When this occurs,
PART OR ALL of the traumatic experience is stored in a dissociated
compartment of the mind.
2. Encapsulated Raw Trauma- Such dissociated compartments contain
RAW UNDIGESTED TRAUMA that is now "on hold". Unfortunately, such
encapsulated trauma cannot be kept on hold indefinitely.
3. Flashbacks and Spontaneous Abreactions- The encapsulated
trauma will develop leaks (flashbacks) from time to time. If a
flashback intensifies beyond a certain point, a spontaneous abreaction
may take place. In an abreaction, the compartment breaks wide open,
the person is flooded with the raw trauma, and he or she begins to
VIVIDLY RELIVE the trauma.
4. Temporary Loss of Contact with the Here-And-Now. When a person
abreacts (relives the trauma), he/she may APPEAR to be psychotic due
to losing contact with here-and-now reality. That is, the person
becomes totally immersed in reliving the there-and-then reality of the
trauma. As a result,the person may seem crazy because, (for example)
he/she may suddenly tuck into a ball with flailing arms and scream
"No, Daddy! No, Daddy!" This is NOT psychosis, it is a dissociated
reliving of trauma.
5. Renewed Dissociation of the Trauma. A spontaneous abreaction
of dissociated trauma can be just as overwhelming as was the original
traumatic experience. Consequently, the person who is inundated with a
spontaneous abreaction cannot handle the trauma this time either.
He/she will try to force the undigested trauma back into its
compartment as soon as possible - usually in a matter of minutes to an
hour or so, but will probably continue to be troubled by intrusive
flashbacks. In other words, SPONTANEOUS ABREACTIONS USUALLY DO NOT
LEAD TO ANY PROGRESS IN DIGESTING THE TRAUMA.
6. Therapeutic Abreactions. Because the encapsulated material is
overwhelming (i.e., traumatic) the person can digest it only if it is
somehow rendered non-overwhelming. Abreactions that are not overwhelm-
ing -are- therapeutic, because the person is now able to METABOLIZE
the trauma.
7. CAREFULLY PLANNED ABREACTIONS. The key to facilitating safe
therapeutic abreactions are careful planning, pacing and titrating. A
carefully planned abreaction for a person with MPD has at least 8
components.
i) The patient knows (and KNOWS that he/she knows) a variety of
basic hypnotic skills that provide control, containment, and dosed
release of the traumatic material.
ii) The patient has an explicit, clear understanding (IN ADVANCE)
of each step in the abreaction - including how he/she will be left at
the end of the session.
iii) The basic details of the trauma are known BEFORE initiating
the abreaction.
iv) All alters who are part of this trauma are known in advance
of the abreaction.
v) The trauma is released A PIECE AT A TIME (e.g., visual
overview, fear, body sensations, anger, shame, grief) in ONE ALTER AT
A TIME.
vi) Adequate time is reserved for the abreactive work to be done
in the session AND for winding down and preliminary cognitive
processing of the trauma.
vii) At the end of the session, either unfinished trauma is
locked away again or unabreacted alters are put hypnotically to sleep
until the next session.
viii) Adequate time is allocated in the NEXT SESSION for more
cognitive processing of the meaning and implications of the trauma
that is being metabolized.
8. ABREACTIVE WORK WITH MULTIPLES. In general, abreactive work should
not begin until months of teaching, stabilization and establishing the
therapeutic alliance across many alters has taken place. An abreaction
may (and, often should) be spread out over several sessions - broken
down into logical chunks that allow session-sized pieces of abreactive
work to be done. Depending on the complexity of the case, therapy may
involve dozens, or even hundreds of abreactions. As the therapy
progresses, and the patient learns the ins and outs of abreactions and
the broad parameters of his/her trauma history, he/she will often be
able to speed up, condense, or even group abreactions in order to move
faster. The impetus for such accelerated abreactive work should come
from the PATIENT, not the therapist.
9. HYPNOSIS, DISSOCIATION and ABREACTION. Hypnotic phenomena,
dissociative phenomena, and abreactive phenomena are intimately
intertwined with one another. An informed approach to treating MPD
requires a rich understanding of all three. Accordingly, a clinician
who seeks to treat MPD must be prepared to seek whatever training,
continuing education, consultation or supervision that might be
necessary.
[I'm not certain if this next item is part of a series]
Note 2 of 3: MPD EDUCATION*FACTS ABOUT DISSOCATION & MPD
1. Dissociation is a normal psychophysiological ability that
allows people to protect themselves when faced with trauma.
2. Dissociation occurs spontaneously in the midst of trauma and
gives the individual partial protection by BLOCKING PART OF THE PAIN,
TERROR, AND AWARENESS of what is happening.
3. This blocked pain, terror, and awareness of trauma creates
"compartments" in the mind that hold the still undigested trauma.
Blockage of awareness causes AMNESIA for part or all of the trauma.
When these trauma compartments "leak", the person has FLASHBACKS,
NIGHTMARES, and PANIC ATTACKS. (i.e., PTSD)
4. Dissociative ability is a normal, inherited talent that
differs from person to person. Approximately 10-15% of individuals
have superb dissociative ability; probably it is only this group that
has the capacity to develop multiple personality disorder.
5. Multiple personality disorder is a survival tactic. It is the
creative attempt of highly traumatized children to protect themselves
from trauma and abuse: "It isn't happening to ME". When children
dissociate (block) trauma, their "compartments" of trauma become
separate personalities.
6. Only children have sufficient flexibility (and vulnerability)
to adapt to trauma by means of creating alter personalities. ALL MPD
begins in childhood; adults do not have the capacity to adapt to
trauma by forming alter personalities. (The exception is that adults,
who became MPD in childhood, CAN continue to make more alters during
adulthood.
7. Because of the frequency of child abuse, about one person out
of 100 (HA!-says I) has MPD (or another closely related severe
dissociative disorder.
8. The most common symptoms of MPD are sudden mood swings,
episodes of depression, lack of memory for much of childhood, periods
of amnesia or time loss, headaches, nightmares, and hearing voices.
Other symptoms may include, flashbacks, self-injuring behaviors,
shame, guilt, self-hatred, panic attacks, wanting to die, and feeling
crazy. Some people with MPD have all of them symptoms, others have
only some.
9. MPD IS NOT SCHIZOPHRENIA. Most people think that schizophrenia
means split personality. Actually, this is totally incorrect. Split
personality is MPD - not schizophrenia. Schizophrenia is a chronic
psychosis due to a biochemical/genetic disorder of the brain.
Schizophrenics do not have other personalities, schizophrenia is not
caused by trauma, and does not involve amnesia and flashbacks.
10. A person who is multiple will REMAIN multiple until
successfully treated.
11. About 90% of multiples are totally unaware that they are
Multiple.
12. The SYMPTOMS of MPS wax and wane. A person who is multiple
may appear to be fine for years and then suddenly begins to have
strong symptoms - usually due to flashbacks of past trauma.
13. The typical personalities in a person who is multiple
include: 1) a depressed host personality; 2) a scared or hurt child;
3) a strong, angry protector; 4) an internal caretaker of the child
alters; 5) an envious protector who is angry at the host.
14. MPD may appear to be exotic or strange, but when seen in
context, MPD "makes sense". It is an ADAPTATION to a TOXIC
ENVIRONMENT. In an environment of danger and abuse, it makes good
sense to be multiple.
15. Each of the alter personalities protects the host by holding
one or more compartments of undigested trauma. HOLDING TRAUMA IS THE
BASIC AND MOST IMPORTANT FUNCTION OF EACH AND EVERY ALTER PERSONALITY.
16. Recovery from MPD is a process of releasing the old hurt and
completing the process of mourning. Successful digestion and full
understanding of the old hurt and trauma puts an end to the
nightmares, flashbacks, and panic attacks. It also allows the various
alter personalities to REUNITE with one another.
Nikki & The Researcher & The Teacher
Note 1 of 7 - MPD Education Series # 4
[this series of notes is more technical than the others]
Etiology of Multiple Personality
-From Abuse to Alter Personalities-
Researchers have yet to fully understand the causes of multiple
personality, but preliminary findings suggest that no single factor
engenders the syndrome and no single intrapsychic pattern is common to
all cases. Instead, according to Dr. Richard Kluft, "There appear to
be both biological and environmental factors which interact with
developmental and psychodynamic processes in each patient with MPD.
The uniqueness of this interaction in each individual case leads to
the wide diversity of the condition's manifestations, structures and
treatment outcomes."
Kluft has developed a "four-factor theory of the etiology of MPD
which reflects this conclusion. The four factors he deems necessary
for the development of multiplicity are:
1. A biological capacity for dissociation.
2. A history of trauma or abuse.
3. Specific psychological structures or contents that can be used
in the creation of alternate personalities.
4. A lack of adequate nurturing or opportunities to recover from
abuse.
Kluft's model was well-received by his colleagues at the 137th
Annual Meeting of the American Psychiatric Association (APA) last
spring in Los Angeles. It was published in a special issue of
Psychiatric Clinics of North America (March, 1984) devoted exclusively
to multiple personalities. Kluft hopes that the work he and others in
the field have done to shape a broad picture of the etiology of MPD
will contribute to the formation of testable hypotheses about the
syndrome.
Note 2 of 7 - MPD Education Series # 4
Defense Through Dissociation
In Kluft's view, the first and most important factor in the
etiology of MPD is a biological capacity for dissociation.
Dissociation, according to him "is an unconscious defense mechanism
which involves the segregating of mental or behavioral processes from
the rest of one's psychic activity and any analogy with
hypnotizability is probably not a capacity of all individuals.
Instead, it is very highly developed and accessible in some -
immediately so in others, and minimal in yet others."
Psychologists say that dissociative mechanisms function in all of
us, to some extent. The experience of dreams or spontaneous waking
imagery, the "automatic" performance of "over learned" behaviors, and
simple forms of state dependent learning are all instances of
dissociation. Subpersonalities may also represent dissociative
processes at work. Hypnosis and trance are considered dissociative
states par excellence.
By comparison with the norm, persons who develop multiple
personality are dissociation-prone. Their response to the experience
of extreme stress or abuse is to isolate the associated feelings and
memories from conscious awareness, as memories are isolated from
awareness in post-hypnotic amnesia (studies have found that nearly all
multiples are highly hypnotizable). Dr Eugene Bliss of the University
of Utah explained how the same mechanism might apply to multiple
personality: - if hypnosis can cause the individual to forget
experiences, feelings or even native language, why should he or she
not be able to forget himself or herself. There is a rapid switch and
the individual forgets herself or to describe it in a slightly
different form, the individual goes into hypnosis, disappears and then
is hidden in hypnosis like a host personality, while the (alter)
personality emerges into the real world, no longer in hypnosis.
Dissociation is the core mechanism in other psychopathological
syndromes besides MPD. Psychogenic fugue, psychogenic amnesia and
depersonalization disorder are among the dissociative disorders
formally recognized by psychiatrists. Dissociation also plays a
partial role in some kinds of phobia and anorexia nervosa. "In fact,
many people may use dissociation as a defense, said Dr David Spiegel
of Stanford University, School of Medicine, but they don't dissociate
themselves, as multiples do". Only in MPD do dissociated processes and
psychic contents form highly organized and autonomous personalities.
This reflects the fact that there seems to be a critical period for
the development of multiple personalities in children, prior to the
development of a mature ego.
Note 4 of 7- MPD Education Series #4
Abuse and Alter Personalities- Part II
DISCLOSURE: The following information may be upsetting.
Multiples have also been given frequent enemas or massive doses
of cathartics because their caretakers believed they must be
absolutely clean not only outside but within as well. Such
physiological abuse has also included "home treatments" in which
children were inappropriately given adult medications, which Wilbur
said is common when a parent attempts to treat other abuses that have
been inflicted on the child.
"Who ever heard of an abusive parent take the child to the
doctor?" she asked. Survey results suggest that the number of a
multiple's alternate personalities is related to the number of
different types of abuse she or he suffered as a child (super
multiples have usually been severely abused well into adolescence,
according to Kluft). Moreover, because of the multiples history of
abuse, at least one personality will almost invariably be an angry,
hostile, and possibly violent alter.
The link between MPD and child abuse creates special problems
both for detecting MPD in its early stages and for alleviating the
conditions which foster it. Until recently, professionals tended to
respond to reports of both child abuse and multiple personality with
incredulity, disbelief, and misunderstanding. "While such responses
may be an understandable attempt on their part to maintain a sane and
manageable perspective on reality in the face of the awful evidence
presented by abused children", Wilbur said at the APA meeting, "they
amount to a shared negative hallucination".
The problem with credibility may be particularly acute for child
multiples. Since they are among the most severely abused individuals,
they may also be experienced as the least credible. Incredulity and
disbelief on the part of family and professional counselors, however,
serve only to reinforce the child multiples use of dissociation as the
best available defense against trauma, or the "only way out".
"There should be a massive approach across the country toward the
prevention of child abuse", Wilbur said. Research on multiple
personality can help authorities and the public understand how
important it is to control this terrible problem.
Note 5 of 7 - MPD Educations - Series #4
The Puzzle of Psychogenesis
Not all children who are abused become multiple personalities.
What then are the other factors which place a child at risk for the
development of MPD? Researchers have a few clues, but their data is
primarily descriptive - the mechanisms of splitting are poorly
understood.
The third factor in Kluft's model of the etiology of MPD refers
simply to all the psychological structures, ego contents and other
unique shaping influences that a multiple can enlist in the creation
of alter personalities. Taken together, these factors determine the
particular characteristics of each alter, many of the relationships
among them, and the ways in which they develop.
Psychiatrists use the term "splitting" in several ways. Most
generally, it simply refers to the creation of alter personalities. In
psychoanalytic theories of MPD, however, the term has a more
specialized meaning. There, splitting refers to a specific defense
mechanism which functions very early in life and results in a
distortion of ego development. It involves the polarization of
emotional identifications so that the child fails to integrate
experiences of "good" and "bad" in developing mental representations
of the self and others. In the narcissistic or borderline personality
disorders, splitting leads to uncertainty about identity, emotional
instability, and problematic relationships.
Some features of MPD support the psychoanalytic claim that ego
splitting of this kind plays a role in its psychogenesis. At the APA
meeting, for instance, Putnam noted that many multiples split off in
pairs of personalities that seem to be emotional opposites. One
personality might have a sweet pollyannish disposition, he said, while
her complement is a "bad" or "horrid" child.
Yet, some researchers also point out that other features of MPD
argue against a strict theoretical interpretation involving splitting.
Not all personalities in a multiple reflect the contradictory psychic
organization that would be expected, and individual alter
personalities may grow and reach more mature stages of psychological
development than borderline or narcissistic patients do. Moreover, in
some cases, a cohesive personality representing the whole self appears
to exist in conjunction with all of the fragmentary alter
personalities who represent split off parts of the self. This hidden
personality may have a normal, integrated self structure and reflects
a unity of personality that is totally lacking in the borderline or
narcissistic disorders.In a paper prepared for the First International
Conference on MP/DD States, Dr. Richard Kluft concluded that while
"some limited support for the presence of "splitting" as a defense in
individuals with MP exists...there is little evidence that the
construct of "splitting" explains the actual formation or maintenance
of alter personalities with unique memories and histories, nor does it
explain the "switching" process between personalities."
The Puzzle of Psychogenesis- Part II
Just what comprises the "window of vulnerability" for MPD is thus
still a puzzle for researchers. While they are amassing a growing body
of clinical data regarding the creation of alter personalities and
their subsequent intrapsychic organization, as yet, no theory unifies
their findings. "There are a lot of competing theories", said Kluft.
Clinical experience with multiples as well as survey results have
shown that:
-Some alter personalities may begin as imaginary playmates and develop
gradually, while others have no identifiable precursors.
-Some alters "live inside" for awhile before coming out and assuming
control of the body, while others emerge full blown "on the spot" at
just the moment they are needed.
-The initial "split" usually occurs before the age of five. Once the
first personality has been dissociated, alters may form at any time
thereafter.
-When an alter personality is formed, he or she may or may not deplete
the parent personality of psychological resources.
-Alters can be clustered or related to one another in terms of
emotional or psychological similarities among them.
-Splitting usually occurs along effective lines, and each alter tends
to deal with a related set of conflicts and feelings.
At the APA meeting Wilbur said, "In the analysis of the various
alter personalities of a MP, we find individuals who deal with rage
and hatred, individuals who deal with hypocrisy and dishonesty in
others, alternates who deal with envy and jealousy in themselves and
in others, and individuals who encapsulate intense affect and conflict
of all kinds."
Another way of putting this, according to Bliss, is that each
alter is initially an invited guest, with specific functions for which
he or she is responsible. In addition to alters who encapsulate
emotions associated wth trauma, there may be personalities who are
responsible for developing valuable skills or abilities, others who
express conflictual impulses and needs such as sexuality or
aggression, and personalities who assume control of the body in
specific behavioral roles or social situations.
Absence of Healing
The final factor involved in the etiology of MPD is the lack of
restorative experiences following abuse and dissociation. The
incipient multiple never given a chance to heal adopts dissociation as
a routine strategy for dealing with problems. Dissociative barriers
are strengthened through reinforcement and elaboration, and alternate
personalities assume an autonomous existence.
Studies by Drs Bennett Braun and Charles Stern help to confirm
the idea that multiples do not find the necessary succor or healing
support in their environment. They have attempted to characterize the
family of origin of the multiple, and the profile that emerges from
their research is remarkably similar to that developed by other
investigators studying families likely to include abused children.
The family of origin of the multiple (often or typically):
-Espouses rigid religious or mystical beliefs.
-Presents a united front to the community, yet internally is riddled
with conflict.
-Is isolated from the community and uncooperative regarding
intervention or assistance.
-Includes at least one caretaker who exhibits severe pathology.
-Subjects the child to contradictory communications from significant
others during childhood.
-Is polarized; one parent may be overadequate (the abuser), the
other underadequate (the enabler)
It is this combination of genetic, psychodynamic, developmental
and environmental factors which perpetuates a tragic chain of abuse,
dissociation and multiplicity.
Edited from a note about kids with MPD
FROM: LISA RICHARDSON (XDSH17B)
A recent research study on a checklist used to screen for MPD in
kids showed that a family history of MPD or Dissociative Disorder was
not statistically significant in predicting MPD/DD in kids.
The most predictive items were: traumatic history of sexual
abuse, periodic intense depression, fearful regressive episodes and
perplexing forgetfulness (Reagor, Kasten & Morelli, 1992).
Symptoms of MPD\DD in kids which others describe include: in a
daze, trance, 'another world'; answer to or use another name; big
changes in personality and behavior; forgets or seems confused about
very basic simple things; odd changes in physical skills; schoolwork
goes from very good to bad (and I see kids who are inconsistent in
what they can do in school--i.e. one day they read above average and
the next day they can't read at all, etc); discipline has little or no
effect; denial of behavior observed by others, extreme inconsistencies
in abilities, likes, dislikes; intense angry outbursts; excessive
daydreaming or sleepwalking; internal voices; imaginary playmates or
companions (past age 6); amnesia.
I would say that if you see some of these symptoms, perhaps you
should have your child evaluated. If you are concerned, perhaps it
would help you to rest easier to have it done, too. Please look for
someone, though, who is familiar with working with children who have
MPD/DD. I hope this helps.
(Adapted note from Doris Bell)
0% PEARL 100%
confidence of confidence
TRUST
-----------------------------O-----------------------------
<-------- chain of confidence ------------>
<=== the pearl can move either way ===>
It helps to find a way to think about trust that allows you to
make the adjustments in how MUCH you trust without needing to go into
a tailspin about it.
Now, say a total stranger does something thoughtful for us and we
feel really good about it. It isn't wise to trust that person 100%
because we FEEL good, because they are STILL a stranger to us. Or, say
a trusted friend does something that makes us feel bad. It doesn't
seem wise to move the pearl of trust to the 0% point, either. We know
them, and have a lot of experience with them, and a long history of
how they've treated us in the past.
So, the trick of learning to trust wisely is to learn to move the
pearl of trust only as far along the chain of confidence as is
warranted by how much we know about the person we're dealing with, AND
by the thing that happened that made us feel anxious, OR good. This
gives us a SAFE way to determine how much trust to give at a
particular point.
Doris
Editor's comment:
I visualize the pearl as being VERY HEAVY, so that a single
action has very little effect on it - like one nudge to a big boulder.
A nice act by a stranger would have to be repeated lots of times to
move it, and by that time the stranger has become a friend! Likewise,
a friend who has been trustworthy for a long time would have to do a
series of deliberate bad acts to move the pearl off the trust level
they had attained over years.
Note 3 of 7 - MPD Education-
~~~~~~~ Abuse and Alter Personalities ~~~~~~~~
The second factor in MPD is some set of traumatic experiences
that overwhelm the individual's capacity to copewith them by any means
other than dissociation. A growing and terrible body of evidence now
shows that this is usually severe physical, sexual or psychological
abuse by a parent or significant other in the the child's life.
In a survey of 100 multiples, Dr Frank Putnam found that 97% of
them had a childhood history of incest, torture, or other abuse.
Psychiatrists now believe that as children, multiples created
alternate personalities as a response to such experiences.
Dr. Cornelia Wilbur of the University of Kentucky School of
Medicine was the first contemporary psychiatrist to identify the role
of abuse in the development of MPD in her pioneering psychoanalysis of
Sybil Dorsett. Wilbur discovered that the severe and sustained abuse
Sybil suffered at the hands of her mother had evoked intolerable
feelings of rage, hatred, fear and pain that Sybil learned to cope
with by blocking them out of awareness entirely, through dissociation.
The feelings and memories that Sybil isolated from awareness, however,
were the nucleus around which her alter personalities later formed
though inner elaboration and through reinforcement by repeated abuse.
"Normal at birth...Sybil had fought back until she was about 2
and a half, by which time the fight had been literally beaten out of
her. She had sought rescue from without until, totally recognizing
that this rescue would bedenied, she resorted to finding rescue
within. First there was the rescue of creating a pretend world
inhabited by a loving mother of fantasy, but being a multiple
personality was the ultimate rescue. By dividing into different
selves, defenses against not only an intolerable but also a dangerous
reality, Sybil had found a modus operandi for survival.
Wilbur discussed the nature and scope of the trauma that
multiples suffer in a keynote address at the First International
Conference on Multiple Personality/Dissociative States.
The sexual abuse of multiples has included rape, incest, sodomy
and fellatio, both heterosexual and homosexual, Wilbur said. Cases
have been reported in which a child's caretaker(s) regularly invited
other relatives or friends to participate in sexually exploiting him
or her, and some multiples have been forced to witness the physical or
sexual abuse of other children.
Therapists have also treated multiples who were psychologically
abused by being compelled to participate in murder, or who were
exposed to multiple murders. Religious activity involving ritual
murder - reportedly still widespread in this country - was said to be
the context, in some cases, for this diabolical kind of abuse.
Physical abuse of multiples has included burying, torture, and
beatings. Neglect has included their being almost completely deprived
of physical contact, or constantly having been fed inappropriate
foods. If the latter practise is widespread, Wilbur noted, it suggests
that nutrition may be an etiological factor in MPD, or may figure in
some of the unusual psychosomatic irregularities in multiples.
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