The Therapeutic Hug
Posts tagged ‘coping mechanisms’
Burnout Ahead
This was first published seven years ago. I’m glad to say that things are better now.
What do you get when you take two people, three doctors, eleven prescriptions, two pharmacies, and an insurance company?
No, wait – I’m not finished.
THEN add another person, two banks, a credit card company, a missing check, and a disputed charge.
Mix in bipolar disorder, clinical depression, and several months of previous stress.
What you get, first of all, is something that rhymes with fuster-cluck, and then a dangerous situation: Two people under pressure, neither of whom can function well enough to find any solutions, running out of psychotropics.
There is enormous inertia. You make a few calls, get a few responses. Fine, you think. That’s taken care of. Except that days later, it isn’t. There are overdraft notices, nearly exhausted supplies of psychotropics, and occasional fits of tears.
So you take another swing at it. More phone calls. More revolving phone trees. More dropped calls. More suggestions that you really need to get someone else to call someone other else to resolve it and here’s a handy 1-800 number that takes you to a department that never heard of you, your problem, or the companies you’re dealing with.
Yes, they all agree. It’s important that you don’t run out of your psychotropics. It would sure be nice if there were enough money in the account to pay the premium for the crappy insurance. It’s a mystery why no one has any record of the complaint you asked them to file.
Another day. Another no check. Another no drug delivery. By now we’re getting into mixed states: immobilizing depression and nail-biting, catastrophizing anxiety.
You look for possible work-arounds. Maybe the local pharmacy can sell you enough pills to tide you over. But, oopsie! Your bank balance just went from -$53 to -$82. And the insurance won’t pay for drugs at the local pharmacy anymore – only through mail order. Which brings us back to D’oh!
This is not hypothetical. This is happening.
What do we do now?
Well, we split up the tasks. I work on the drugs and insurance end, while my husband works on the banking problem. We both hover over the mailbox, waiting for the check.
We take turns with symptoms. Both of us having a meltdown at the same time is not pretty. I’ve seen it. Trust me on this.
We do all we can do and then stop. For the moment anyway. When the pitch of my voice starts rising to dog whistle range and I start sniffling and tearing up, I know I’m just moments away from becoming incoherent, which may demonstrate the need for the psychotropics, but is not actually any help in getting them.
We try to take care of ourselves. Dan can sleep (I can’t), so he does. He buys me comfort foods (fried rice, mashed potatoes). I decide that this may not be the best time to be reading a new, fast-paced zombie apocalypse thriller and switch to a familiar old standby character study.
There’s never a good time for these cosmic pile-ups to happen, but now is unusually bad. The last few months have brought assorted financial and medical troubles (the two being related, of course), plus the death of three elderly pets within a couple of weeks of each other. Dan is dealing with the fact that the house he grew up in is up for sale. I haven’t been getting as much work as usual. Soon, I will have to look into expanding my client base or finding another line of work.
After I get the drugs. And after they start to work. Whenever that is.
Sorry I don’t have anything encouraging or amusing or informative to share this week. That’s just the way it is sometimes. And now is one of those times.
Stuffing Your Feelings in a Box
We all know it’s a bad idea to stuff your feelings, especially if you then pile food or alcohol on top of them.
The thing is, sometimes you need to suppress a feeling, for just a little while, in order to get through a difficult situation. When that happens, I put my feelings in a box.
Here’s an example. My father was dying, and had only days to live. We all knew it. My mother, who didn’t drive, asked me to take her shopping for something to wear at his funeral. “Do you mind if I don’t wear black?” she asked. “If you don’t mind that I do,” I replied.
It was my first encounter with a close family death, and I had to get through this awful, wrenching shopping trip. I had to keep my composure so that my mother could keep her composure. I had to steer her away from a flowered dress, which would have been fine for church, to a navy suit and a lighter blue top, which would be suitable for a funeral but not so somber that she couldn’t wear it for anything else. All while my father lay in the hospital, dying painfully of bone cancer.
My feelings were complicated and I absolutely could not afford to feel them at that time. I had to stuff them in a box and close the lid on them until my mother’s needs had been met. Then I could let them out, in a time and place where it was safe to, in the presence of a person I could trust with those feelings.
When such circumstances arise – and they will, in one form or another – I recommend using a box, one in which the feelings will be out of sight for a while. A box is small; only a few feelings will fit in it. If you think the feelings are going to leak out, you can sit on the lid. Then, when it has served its purpose, you can rip the box open (or gently lift the lid) and feel the feelings. Cry. Rage. Grieve. That’s the important part.
You have to experience the grief or fear or even the crushing weight of guilt in order to come through it and heal.
But why put feelings in a box instead of something stronger? Who wants to feel those negative emotions anyway? Aren’t we better off without them? Shouldn’t you just build a wall around them to keep them from breaking out?
We’ve all tried it. It works for a while. But a couple of consequences go with the practice. First, all of your feelings get trapped behind that wall – the good as well as the bad. When you find yourself disconnected from all your feelings, life is a gray blur. In your depression or anxiety or fear or rage, you may not have had many good feelings. But when you build that wall, you cut off even the possibility of having them.
Second, you’re only postponing the pain. The wall will leak sometimes; your unpleasant feelings will come out some way – in your dreams, around your eyes, in sudden spurts, or trickling back into your everyday life. Worse, the wall may shatter – fail altogether, releasing all those feelings in an unstoppable torrent, only stronger and more concentrated from having been confined. They overwhelm both you and anyone in the vicinity. It’s not pretty. And it’s destructive – to you, your mental health, your healing, your employment, your relationships – to every aspect of your life.
If feelings are behind a wall, you may be able to tell yourself they don’t exist. But if you stuff them in a handy box, you can choose the time and place to open it – and yourself – back up.
Distract Me!
I recently saw a meme that said being happy was different than being distracted from sadness. I couldn’t deny that they are different. But it seemed to me that it was saying that being distracted from sadness was a bad thing. And I don’t believe that, necessarily.
Sure, happiness is better than sadness, and something to aspire to. But it’s not always possible, especially for those of us who struggle with bipolar, depression, and other mood disorders – despite what the positive thinking people say. (I don’t think that “smiling depression” is a good coping mechanism to recommend. It denies reality and doesn’t help someone realize that they should seek out the help they need.)
But when I’m down in the depths, distraction helps. Unless I’m in the total Pit of Despair, it short-circuits my overthinking, relieves (at least for a while) my brooding, and even gives me something I can smile at, if only momentarily.
Where do I find distraction? First, there are other people. There’s my husband. He has the ability to make me laugh at the silliest things. We sometimes toss a soft toy back and forth at each other, exclaiming, “Eeee!” It’s really a stupid game, and not one we play every day, but when you’re not expecting Eeee to fly through the air and bop you, it’s definitely distracting. We giggle like fools.
Another one of my go-to distraction providers is a friend named Tom. He’s a singer-songwriter and improv comedian who has dozens of different songs and jokes I’ve never heard. If I’m too much “in my head” and can’t get out, I can call Tom. Once when I called him, I just flat out said, “I need to be distracted.” “Look at the grouse! Look at the grouse!” he instantly replied. I had no idea it was from a Three Stooges routine, but it was absurd enough to ease me closer to where I needed to be.
That’s an important point, too – the ability to ask for distraction. It’s good to have people around who respond and help. Sometimes a calming voice is all it takes. My Uncle Phil has the most soothing voice, and he has many times centered me by distracting me with stories about anything – using computers for business, tarot cards, religious stories, or whatever. My friend Leslie grounds me by expounding on esoteric subjects – epigenetics, for example – if I ask her to. We’re perpetually told to reach out when we need it. This is just another way to do that. If you don’t want advice or commiseration, reach out for distraction.
Of course, there are other distractions like music, television, movies, and even pursuits like gardening. Doing something you have to concentrate on, like needlepoint, keeps your mind focused, and can be a great distraction if you are able to do it. And there are the cats. They’re so completely unconcerned with whatever’s troubling me that they can’t help but draw my attention away from it too.
I’m not saying that one should distract oneself to the exclusion of working on one’s problems. That way nothing which is necessary gets done. We all know that dealing with our difficulties is the path out of the pit.
And I’m not saying that distractions always work. Dan used to tell me terrible jokes to try to jolly me out of my depressive moods. When that didn’t work, he would tell the same joke again in hopes, I suppose, that I had merely misunderstood it and would think it was funny the second time. At that point in my life and my illness, not even Eeee would have gotten through. I’d have let it bounce off me. Or hidden it so he couldn’t try it again.
I’m hardly going to say that distraction can replace therapy and medication. But as an adjunct, I can’t see the harm in it. If you’re at a point where you’re able to, look at the grouse!
My Emotional Protection Animals
I have what I refer to as emotional support animals – principally my husband. He goes with me to places and into situations that upset me, like a dentist appointment or a class reunion. He puts a comforting hand on my shoulder and encourages me.
My cats provide emotional support as well. They ground me when I’m upset and help me calm down. They give me something to focus my attention on instead of the turmoil in my head. They soothe me with their purring and distract me with their antics.
You would think that the animals I identify with most would be cats. I do believe that if I could be any animal, I would choose to be a cat – as long as I could be one of my own cats and not an unwanted, feral stray.
But the animals I identify most with are bunnies and armadillos. Here’s why.
There’s an expression among chefs – when they’re absolutely slammed with work, falling further behind with each passing minute, they describe the situation as being “in the weeds.” I use the phrase a little differently. I was experiencing a mixture of anxiety and depression, totally overwhelmed, though not necessarily with work. Every day brought new challenges that terrified me. Every day I found myself immobilized. And every day I found myself retreating. I felt like a little bunny hiding in the weeds.
That became the shorthand my husband and I used to describe the feelings. He would ask me how I was feeling, and I would reply, “I’m hiding in the weeds.” When I couldn’t express what I was feeling, he would say, “Are you hiding in the weeds?” and I would nod. That’s how I felt – like I had to hide from the flood of feelings and problems that beset me. Like I needed a screen of weeds to offer me what little protection they could. Like I had to be ready to jump at any minute the next time I sensed a threat.
I moved past this phase. After years of therapy and medication, I no longer need the weeds. I have stronger forms of protection that come from inside now. (My husband does calls me “Bunny” as a term of endearment, though.)
Armadillos are another story. Again, though, my fascination with them was in relation to another form of protection, seemingly more solid than weeds.
Armadillos are covered, of course, with bands of scales that protect them from most dangers. They can also roll up in a ball to protect their soft underbellies. I tried to develop hard scales that would prevent trauma from invading my fragile emotional makeup. At times I even rolled up into a ball (or at least a fetal position) when I had a meltdown.
Eventually, I did learn that if you wall off your feelings, it’s hard to get back in touch with them. And the good emotions get blocked off as well as the bad ones. The armadillo armor was not a viable solution for the long term.
I also learned that the armadillo has another defense mechanism. It jumps straight up about two feet into the air, presumably to escape from or startle any predators. Unfortunately for the armadillo, their main predator is the automobile. The little critter’s jump puts it at just the right height to be smashed by the car’s bumper. As a defense mechanism goes, it’s not really what you’d call successful.
That’s when I realized that neither were mine. When I got jumpy – when my anxiety was out of control – I was often smashed by onrushing difficulties, the very ones I was trying to escape.
So, bunnies are out. Armadillos are out. Where can I find an animal to identify with in terms of protection? We’re back to cats, I guess. They at least have claws that they can choose to extend or sheathe. I like the idea of bringing out a defense mechanism only when I really need it.
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DonateWhen I Need to Feel Normal
A lot of the time, I live with sort of a low-grade dread, kind of like coming down with a fever. I’m well-known for overthinking and catastrophizing. The combination is exhausting.
When anything alarming happens, I ratchet up into an agitated state. It could be anything – a relationship problem, a looming financial disaster, a health scare. I respond with racing thoughts, trembling hands, and sleep disturbances. I find myself at 2:00 a.m., wide awake though a little bit foggy, with no real idea what I should do. Most of the time, there isn’t really anything I can do.
This happened a lot when I was in college. My life was complicated then – well, it always has been and still is. I wasn’t particularly worried about my grades or about graduating. No, it was other things that occupied my troubled mind. A difficult relationship was ending in great turmoil. I had lost a lot of weight and didn’t look or feel healthy. I had to pack, move, and find a job. My parents were coming for the graduation ceremony and I didn’t want them to see me in such distress. It was all overwhelming.
I had insomnia that summer. I would find myself lying on the sofa, wide awake, my brain on overdrive, with only a large black cat to keep me company while everyone else in the house slept. That cat kept me anchored in a way. He distracted me with his solidity and his insistent purring. He was a soothing presence that helped me not feel totally alone, without putting any demands on me.
It was that summer when I learned a technique I could use when everything seemed to be spinning out of control. I found that I could ground myself and stop all the whirling thoughts, at least for a while, by doing something small and totally normal. Making myself a cup of tea was my go-to. The familiar actions of finding a mug and a teabag, heating the water, and steeping the tea gave me something physical to do that would get me out of my head and back into my body. No matter how distraught I was, I could always manage to make a cup of tea. It’s not a demanding task. I could do it practically by rote. But it was so familiar – so completely normal – that it was a form of reassurance.
It turns out that the feeling of normalcy can soothe other people too. Once that summer, my uncle Phil was also having a hard time sleeping. Like me, he was afflicted by personal problems and feeling out of touch with his body and tangled up in his head. I busied myself making him a can of soup. It kept me from getting swept up in his turmoil, and it helped him become calmer as he watched me puttering around the kitchen. Again, it was all so normal that it soothed us both.
Now, when I have racing thoughts and distress, I try to find something manageable and entirely normal to do – something I can do automatically, without expending any thought. Putting out fresh food for the cats. Making lists. Watering a plant. Anything that I can do with little expense of energy or thought. In a way, it’s kind of a mindfulness exercise, paying attention to the steps involved and experiencing every movement as I go about accomplishing my normal little task.
This technique doesn’t work for me if I’m having a full-blown panic attack, but maybe it at least helps me stave one off if I catch it creeping up on me. It’s one of my more effective – and non-counterproductive – coping mechanisms.
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DonateHow Do You Find Relief From Stress?
Stress is a major factor in my life, and I’m sure it is in your life as well. As far as I can tell, there is no one these days that doesn’t suffer stress. I don’t know any millionaires or billionaires, but I imagine that, perhaps counterintuitively, even they suffer stress. There’s the stress of keeping their businesses going, watching their investments shrink when the stock market tanks, and stress in their personal lives. It’s hard to feel sorry for the very rich, but I can at least understand that they do have stress.
Yet, the stress I feel as someone with SMI is different. It’s not just the normal stress that comes with day-to-day life – bills, health, family, and the buildup of petty annoyances, et endless cetera. There are stressors specific to people with mental illness.
There’s the stress of symptoms or waiting for them to come back or get worse. There’s the stress of trying to find a therapy – medication or otherwise – that will help. The stress of trying to make a living or get on disability. Avoiding our triggers. Trying to find or maintain relationships. Remembering to take medication every day. The things we think of as stress relievers can be counterproductive, too. Booze or drugs, overeating, over-shopping, and other compulsive behaviors can actually add to the stress. Even performing self-care activities can cause stress – guilt over not doing the things we “should” do like exercise or meditation.
Having a caregiver can help lessen some stress. Caregivers can’t completely eliminate stress, however. In fact, they can be the cause of certain kinds of stress – worry about whether they’ll show up, whether we’re putting them through too much stress, or whether they resent us, to name a few.
So, what are some ways to relieve stress that don’t cause more stress?
My go-to stress reliever is music. When it all gets to be too much, I have myself a little music party. Usually, I party by myself, but sometimes my husband joins me, at least for the first half hour or so of it. I have plenty of slow, sad songs on my computer, but my music parties emphasize loud, raucous tunes. My playlist also contains silly songs (think Dr. Demento). I am fortunate enough to have a number of friends who are singer-songwriters and who specialize in the ridiculous, so I’m amply supplied. Sometimes I bounce around from song to song as they occur to me. Other times, I let the shuffle feature pick. An hour or two and I’m unwound enough to sleep.
My cats also provide distraction from stress. For some reason, I find it calming to watch cats wash themselves. The sound of purring is a stress reliever, and one of our cats snores (daintily) while she sleeps. Besides, they generate lots of alpha waves, and those are contagious.
I do also want to address the use of CBD/THC products for stress relief. I don’t have much experience with this, so I’ll have to defer to people more knowledgeable than I am. And I certainly don’t want to encourage anyone to break any laws. But I understand that one of the difficulties of using CBD in particular can be balancing the relaxing effects with potential paranoia. Still, many people find CBD to be a sleep aid, and good, restful sleep is a major stress reliever. At the moment, in my state (Ohio), PTSD and Tourette’s are the only mental disorders for which medical marijuana can be prescribed. Other forms of CBD such as hemp products are more widely available, including online.
What you actually do for stress relief matters less than that you do something. Maybe for you, that’s a massage or a warm bubble bath. But maybe it’s hugs, music, grounding exercises, meditation, or yoga. Whatever you find relieves your stress, making time for it on a daily basis isn’t a bad idea. That way, you’ll be in practice when the stress does hit.
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DonateSelf-Care and the Power of Routine
When a lot of people hear the word “routine,” they think “rut.” My opinion, though, is that routine and rut are completely different. A rut is what you get into when you have nothing else in your life but work and chores, while routine is something that provides structure to your day. Of course, a routine can become a rut, if it’s not flexible enough to make room for variety somewhere.
What I think routines are particularly good for is self-care.
Let’s consider how you develop a routine. The business concept of “time-blocking” will help.
Time-blocking is a method of scheduling that relies on dividing your day into blocks of time (duh!) for each of your tasks or activities. A businessperson might have time blocks reserved for “planning meeting,” “business lunch,” and “create spreadsheet.” They estimate how long each will take and adjust the time blocks accordingly. If their time estimates are off, they revise for the next day or week.
One of the principles of time blocking is grouping similar tasks together. For example, one might have a single time block for making phone calls or answering emails. Another one is to leave some blocks empty so they can be used for tasks that you may not have completed or blocks that had to be shifted because of having to put out fires.
You can do time-blocking on a daily or weekly paper calendar, but business books recommend using scheduling software. I like the idea of using an erasable board that you can put up on your refrigerator or in another convenient place.
How does this relate to self-care? Well, it’s a good idea to make self-care part of your routine, and time-blocking is one way to develop that routine.
The first things to schedule are good habits that help you manage your disorder. For me, these are medication, food, and sleep. I take my meds as soon as I wake up and on my way to bed. I don’t consider that a time block, more like a habit, something to check off on a mental list.
I usually wake around 7:00, unless I have a work assignment that needs to be turned in early in the morning. I usually go to bed around 9:00. I need lots of sleep.
I have a time block for lunch at 12:00 and for dinner at 6:30. I make sure to have food on hand that is easy to prepare for lunch – cheese and crackers, soup, applesauce, and so on. My husband makes dinner because he wants to make sure that I eat at least one complete meal every day.
The other important time block for me to schedule is work. I’m a gig worker, so my assignments can vary. Generally, though, I work until about 11:00 in the morning and till 4:00 or 5:00 in the afternoon. I try to make working a habit, too. It keeps me from falling too far behind if I have a day when I’m simply not able to face getting out of bed and working.
You may have noticed that there are gaps in my schedule of time blocks. These are when I fit in self-care. In the morning, I have time for checking my email and Facebook. Why are these self-care? They’re the ways I keep in touch with friends and acquaintances – the outside world in general.
In the afternoon, between work and dinner, I watch some TV, usually cooking shows, which I find comforting. After dinner, I have time with my husband to see a movie or binge-watch a favorite series. When I take my meds and go to bed, I read for about half an hour. All these are part of my self-care. A person needs to set aside time for relaxation, which is a vital part of self-care.
Sometimes, I have to set aside a time block for something else. If I have to go out somewhere, I usually schedule an hour before I have to leave. It sometimes takes me that long to shower, dress, put my hair up, and make sure I have everything I need in my purse. I know that, so that’s why I leave an hour for it. Then there’s time for whatever errand it is, or maybe lunch out on my husband’s day off.
That’s my daily schedule of time blocks. I also have a weekly set of time blocks. I try to have a first draft of my blogs done on Thursday, finish them and tag them by Friday, proofread on Saturday, and post on Sunday. This is something that’s not quite work, because I don’t get paid for it. It’s something I do for myself and I get satisfaction from it, so I think of it as a self-care activity.
I also use my Google calendar to keep track of things that need to be done monthly – bills, recycling, doctor appointments for me and my husband, deadlines for my gig work, and so on. That’s self-care too, because I suffer an unhealthy amount of stress if our finances get out of control. Reducing stress is part of keeping me on a steady course. I could use the weekly or daily functions, but those are tasks I’m used to after getting into the habit for so long.
I prefer having these times and tasks in a reasonably consistent schedule, with some room for adjustments. Routine helps me get done what I need to do and enables me to schedule self-care too, rather than leaving it to last.
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DonateOn My Own
Earlier this month, my husband went away for 11 days to visit his 96-year-old mother, leaving me at home to fend for myself. I didn’t object to his going (though that hasn’t always been the case on other occasions). But it left us both concerned about how I was going to manage without him for nearly two weeks.
My husband helps me with most of my self-care needs. I guess I shouldn’t even call it self-care because he does so much of it. He makes sure I eat regularly, shops for food, and usually prepares dinner. He recognizes when I’m overwhelmed and gives me a hug. He helps me get ready if I have to go out. He does most of the physical chores. (I do the ones involving a computer, like correspondence, bill-paying, and scheduling appointments.) He calls me twice a day to make sure I haven’t fallen and been unable to get up. If I don’t answer the phone, he rushes home on his break to help me. I really don’t know what I would do without him.
For 11 days, though, I was going to have to. We hadn’t been apart this long for years.
Since one of my major self-care problems is forgetting to eat or not having the energy to make myself something to eat, he stocked up with all the things I like that were easy to fix and eat: juice, cola, ginger ale, yogurt, cans of soup, whole wheat bread, bologna and salami, assorted kinds of cheese, applesauce, and those little frozen meals for useless people like me. There were muffins and frozen waffles for breakfast, peanut butter and mac-n-cheese and spaghetti for lunch and dinner, and even jello and pudding for dessert. Everything that needed heating was microwaveable.
I often eat in my study, where there is a little tray table, so we devised a strategy for getting to and from the refrigerators. The time when I trip and fall most often is when I’m carrying several items and lose my balance. He came up with the idea that I should carry my food items in a plastic grocery bag to and from my room. We have hundreds of those bags. And it worked. I didn’t fall once. I don’t know why we didn’t think of that before.
He still called me every day, though of course there was nothing he could do for me if I fell. In fact, he called me much more often than twice a day, just to talk. We found the thing we miss most when we’re away from each other is simply shared conversation.
I developed a little routine to see me through the days. In the morning, I would have breakfast and watch a cooking show till I was awake and alert enough to start my day. Then I would do my work in the mid-morning until lunch. After lunch, more writing. After dinner, music or TV, or more work, if I had an especially pressing assignment. Go to bed early. Lather, rinse, repeat. Repetitive, certainly, but it seemed to work.
So, what did I learn from this exercise? Well, first of all, I found out that 11 days on my own is a doable thing – if we anticipate difficulties and prep for them. That I am able to continue my daily rhythms and keep up with my work, eating, and sleeping. That I experienced no recurrence of my bipolar symptoms even though my usual environment had changed. (I had been worried about depression or anxiety setting in.) That the loss of my husband’s presence wasn’t crippling. That we managed to retain our important connection despite the physical distance between us.
That photo with this post isn’t entirely accurate, though. I didn’t meet my own needs completely on my own. My continuing self-care still required my husband’s help. But once the systems were in place, I managed. On my own.
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DonateDissociative Identity Disorder: The Basics
I had a friend, Hal, who had Dissociative Identity Disorder (DID). I never met any of his alters until once we went to the corner store. He giggled. He grabbed numerous bags of chips and other snacks. When we got home, I mentioned this to him, and he said, “You just met Julie. She’s a teenage girl.” Later, I met an alter known only as The Angry Man, which is part of why we’re no longer friends.
DID, as its name says, is a dissociative disorder, one of three different kinds – Dissociative Amnesia, Depersonalization Disorder, and Dissociative Identity Disorder. DID is the most severe of the three conditions. All involve symptoms such as memory loss, “out of body” experiences, emotional numbness, and lack of self-identity. DID is thought to be a reaction to the trauma of extreme physical, emotional, and sexual abuse that occurs usually before the age of six.
Some trace the history of DID to 1584, when the records of a French woman who was exorcised recounted symptoms that today would very likely be attributed to DID. It’s likely that more cases that were actually DID have over the years been attributed to demonic possession. Later, it was seen as a form of hysteria, another disorder with dissociative symptoms.
DID really hit the big time in the 1950s through the 1970s, when the books The Three Faces of Eve and Sybil became best-sellers and were made into movies. The books, written by Corbett H. Thigpen and Flora Rheta Schreiber, respectively, were accounts from psychoanalysts about the diagnosis and treatment of DID, which was at the time called Multiple Personality Syndrome, since the disorder was notable for “alters,” or separate personalities that appeared while the primary personality was unaware that they existed. “Eve” had three alters, while “Sybil” had 16.
Since that time, both of those cases have been controversial, with exposes purporting to reveal that neither Eve nor Sybil really had multiple personalities. The theories were that either the subjects were faking the disorder, or that the doctors suggested to them via leading questions and hypnosis that they had multiple personalities. (This was related to the “repressed memory” controversy in the 1980s to 1990s, which raised many of the same issues. Healthline recently reported that “the majority of practicing psychologists, researchers, and other experts in the field question the whole concept of repressed memories. Even Freud later discovered many of the things his clients ‘remembered’ during psychoanalysis sessions weren’t real memories.”)
Still, DID is real enough to have made it into the DSM. (We should remember, though, that diagnoses of “illnesses” such as homosexuality were present in earlier editions but later removed.) There are therapists who treat it with Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), medications, Eye Movement Desensitization and Reprocessing (EMDR), and/or hypnosis, which started to be a treatment in the 1830s and is said to lead to a rapid recovery. Although hypnosis for diagnosis or treatment of DID is still controversial, it may be useful for reintegrating the alters back into the primary personality.
DID has also been used as a potential criminal defense in legal cases over the past several decades, in cases that range from drunk driving to murder. It has been used to support a plea of “Not Guilty by Reason of Insanity” (NGRI). This defense is used in less than 1% of felony cases and is successful in only a fraction of them. The theory that a crime was committed not by the primary personality but by one of the alters has not always proved persuasive. It’s difficult to prove, for one thing, and there are professional witnesses and psychologists who testify that either DID does not exist or that even if an alter committed the crime, the primary person is legally responsible for it. The DID defense did work in 1977 for Billy Milligan, who was said to have 24 separate personalities, two of whom were claimed to be responsible for his crimes of rape.
DID is subject to a number of myths or beliefs. For example, many people believe that DID is either nonexistent or an overdiagnosed “fad” seen only in North America. Some believe that it is caused by the doctors who treat it rather than by childhood trauma, or that it is in reality the same as Borderline Personality Disorder (BPD). However, there have been neuroanatomical changes recorded by MRI in cases of DID: “The neuroanatomical evidence for the existence of DID as a genuine disorder is growing and the structural differences seen in DID patients’ brains…contribute to that growth.” So, although DID is believed by some to be nonexistent, there are studies that back up its reality.
As for me, I have experienced a few mild instances of dissociation related to my bipolar disorder, but nothing even remotely like what occurs in DID. But then, I didn’t have the childhood trauma associated with it. (During the “repressed memory” days it was said that the only truthful answer to “Have you experienced extreme childhood trauma?” is “Not that I’m aware of.”) Nonetheless, I find the subject fascinating, as well as dissociation in general. (This is not intended to diminish the experiences of people who have a dissociative disorder.) But I look forward to learning more about DID, particularly the neuroanatomical changes when they become available.
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Janet Coburn
Bipolar Me 
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