Thursday, April 3, 2008

Saying Good-Bye



I packed up the last of it today, reminders of an old friendship.  While I packed, I wondered what would happen to my friend.  I wondered if I could have done more.

We met a few years back in a victims forum.  Laura (not her real name) seemed mostly through her healing.  She had a fun sense of humor and an unusual zest for life.  Laura's outlook on life could have been called inspiring.  We talked about being survivors and even about working on a few projects together.

Laura shared bits and pieces of her story with me through the years.  Some of her story was familiar to me.  Some of her story involved abuse that I hadn't even heard of.  I felt hurt for her and wondered how anyone could ever be so cruel, especially (in her case) to a child.  I listened and tried to find some kind of meaning in it all.

Then, Laura told me that she had multiple personalities.  Today, it's called Dissociative Identity Disorder.  I'll get to the "medical description" in a minute.  Before we talk about the "science", I want to say that my old friend (and anyone else who suffers from DID) wasn't and isn't a bug to "study under a microscope".  She's real.  She's been through a lot and come a long way.  Laura, and people like Laura, don't need our criticism.  They need our understanding and our compassion. 



A
Dissociative Identity Disorder: Merck Manual Home Edition says:


Dissociative Identity Disorder and Childhood Abuse

About 97 to 98% of adults with dissociative identity disorder report having been abused during childhood. Abuse can be documented for 85% of the adults and 95% of the children and adolescents with dissociative identity disorder.
 
Although childhood abuse is a major cause of dissociative identity disorder, that does not mean all the specific abuses alleged by people with this disorder really happened. Some aspects of some reported experiences clearly are not accurate. In addition, some people were not abused at all, but rather, suffered an important early loss, such as the death of a parent, a serious physical illness, or some other very stressful experience.



What I came to believe is that inside all of us, when the pain is too much for us to bear, God gave us an extreme coping skill where we can bundle up all that pain and place it in the care of a tiny part of our self.  Then, that part of our personality simply breaks off to hold the memory until we are strong enough to take the memory back, if we are ever strong enough.

I felt compassion and concern for Laura.  I worried because I saw how some of those personalities interfered with her daily activities ... like the "five year old personality" coming out to play while Laura was driving the car.  I was on the phone with her at the time.  I tried very hard not to panic and remain calm, but inside, I felt the same way anyone would feel if a five year old were driving down the freeway in rush hour traffic.  I didn't know anything about multiple personalities, but I thought I better learn if I was going to be able to support my friend ...



Dissociative Identity Disorder

In dissociative identity disorder, formerly called multiple personality disorder, two or more identities or personalities alternate.
 
Dissociative identity disorder appears to be a rather common mental disorder. It can be found in 3 to 4% of people hospitalized for other mental health disorders and in a sizable minority of people in drug abuse treatment facilities. However, some authorities believe that many cases of this disorder reflect the influence of therapists on suggestible people.
 
Dissociative identity disorder appears to be caused by the interaction of several factors. These include overwhelming stress; an ability to separate one's memories, perceptions, or identity from conscious awareness; abnormal psychologic development, and insufficient protection and nurture during childhood.
 
Human development requires that children be able to integrate complicated and different types of information and experiences. As children learn to achieve a cohesive, complex identity, they go through phases in which different perceptions and emotions of themselves and others are kept segregated. These different perceptions and emotions become involved in the generation of different selves, but not every child who suffers abuse or a major loss or trauma has the capacity to develop multiple personalities. Those who do have the capacity also have normal ways of coping, and most of these vulnerable children are sufficiently protected and soothed by adults, so dissociative identity disorder does not develop.
 
Although childhood abuse is a major cause of dissociative identity disorder, that does not mean all the specific abuses alleged by people with this disorder really happened. Some aspects of some reported experiences clearly are not accurate. In addition, some people were not abused at all, but rather, suffered an important early loss, such as the death of a parent, a serious physical illness, or some other very stressful experience.



What all that meant for Laura was that even though she is very intelligent, her perceptions and emotions swung way out of control sometimes.  I would try to sooth and calm her the same way I would any adult, but in reality, those out of control moments were probably one of her more immature personalities.  

I couldn't always tell when there was a shift because whatever was happening on the inside of her always looked the same on the outside.  I could have a whole conversation with "one personality" and the others would have no memory of it.  I think now that one of the mistakes I made was trying to "normalize" those moments by thinking that "she just forgot" or "maybe, she's in menopause too".  I'd shrug it off and repeat myself.

The first time I saw Laura "be another person" was surprising, only because she "became" a "five year old in a woman's body" in the middle of a gift shop full of breakables.  Her face changed.  Her voice changed.  It was kind of like having a severely retarded adult "appear" out of nowhere, but I have volunteered with retarded adults before ... No problem, right? ... Except, I remember wishing my friend was there to help me cope with the person she was ... It doesn't make sense to say it that way, but it is how I felt.

See?  I'm doing it again.  Even now, I am trying to put it into a "normal" context, as a way of explaining it.  It's not "normal", but shoot, who of us really is "normal"?

I still choose to believe that it was God's way of saving that precious soul all those years ago and the journey back to herself will be harder than some ... easier than others ... but I ask God to be with Laura all along the way.  Amen.

 
 
Symptoms
 
People with dissociative identity disorder often describe an array of symptoms that can resemble those of other mental health disorders as well as many physical disorders. Some symptoms are an indication that another disorder is indeed present, but some symptoms may reflect the intrusions of past experiences into the present. For example, sadness may indicate coexisting depression, or it may be that one of the personalities is reliving emotions associated with past misfortunes.
 
Dissociative identity disorder is chronic and potentially disabling or fatal, although many with the disorder function very well and lead creative and productive lives. People with this disorder are prone to injuring themselves. They may engage in self-mutilation. Many attempt suicide.
 
In dissociative identity disorder, some of a person's personalities are aware of important personal information, whereas other personalities are unaware. Some personalities appear to know and interact with one another in an elaborate inner world. For example, personality A may be aware of personality B and know what B does, as if observing B's behavior; personality B may or may not be aware of personality A. Other personalities may or may not be aware of personality B, and personality B may or may not be aware of them.
 
The switching of personalities and the lack of awareness of one's behavior in the other personalities often make life chaotic for people with dissociative identity disorder. Because the personalities often interact with each other, people with dissociative personality disorder report hearing inner conversations and the voices of other personalities commenting on their behavior or addressing them. They experience distortion of time, with time lapses and amnesia. They have feelings of detachment from one's self (depersonalization) and feelings that one's surroundings are unreal (derealization). They often have concern with issues of control, both self-control and the control of others. In addition, people with dissociative identity disorder tend to develop severe headaches or other bodily pain and may experience sexual dysfunction. Different clusters of symptoms occur at different times.
 
People with dissociative identity disorder may not be able to recall things they have done or account for changes in their behavior. Often they refer to themselves as "we," "he," or "she." While most people cannot recall much about the first 3 to 5 years of life, people with dissociative identity disorder may have considerable amnesia for the period between the ages of 6 and 11 as well.



The switching of personalities, lack of awareness, memory gaps and overall behavior really got confusing.  I'm sure that life is confusing for my friend, but it is confusing to be her friend too.  I am pretty accepting of people and their stories, but what if their stories keep changing and you can't call them on it because depending on the person you talk to, the person who did it might "not be home"?

Twice, Laura drew me into her personal conflicts by making me feel like she was really being hurt.  I'm a Mom, a Grandmother and a recovering co-dependent so "rescuing" isn't a big leap for me.  Twice, I jumped in to the middle of a fight, looked around and realized that there was no fight.

I began to look at Laura differently ... I realized that she didn't see herself even close to the way she was.  In her mind, she sees herself as an artist, a writer, a photographer, a totally in charge businesswoman who loves life, but it's just a mask.  I think on some level, she knows it's a mask, but I'm not sure how aware she really is.

I started to listen to Laura's stories and heard contradictions I hadn't noticed before.  It wasn't that she was intentionally lying.  She really believes the voices in her head.  She really doesn't know the difference.  It is impossible to argue or debate with someone who has four-five internal conversations going on at the same time.  Inside, even after years of managing the voices, she couldn't really hear me.  Outside, I never really knew who I was talking to.  Laura argues in a rigid point by point way ... saying she learned to talk/write that way in management training ... but I believe she argues that way to keep all the voices straight, even if the facts get muddled.

I have never been through the kind of pain Laura has suffered.  There is no way that I can really understand what she goes through on a daily basis.  I know it's a struggle just to get up in the morning and go through her day, acting "normal".    



Diagnosis
 
To make the diagnosis of dissociative identity disorder, a doctor conducts a thorough psychologic interview. A medical examination may be needed to determine if a physical disorder is present that would explain certain symptoms. Special questionnaires have been developed to help doctors identify dissociative identity disorder.
 
Interviews may need to be prolonged and involve careful use of hypnosis or drug facilitation (see Amnesia and Related Disorders: Treatment and Prognosis). Hypnosis or drug-facilitated interviews may make the person more likely to allow the doctor to encounter other personalities or to reveal information about a period for which there is amnesia. However, some doctors feel that hypnosis and drug-facilitated interviews should not be performed because they believe the techniques can themselves generate symptoms of dissociative identity disorder.

Treatment and Prognosis
 
Some symptoms may come and go (fluctuate) spontaneously, but dissociative identity disorder does not clear up on its own. The goal of treatment is usually to integrate the personalities into a single personality. However, integration is not always possible. In these situations, the goal is to achieve a harmonious interaction among the personalities that allows more normal functioning.
 
Drug therapy can relieve some specific coexisting symptoms, such as anxiety or depression, but does not affect the disorder itself.
 
Psychotherapy is often arduous and emotionally painful. The person may experience many emotional crises from the actions of the personalities and from the despair that may occur when traumatic memories are recalled during therapy. Several periods of psychiatric hospitalization may be necessary to help the person through difficult times and to come to grips with particularly painful memories. Generally, two or more psychotherapy sessions a week for at least 3 to 6 years are necessary.



My friend has been in the process of integrating, but maybe, it's a little like cleaning an office ... It gets worse before it gets better.  

During therapy, Laura got much closer to her pain.  She became more rigid in her interaction with her closest friends, getting angry if we didn't do what she wanted us to do or say what she wanted to hear.  Sometimes, it felt like she expected us to read her mind.  Her other personalities knew what she wanted without having to ask.  Why didn't we?  I saw her get frustrated with people and just write them off, refusing to even talk to them.  She was really cold about it.  Ice.  She would talk about them in the cruelest way and then, later, say that someone else said it.  She used me to hurt someone and to this day, claims she had nothing to do with it.

I tried to talk to her several times, but if I got too close to something she wasn't ready to see, she said I was throwing it in her face.
If she thought I was telling her what to do, she said I was being controlling.
If she felt like I was too direct, she said I was rude.
If I spoke too softly, she said I was being condescending.
If I didn't give her a good enough answer, she said I was cold or uncaring.

I think that's probably when I gave up the friendship.  How can you be a friend when you aren't "allowed" to talk?

Laura asked me several times to describe love to her.  It's possible that because of her abuse, she really doesn't know what love was.  Who can blame her for that?  Not me.  It becomes exhausting to be her friend when she wants/needs/expects me and anyone else close to make up for the love she never had.  Most of us have family, extended family and friends ... but how would it be if we never had a REAL family or a REAL friend?

I feel sad because I couldn't be that friend.  I would have liked to have been, but who could ever make up for a lifetime of lost friendships?

When Laura realized that I wasn't that ONE GOOD FRIEND, she turned on me the same way she turned on the others.  Where I once was this "amazing, awesome, wise and wonderful friend" (I never really was amazing, awesome, wise and wonderful by the way ... sure, I have my moments ... but I am quite human), I now was everything she hates in the world, and believe me, she has a lot of HATE stored up.

How do you be a good person and a kind friend to someone that is swinging at the whole world?  I don't know.  The truth is, even though she is out there saying really ugly things about me, I am grateful for the distance. 

It's a relief.  I am grateful for the rest.

Of course, it hurts, but I won't defend myself.  I know the truth.  I know who I am.  I can't defend myself without telling her story and I won't do that.  I don't want to add to her hurt.  She has enough hurt to last 100 lifetimes.

Of course, it helps for me to talk about my friend.  I miss her, even if she was wearing a mask.  It was a really nice mask.  I don't want you to feel sorry for me or my friend.  I don't think she would want that either.  I am hoping that our story will help you be more understanding as you move through your day. 

We never really know how much pain the person we meet is carrying, because some of the worst pain is invisible.  There is a lot of hurt in the world.  People don't need our fear or our anger.  They need our compassion and our kindness ... as much as we have got to give.






 
Disclaimer:  My friend will probably read this.  If she does, she should know that her secret is safe with me.  If anyone on the internet thinks I am talking about them, you are wrong.  If anyone else reading this, attempts to guess at who I am talking about, you are missing the point.  My point is that it helps me to talk about it.  Like everything else in my life, I believe that awareness and understanding can lead to mighty miracles ... and I am hoping for a miracle for Laura. 

                                                                     

2 comments:

Anonymous said...

you are an amazing person. I wonder how you can care about so many issues and still remain sane. I am like this to a point but then I look around and ask Am I the only one who cares about this/ and WHY do I care? lol
i used to have ajournal but I made an innocent comment on a "friends "journal and she attacked me with such venom that i lost the heart to journal. Other readers  privately  expressed sympathy for her attack on me but I still left feeling like an outsider.
I didnt want her to be abandoned by her readers yet I wanted validation that she had attacked me unfairly. I did not get it.
Now after reading this I wonder is it me or her that has multiple personality disorde? lol

Anonymous said...

Hello mjgm1954,

Thank you for the compliment, but I am not so amazing. I am a recovering co-dependent. For most of my life, I looked at the world through a different window. One day, about five years ago, something happened to shatter the glass. For the first time in my life, I realized that there was a great big world out there full of people who didn't think like me. I had to change the way I thought, one day at a time.
LOL ... I don't know if your friend or you really have multiple personality disorder. A Dr. diagnosed Laura. Multiple personalities are actually pretty rare ... but, we probably think of several people who suffer from anxiety. Whether they are feeling the loss of a loved one, overly worried about their home or their job, or maybe, they just survived a natural disaster ... even a car accident or a particularly precocious teenager can propel us into extreme anxiety.
When people are hurt or afraid, they are not their best ... We are not always at our best either. We can't fix everyone or everything. We can't kiss it and make it better. We can only be aware that there is always more to the story and try our best to be kind.
Thanks for commenting.

Huggggggggggggz, Taylor