Monday, December 28, 2015


Multiple identities
Why isn't it an advantage?
Maybe it is.

The kids used to call it “spacing out.”  They would say, “I’m spacing on what an adverb is.”  Or “he’s a space cadet.”  And if I lost my line of thought, “You’re spacing out, Mrs. Scriver.”  Usually interpreted as a kind of loss of consciousness, it’s really more like an electrical brownout when something is sapping all the energy before it gets to the normal goal.  If we all knew about it, it must be more common than people think.  Maybe it's a matter of how intense it is.

Human society, just like other animal societies, often keeps order through peer pressure.  If someone is acting a little different or responding to causes other people can’t sense, they may be challenged or even punished.  They might be accused of deliberately making trouble.  Teachers who watch a set of students in a classroom see faces that might show daydreaming or might demonstrate a petit mal seizure.  Unsophisticated teachers will not know the difference and may react in damaging ways.  Likewise the other students. 

It’s possible that dissociation might be produced organically in the brain: malfunctioning electro-chemistry in synapses, molecules missing atoms or folded wrongly, outside chemistries interfering (drugs), rhythms garbled.  If the phenomenon is happens a lot and interferes, it probably ought to be investigated medically.  The intense hormonal changes of pregnancy or the drastic introduction of chemotherapy can induce “fog” to thinking or even throw the person into another interior reality.

If the “under mind” is wrestling with strong feelings or ideas or new information that needs to be resolved, it can put everything else on hold.  Onstage an actor knows this and when depicting something powerful will not move for a few seconds to show that everything is going to processing.  We recognize this.

Years ago I paid a counselor to talk me out of going into the ministry.  She failed.  (She also lost her marriage and became a torch singer.)  Sometimes when we were talking, she would ask what she had said and what it meant to me — because she said I suddenly looked as though she were speaking Chinese.  She taught me that it meant that I was “spacing” because she had said something I needed to process.  She taught me to try to recognize what had just happened and therefore to explicitly ask for time to process the feelings.  This works.  It appears that I pick up more information and emotion than I can keep up with, esp. in meaningful situations.  This was probably the most important thing she taught me.

Sometimes one can actually feel through the autonomic nervous system the emotion thrashing away in the breathing, heartbeat and other viscera.  Sometimes it is like entities wrestling with each other and sometimes, if the tip of a tentacle appears in the consciousness, one can seize it and pull it out for observation.  This can happen in therapy, in dreams, and in poetry.  Metaphors help.

"Would you marry me?"

My movie last night was “The Golden Door,” an Italian film about emigration to America at the turn of the 19th century.  (Excellent!)  The protagonist has been told that in America there are rivers of milk and he quite likes the idea.  We are shown what he imagines as if it were an actuality.  We are used to this in movies since so many show “flashbacks” and the like — a glimpse of another reality and then a return to the mainstream.  In fact, modern life in the “fast lane” is so tachistoscopic and mixed-context that we easily recognize it.  

In older movies, people are sometimes depicted as losing control and even contact with reality when something traumatic and intense happens.  The another character (usually a man) will slap the dissociating person (usually a woman) across the face and she will say, “Thanks, I needed that.”  This is not recommended.

Consciousness is honored and privileged so much that we lose the value of being attentive to feelings, so that part of the brain, even in the forebrain, is suppressed. But it’s as though the metaphorical “operating platform” is the site of a riot of concepts that cannot produce anything ready for consciousness.  At least not daily conventional consciousness.

The Five Dissociative Disorders

The SCID-D can identify whether a person is experiencing one of the five types of dissociative disorders. The first four are 
dissociative amnesia, 
dissociative fugue, 
depersonalization disorder and 
dissociative identity disorder (previously called multiple personality disorder). 
The fifth type of dissociative disorder, called dissociative disorder, not otherwise specified, occurs when a dissociative disorder is clearly present, but the symptoms do not meet the criteria for the previous four.

The five disorders can be distinguished from one another by the nature and duration of their stressors, as well as the type and severity of the symptoms. A brief review of each dissociative disorder is presented below.

Dissociative Amnesia
A defining characteristic of dissociative, amnesia is the inability to recall important personal information. This common dissociative disorder is regularly encountered in hospital emergency rooms and is usually caused by a single stressful event. Dissociative amnesia is often seen in the victims of single severe traumas such as an automobile accident (forgotten details might include one's actions immediately before an auto accident in which the person with the disorder was involved). The condition is often seen in wartime; witnessing a violent crime or encountering a natural disaster may also trigger dissociative amnesia.

Dissociative Fugue
Like dissociative amnesia, dissociative, fugue also is characterized by sudden onset resulting from a single severe traumatic event. Unlike dissociative amnesia, however, dissociative fugue may involve the creation of a new, either partial or complete, identity to replace the personal details that are lost in response to the trauma. A person with this disorder will remain alert and oriented, yet be unconnected to the former identity. Dissociative fugue may also be characterized by sudden, unplanned wandering from home or work. Typically, the condition consists of a single episode without recurrence, and recovery is often spontaneous and rapid.

Depersonalization Disorder
The distinguishing characteristic of depersonalization disorder is the feeling that one is going through the motions of life, or that one's body or self is disconnected or unreal. Mind or body may be perceived as unattached, seen from a distance, existing in a dream, or mechanical. Such experiences are persistent and recurrent, and lead to distress and dysfunction. Chronic depersonalization is commonly accompanied by "derealization," the feeling that features of the environment are illusory. It should be noted that characteristics attributed to depersonalization disorder must be independent of any kind of substance abuse. It should also be noted that depersonalization as an isolated symptom may appear within the context of a wide variety of major psychiatric disorders. For example, mild episodes of depersonalization in otherwise normally functioning individuals have been reported following alcohol use, sensory deprivation, mild social or emotional stress or sleep deprivation, and as a side effect to medications. However, severe depersonalization is considered to be present only if the sense of detachment associated with the disorder is recurrent and predominant.

Dissociative Identity Disorder (previously called Multiple Personality Disorder)

Dissociative Identity Disorder (DID) occurs in people with varied backgrounds, educational levels, and from all walks of life. DID is believed to follow severe trauma including persistent psychological, physical, or sexual abuse during one’s childhood. In this condition, distinct, coherent identities exist within one individual and are able to assume control of the person's behavior and thought (American Psychiatric Association, 1987). Unlike depictions in sensationalistic movies, most people with DID do not have dramatic shifts in personality and only persons very close to them are aware of mood swings.  In DID, the patient experiences amnesia for personal information, including some of the identities and activities of alternate personalities. Some people with DID experience subtle memory problems, and may only appear to have memory problems associated with attention deficit disorder. 

 DID is often difficult to detect without the use of specialized interviews and/or tests, due to: 
1) the hidden nature of the dissociative symptoms, and 
2) the coexistence of depression, anxiety, or substance abuse which may mask the dissociative symptoms, and 
3) feelings of disconnection that are often difficult to verbalize.

Because people with DID may experience depression, mood swings, anxiety, inattention, transient psychotic like states, and may self-medicate with drugs or alcohol, they are frequently diagnosed as having solely bipolar disorder, major depression, attention deficit disorder, anxiety disorders, psychotic or substance abuse disorders. Studies indicate that previous diagnoses in these areas are common to people with DID. 

It is not uncommon for a decade or more to pass before a correct assessment of DID is made. Research with the Structured Clinical Interview for Dissociative Disorders has identified five distinct dissociative symptoms experienced in individuals who have DID (see section above, Five Dissociative Symptoms.) 

Though DID is the most severe of the dissociative disorders, this disorder  can respond well to specialized psychotherapy which focuses on understanding the dissociative symptoms and developing new constructive ways of coping with stress.  Medication can be used as an adjunct to psychotherapy, but is not the primary form of treatment.

Dissociative Disorder Not Otherwise Specified

Dissociative Disorder Not Otherwise Specified (DDNOS) is an inclusive category for classifying dissociative syndromes that do not meet the full criteria of any of the other dissociative disorders. A person diagnosed with Dissociative Disorder Not Otherwise Specified (DDNOS) typically displays characteristics very similar to some of the previously discussed dissociative disorders, but not severe enough to receive their diagnoses. DDNOS includes variants of Dissociative Identity Disorder in which personality "states" may take over consciousness and behavior but are not sufficiently distinct, and variants of Dissociative identity disorder in which there is no amnesia for personal information. 

Other forms of DDNOS include possession and trance states, Ganser's syndrome, derealization unaccompanied by depersonalization, dissociated states in people who have undergone intense coercive persuasion (e.g., brainwashing, kidnapping), and loss of consciousness not attributed to a medical condition.

Naive persons will often interpret consciousness changes as balkiness or not paying attention.  Therefore the first descriptions of syndromes or disorders are often pejorative.  People will shout, possibly strike, and exclude those who exhibit this behavior.  Or if it’s mild, they may deny it, refuse to admit it exists.

Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. It is also sometimes called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, pseudodementia, hysterical pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials.

The examples given of Ganser Syndrome are not very enlightening.  “When asked how many legs a horse has, they will answer five, which shows that they understand the question and are close to the right answer.”  I don’t think that demonstrates anything of the kind.  It could be anything from neurological inaccuracy to a creative definition of “legs.”  Also, I would not discount the Alzheimer’s patients tendency to give teasing or deflecting answers to hide problems that are worrisome, undefined by the person suffering from them.

Emigration "The Golden Door"

In “The Golden Door,” officials try to test the Italian-speaking peasants to see if they are sane and competent.  They ask, “how many legs does a horse have?”  The confused peasants can’t figure out why anyone would ask such a thing when it’s perfectly obvious.  In the tangle of conflicting realities, injustice appears and fearful indignation on all sides.  

This is in miniature what many nations are facing with waves of immigration.  We face it in classrooms and court rooms daily because separate generations are as different as separate national origins.

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