A Profound Appt with My CPN

Yesterday I had another appt with my community psychiatric nurse (CPN). At first, we went into how I’m doing at the moment. Then my CPN scheduled some appts for me with my nurse practitioner. Last Monday, after all, he and the behavior specialist from my care facility had finally come to the conclusion that I need to do some work on stabilizing myselves and developing inner cooperation before I can do EMDR or another form of trauma therapy. At first, the secretary said the first appt she had available was late December. It turned out to be December 17, so that’s pretty early considering how long I’ve been waiting already.

Then we got to discuss some issues relating to my diagnosis or the lack thereof. These were mostly theoretical, since I have no idea what my current diagnosis is and I really don’t care. I mean, the most recent treatment guidelines here in the Netherlands for complex dissociative disorders, aren’t suited to me (or most plurals, honestly), so I have no reason to want such a diagnosis. All I want is help in getting the inner turmoil under control.

Then I somehow got to mention my former psychiatrist’s comment when first considering assessing me for DID/OSDD in the summer of 2018. She held both of my hands and said: “You have just one body.” Then she went on to explain that, while she was holding our hands, none of us could put our fingers in our ears and pretend not to listen.

We then repeated this exercise. A staff always attends our appts with mental health with us. She now held both our hands and said that we can stay at the care facility. Someone asked cautiously: “Even if I need more help than I get now?” She then reassured us that yes, even if we need more help, we can stay here.

Then the staff asked our CPN what she’s supposed to do when we openly switch, as we had the day before. My CPN seemed not to know, so I suggested she do not elicit it, but do not fight it when it happens either. After all, when she insists that “Astrid” come back, this may create some trouble since “Astrid” is either everyone or no-one at all.

I really hope our nurse practitioner isn’t going to insist people only talk to “Astrid”, as the current guidelines on DID/OSDD seem to suggest as far as I know. I mean, we are okay all listening to the body’s name and won’t sign our names on E-mails or the like when it’s not appropriate, but one of our main issues is that there is no host who somehow “owns” the others. As such, the daily living parts or apparently normal parts or whatever don’t have access to every bit of information needed to cooperate.

We Ordered Some Beads

I’m feeling pretty uninspired to write today. I’m still feeling upset about last Friday’s meeting with the nurse practitioner. I mean, I don’t want to claim to have a dissociative disorder, even though on this blog I do sort of claim this. At least, we claim to be multiple. I’m not sure we fully are, but we’re definitely not fully singlet either.

We sent an E-mail to my assigned support worker explaining our issues with the nurse practitioner’s comments. She might forward it to my other staff and maybe the behavior specialist too. The behavior specialist replied to her E-mail from last Friday that I could ask my nurse practitioner why he thinks ACT is proper therapy for me and why he doesn’t want me to do EMDR. Some of us were pretty upset at her reply too.

Today we were upset at not being able to do much with respect to day activities. It rained all day, so we could only take one walk. Other than that, we sat in the living room or in my room. At the end of the day, our crafty part came up with some ideas. We might try making some bead jewelry. It doesn’t have to be professional-looking, but it could be cool.

So I ordered some beads at a store called Creadream. I originally intended on ordering glass beads, but ended up going with plastic ones. They were cheaper and the store had a larger variety of shapes. I got some round beads, some cubes, some rectangles and even some butterflies. Some of the purple ones were on a discounted price, so only like €0.66 for 25 grams (about 45 beads I think it said).

I also ordered some wire and elastic, including memory wire. This is a type of metallic wire that is shaped like a coil that fits around your arm. It can be used for making bracelets. I forgot to order pliers to cut and bend the wire with, but I or my day activities staff might be able to find some later. I also forgot to order a beading needle.

I think the littles will definitely enjoy working with all the different shapes and colors. Of course, we can’t see the colors, but we have some memory of what they look like. We ordered mostly purple ones, like I said, but also some pink, green and I can’t remember what else.

Now I constantly feel shame when I refer to the littles or write in first person plural or the like. I know I can’t fully be myself with mental health professionals, because they aren’t my friends, but why can’t I be myselves on here? My CPN knows the address to this blog and has occasionally read it, but yeah.

Not Quite a (Traumagenic) System?

I feel so awful right now. The visit from my parents went so well and this is actually confusing me. I mean, I consider some of my childhood experiences traumatic. Quite a few, in fact. How can this be the case if I have such loving parents? I mean, yes, they’re still a bit odd. My father just talked about the birds and butterflies and flowers we encountered. He didn’t ask me any questions or share anything about himself. That doesn’t make him a CPTSD-engendering parent though.

I had a dream yesterday about me needing to take the SCID-D assessment for dissociative disorders and it came back showing that I don’t have a dissociative disorder. It was probably triggered by my having read a message in a DID support group about how plurality is now something anyone can claim because of endogenic (born multiple) systems etc. We’re not an endogenic system, but can we claim to be traumagenic? Can we even claim to be a system at all?

I mean, other than online and to a few specific people who know us closely, we don’t share our names. It could just be that I gave names to different emotions or aspects of myself that I find hard to understand. This is what my community psychiatric nurse said on our last appointment. She said the consultant recommending EMDR for my traumatic experiences hadn’t recommended any type of “deep-digging” therapy. Not that I want that, but on some deep level (no pun intended), her claim that my parts are feelings, made me feel invalidated.

I told my CPN that, whichever treatment approach I try, my parts always show up and disrupt the process. She countered that we hadn’t tried EMDR yet. I know, but this approach is known to cause worsening of dissociation in those with dissociative disorders. Can it get me to “split” even more, even if I’m not a genuine multiple in the first place?

When I shared my doubts/denial on an E-mail list for DID, someone replied that I sign my E-mails with lots of different names. Well, that’s as easy as typing on a keyboard. No-one needs to have any special characteristics to be able to do this. It doesn’t prove my multiplicity. Besides, I know there are parts and they have names, but are these parts truly differentiated enough?

In a sense, it doesn’t matter. I’m not planning on seeking a DID/OSDD diagnosis anytime soon and by the time I might have overcome my fear of psychological evaluations, I guess DID has been removed from the DSM. Either that or Onno van der Hart and other scandalous therapists have given it such a bad name that no-one in the whole country will support me. And that’s even assuming that said assessment would show some type of dissociative disorder. Then again, if I’m claiming plurality for the sake of it, am I not contributing to the stigma surrounding DID myself?

In addition to the dream I had yesterday, I have recurring dreams about my parents finding out I’m in childhood trauma survivor support groups. They always confront me and my husband always sides with them. I guess I should leave those groups in case it really happens. I mean, I’m not an adult child of normal parents, maybe, but then again who is?

A Twelfth Grade Memory

Last Monday, I already shared some memories from the year 2003. Today, one of the prompts over at Mama’s Losin’ It’s Writer’s Workshop is to share a twelfth grade memory.

My senior year of high school was the year I was supposedly planning on going to university after graduation. I knew this was going to be hard, but my aversion to going to college straight out of high school, didn’t really form. Besides, I had no idea what else I was going to do. I remember one day, August 31, 2004, one of the first few days of the school year. I had already come out as dissociative (multiple personality) on my blog in March, but had only been aware of three alters at the time. That day, Carol, who was up to that moment my assertive helper part, gave up and a new one, who called herself Clarissa, emerged.

I wasn’t aware at the time that what I was experiencing was an actual mental health diagnosis, mind you. A friend of mine had told me about dissociative identity disorder after I first came out in March of 2004, but I was still in denial. Part of the reason is that one criterion of DID is amnesia, which we rarely experience.

In March of 2005, my high school tutor had arranged for me to see a blindness rehabilitation center psychologist. The high school tutor, I must say, read my blog, so he knew about the parts, including Clarissa. He had told the psychologist, who obviously immediately thought of DID. She started to ask me all sorts of questions, all of which I either circumvened or answered negatively to. I knew, after all, that, if I’d gotten the psychologist to think I had DID, I wouldn’t be accepted into the rehabilitation program.

In hindsight, of course, I wish I would’ve been more honest. I knew I didn’t have amnesia or time loss, but I did have most other symptoms of DID, some of which I hadn’t become aware of being abnormal. It took over five more years before I was diagnosed with DID.

In the end, I was accepted into the rehabilitation program. I started on August 22, 2005.

Full disclosure: after being diagnosed with DID in 2010, I lost my diagnosis again in 2013. I am pretty sure I don’t have full-blown DID, but probably do have some dissociative disorder.

Mama’s Losin’ It

Validating Jane?

On Saturday, it’s the twelfth anniversary of the mental crisis that landed us in a psych hospital. As those who’ve checked my “About” page or those who’ve known me long-term know, this hospital stay took 9 1/2 years. Then we were kicked out for allegedly being too dependent.

We fought a long battle for the right care. In a way, it started that very day, November 2, 2007, or even before. It hopefully ended when we moved into the long-term care facility we now live in on September 23, 2019.

Most of us are relatively happy here. Content, at least. At least one of us though isn’t. Jane is still telling us to get a real life. To give ourselves a good kick in the behind and go to university, find a jjob and above all, live fully independently. She doesn’t even want us living with our husband, as we could be manipulating him into getting us care.

Today, I’ve been thinking. I recently joined a Facebook group for DID that subscribes to the philosophy of managing dissociative symptoms by thinking of each of your system members as their own individual. We need to work for the betterment of the entire system.

In this light, I’ve been thinking of how to validate Jane. She’s been saying “No” to our every attempt at getting care ever since, well, since she emerged in 2001. I wonder whether she’s “just” an introject, as our parents hold similar views to hers, or there’s more to it.

I remember once, when we’d only been diagnosed with DID for a few months or maybe a year, so in 2011 I think, our then therapist saying that Jane represents our healthy side. Another therapist called her a punitive parent. That never sat well with any of us, but neither does seeing her as the healthy adult. After all, why then does she minimize our every struggle? Isn’t vulnerability part of being an adult, too?

I’m wondering whether we’re doing more than just her a disservice by being in the care facility. I don’t mean we need to leave, but I realize most of us, including me, would like a more enriching life. Many of us feel bored at day activities.

Of course, our recent (and not-so-recent) attempts at doing something to enrich our life, have usually failed. I mean, we could be committing to a class at college, but that hasn’t been a success in ten years. I’ve been looking at writing courses, but they are pretty expensive and I don’t know they’ll actually make me a better writer. I want to go to the gym or horseback riding again, but don’t know whether I could commit to that on a weekly basis considering even just the limits of the ParaTransit system here. Ugh, I’m not sure how to get out of the boringness of lying in the sensory room for over an hour each day, walking for maybe half an hour, and sitting on our ass the rest of the time. I don’t know whether that’s an entirely accurate picture of our day, but it feels like it is.

Clarissa

Co-Consciousness #SoCS

Today’s prompt for Stream of Consciousness Saturday (#SoCS) is “Co-“. I immediately thought of co-consciousness. This is a term in the DID (dissociative identity disorder) / multiple personality community referring to more than one personality sharing memories or other information. It is often desired as a goal in treatment. Another one is cooperation, in which alters are able to work together for the betterment of the entire system of personalities and the body.

Co-consciousness is often implied to mean a system has less severe dissociation. I mean, since amnesia (inability to recall important information) is a criterion for DID, technicallyy those who are fully co-conscious cannot be diagnosed with DID. Then again, there are a lot of degrees of amnesia. For example, one is time loss, where someone “wakes up” to discover their alter has done something they have no recollection of. However, identity amnesia also counts, where a person forgets their name, age, etc. Loss of skills also counts, where a person cannot for example ride a bicycle or car when a young alter is out in the body.

There is also this phenomenon called emotional amnesia. I have yet to find out more about it, as it seems to be very common in our experience. For example, last Wednesday, we were aggressive. Though I do know that we kicked a wall, I do not actually remember it or the feeling attached to it. That belongs to one of the other personalities.

We do aim to share information amongst ourselves. However, usually we cannot all be present at the same time. That is, of course we can, in that we’re all in this body and when for example I give someone my hands, another alter cannot be simultaneously holding our hands over our ears. That’s what our psychiatrist explained last year and it was so fundamentally new to us!

Co-consciousness and cooperation can be an end goal in DID treatment, but some systems choose to merge or integrate. There are also different degrees of integration or so I understand. I recently joined a support group on Facebook specifically for DID systems looking to integrate, even though that’s always been a very scary idea to most of us. It feels as though we’re getting rid of some of us, when really all of us are part of this system, inhabit this body.

As a side note, I can totally understand most regular #SoCS readers cannot fathom the concepts I just wrote about. I was even once told by people in a Dutch DID community that I knew too much for someone who’d only been diagnosed for a few months, when I mentioned the term “co-consciousness”. Clearly those people had never ventured out into the English-speaking DID community.

Multiplicity: Living with Dissociative Identity Disorder #AtoZChallenge

Welcome to day 13 in the #AtoZChallenge. I had today’s theme in mind for a while, but then I realized I already shared about my experience of being multiple in early March for DID Awareness Day and Plural Pride Day. Several other possible topics floated through my mind, but none felt right. So instead of choosing a topic I don’t know what to write about anyway, I”m choosing multiplicity again. I will try not to repeat myself in this post. As such, I recommend those unfamiliar with dissociative identity disorder read the post I wrote last March first.

We are a system of, last time I counted, 26 alters. Most are female, ranging in age from one month to 42-years-old. Each has a different role in our system (the whole of me). We don’t subscribe to rigid categories of alters. Like, the currently most scientifically proven theory of dissociation distinguishes between apparently normal parts (ANPs) who do the daily living and emotional parts (EPs), who are stuck in trauma time. Though most of us can be put into one of these two categories, we prefer to refer to them by different terms. We for a while tried dialectical behavior therapy (DBT), in which the different states of mind are called rational, emotional and wise mind. We see the ANPs as rational mind, the EPs as emotional mind and wise mind would be if all these parts can constructively cooperate.

Another way of distinguishing alters is by categories such as protector, persecutor (often a perpetrator introject), inner self helper, etc. We do have an inner self helper of sorts. Other than that, our roles are more complex than these. I mean, some of our protectors can be highly destructive relationally.

As you may know, dissociation stems from severe, repeated trauma in early childhood. This used to be thought to only encompass sexual and ritual abuse, but more and more people are realizing that physical and emotional abuse and neglect can also cause DID. There is no evidence that the severity of one’s trauma can predict the extent of dissociation. For example, we didn’t endure major sexual violation at all, but still have a pretty large system. DID is largely seen as an attachment-based disorder now, so insecure attachment early on could predispose one to further dissociation even in the event of relatively “minor” trauma. I, for one, was at a disadvantage already due to being born premature.

I also think that people on the autistic spectrum are more likely to develop DID than neurotypicals, because living in a neurotypical world predisposes us to a lot of trauma. I remember once, when in a Dutch DID community, being told that autism is so pervasive a disorder that it keeps us from developing multiple personalities. There is absolutely zero evidence for this.

I had a nurse practitioner’s appointment last Thursday. At the end of it, we got to debate the end goal of treatment (even though I haven’t even been formally diagnosed with DID yet). The three phases in treatment are stabilization (learning coping skills and internal cooperation), trauma processing and finally integration. There are some DID therapists who believe merging of all alters is a requirement for completing DID treatment. Others mean rehabilitation into society when they say integration. We prefer cooperation to a full-on merger. We wouldn’t mind if alters merged spontaneously, but we have zero interest in forcing it.

DID Awareness Day and Plural Pride Day 2019

Today is DID Awareness Day and Plural Pride Day. I really want to share something for it, but I struggle with knowing what to share. I haven’t written about our experience of being plural in a long while, so maybe today I should jump at the opportunity. For today’s post, I am just going to introduce the subject of DID and our system to people who may not be aware.

Dissociative identity disorder (DID) is a trauma-based mental health condition in which the sufferer experiences two or more distinct identities or personality states, each with their own unique way of perceiving and relating to the world. People with DID also have amnesia for important information either in the present or past that is too extensive to be due to ordinary forgetfulness. People who do not have this type of amnesia, or whose identities are not fully formed, may be diagnosed with other specified dissociative disorder (OSDD) type 1A or 1B.

We were diagnosed with DID in 2010. At the time, we could be pretty in your face about ourselves, because we were in an environment where we felt relatively safe to be ourselves. This, however, also opened us up to suggestion, as our therapist concluded pretty early in the process that we have DID. Normally, a diagnosis of full-fledged DID is not made after initial assessment, but requires at least six months of therapy with a DID therapist.

Anyway, we probably do experience some level of amnesia, but didn’t know how to explain it to our therapist. For this reason, we would report we didn’t remember something, even though we showed in our actions that we did. This got people to assume we were faking our amnesia and by extension the whole dissociative experience.

When we moved from one psychiatric institution into another in 2013, we no longer felt safe. We actively denied the alters and started to explain ourselves away as bad moods. That’s probably one reason our diagnosis was changed from DID to borderline personality disorder (BPD). My next psychologist, some years later still, went so far as to say we invented our DID because we felt it’d be an interesting diagnosis. Well, no.

We first became aware of ourselves in the summer of 2001, when the body was fifteen. At the time, the host didn’t see the alters as part of herself. In fact, if I reread my diary from back then, it felt as though I was bordering on psychosis. I wasn’t though.

In early 2004, the alters started to appear more and claim their own names. We denied having “multiple personalities”, but only on the grounds that we didn’t lose time. Like I said above, while this could rule out full-fledged DID, it doesn’t necessarily do so (identity amnesia and amnesia for past events also counts), and it still means we’re multiple, ie. diagnosable with OSDD.

Currently, we don’t have a diagnosis of a dissociative disorder. We’re not ready to undergo the assessment process for it, as psychological assessments are a huge trigger for us. However, here we are, all 26 or so of us.

A Letter to the Insiders

I want to write, but I don’t know where this is going. In fact, until I wrote down the title of this blog post just minutes ago, I had no idea I was even going to write a letter to my alters. I was inspired to do it by the recovery-based letters some people write to their mental health conditions.

Another thing that inspired me subconsciously, was a conversation with a dear friend on the need to integrate as part of treatment for dissociative identity disorder. This is often seen as the only possible end goal, and this dear friend was even told so on her first appointment with a therapist. We feel very strongly about this. First of all, integration is the third and last phase of treatment for DID, so it feels very wrong to discuss it at the very start. Second, integration can also mean living a functional life (ie. integration into society). I know many therapists, including I think our psychiatrists, feel a merger of all alters as somehow more healthy than living as a functional multiple. Well, agree to disagree.

The first phase of treatment is stabilization. This includes getting to know your system, learning to deal with feelings, developing inner communication, etc. After this, the second phase is trauma processing. Only once all traumas have been processed can you begin to integrate.

We don’t do DID treatment and aren’t likely to get it ever at all. After all, the diagnosis process scares the crap out of us and we’re unlikely to be believed. As such, it’s all the more important that we validate ourselves.

Dear you,

Welcome. We appreciate you. We are glad that you’re here, for you helped us survive. Without you, we wouldn’t be where we’re now. Thanks for that!

We know you may feel sad, or angry, or confused. that’s all okay. It may not feel okay to you, but that too is okay. Your feelings are valid. They’re there for a reason.

We want you to know there are people out there to support you. Inside, you have an entire system of alters that will help you be the best you you can be. If we work together – and that includes you -, we’ll heal.

Outside of the body, you’ll meet our support staff. Maybe you’ll be able to meet our mental health team too. Most of the people in our current life are supportive. We know this hasn’t always been the case and that’s one reason you’re here. We are here to help you heal from those experiences. You can trust us.

You may not be able to disclose your true identity as an alter to everyone, but there are people in the DID community you can talk to as yourself.

We hope this letter helped you feel a little bit safe. It’s still scary, but things will get better.

Love,

Us

Five Years

Today marks five years since our DID diagnosis got removed and changed to BPD. I’m not sure how to feel about it. I mean, that diagnosis was most likely incorrect but so is the BPD (which later got downgraded to BPD traits, which I do think we have but then again who doesn’t?). I mean, we rarely if ever experience amnesia and don’t go around disclosing ourselves when it’s not safe, but we do clearly exist as multiple identities.

Besides, the therapist who diagnosed us with DID at least took us more seriously than any before or after her (except for maybe our current psychiatrist, whom we just came out to three weeks ago). She didn’t allow us to be out with the nursing staff, which was okay’ish with us, but she did allow all of us to talk to her and didn’t try to fit us in a therapeutic box. The therapist who changed our diagnosis to BPD did, mislabeling Jane as a “punitive parent” and telling her to go away.

We at one point insisted on getting formal testing for DID. The therapist administered the SCID-D (a structured interview for diagnosing dissociation) to us but never finished the report. I wish she had even if it showed we’re fake. I mean, we have a right to information, don’t we? She also never responded to our E-mail, once our diagnosis was changed, asking her whether she’d ever suspected BPD in us.

I feel really odd now. I don’t know where we’re headed with regards to our mental health treatment. It’s all so scary. What if we’re really all imaginary? Since it’s unlikely we’ll ever be diagnosed with a dissociative disorder or get related trauma treatment again, will we ever learn to not exist?

A while back, someone asked in an FB group what happens to those misdiagnosed with DID after they get de-diagnosed. Whether their parts vanish. I don’t know really what I hope happens to us. I mean, we’ve tried to hide for a long time after our diagnosis got changed, but it was unsuccessful. We’ve tried to identify with the natural/endogenic multiple community before, since we felt not having a diagnosis meant we shouldn’t intrude upon the DID community. That was unsuccessful too. Does the fact that we can’t hide successfully for a long time mean we’re real after all, or does it mean I’m just terribly stubborn? I initially wrote “we” instead of “I”, but of course if we’re fake, we are not we anymore and never have been.