When #MeToo Hurts
When #MeToo Helps.....then Hurts
It was mid-October when the words “Me Too” took us all by storm and shook the ground; impassioned, strong voices broke through the earth to let their stories of sexual assault be heard and felt. Survivors worldwide began disclosing their experiences, discussions about sexual assault began to spark, and together we all faced the brush fires stirring in our own communities. What started in Hollywood spread to our personal feeds and many were completely overwhelmed by the sheer volume of loved ones who’d been affected by sexual misconduct in some way. Brave, courageous stories were being told, honesty and openness were being more respected, and incredibly moving work was taking off at an unprecedented rate. While difficult, it offered the first glimmer of hope to all the survivors who’d been sitting in their silence since they were small children, ignored and mistreated for so long. This could be the turning page! “This could be the moment we’re seen. This could my chance to be believed! The battles I face every single day just to make it through could lift! …someone will finally understand us!” Unfortunately, over time many started to see that the movement that held, and still holds, so much promise was letting them down and, at times, even actively causing them pain. Survivors who were most broken by sexual violence were being left out, others were being narrowly characterized as the problem, and then there were those being lifted into the spotlight with whom most couldn't identify. What aimed to amplify the voices of those hidden and silenced the harshest, instead began doing the silencing and hiding.
It’s been three months. Three months since we’ve begun having daily, public conversations about sexual assault, consent, harassment, power dynamics, manipulation, silencing, fear, coercion, and so much more. These topics are fiercely important. Yet, somehow we’ve moved on to where the conversation delved into the smallest of details, to where we even openly analyze the very minutia of one person’s assault, but managed to jump right over entire groups of men, women and children who are most affected by sexual assault. They were left out of the broader conversation entirely. Men have been almost completely shut out. We even had two famous men come forward with their experiences, but as more came forward against Spacey, those men devolved into just part of a number count - not people with names and stories, like each individual woman against Weinstein was given. You also had to work exceptionally hard to find anything about them. On another plane, and it has already been well-observed but bears repeating, people of color have been largely overlooked in favor of powerful, white, attractive women. The most neglected, however, have been those abused as children and teens. So, if you are/were a little boy, or a child of color, forget it. Three months and no one with influence has taken the time to speak on your behalf or any of the populations most exposed to sexual/complex trauma. Survivors themselves have been speaking, though. They’ve been sharing their stories, as well as their frustrations, their pain, their sense of invisibility, their disappointment, and their desire to just be seen and be given care. But, these strong souls are forced to talk mostly amongst themselves — with those who already get it. Any attempt at more public dialogue or even education has been so explicitly redirected or avoided. That's unacceptable.
Several weeks into the movement, we saw branches like #ChurchToo take off. This brought with it renewed hope for many, particularly the groups feeling most ignored. It felt like there was still a chance we could get to them soon; just give it time, soon the spark will catch. But, then the compassion fatigue seemed to set in, sympathies were waning, and many had their embers snuffed out as they saw it barely trend, never given a hashtag icon, and articles about it remaining very few and far between (and, most were about churches defending themselves). Over time, it seemed concerns about the direction of MeToo - including its re-traumatizing and triggering effects - were either disregarded or met with hostility. ..as if by expressing concern, one was arguing against its necessity or importance as a movement. Which, is typically untrue and worrying at best.
In the last month, MeToo has been increasingly described as a women’s movement. “Thanks to #MeToo, it’s the year of the woman,” “#MeToo gave a chance for women to tell their stories,” “Stars are dressing in black to support the women affected by sexual assault.”. To add insult to injury, men were universally being characterized as the perpetrators. They were emphatically told it’s their turn to LISTEN. They were told they aren’t to be doing any talking, just listening and taking notes on what they plan to do to help women. Male victims are an afterthought or a parenthetical to an article about women. They aren’t allowed to speak, just learn and don’t abuse. This is dangerous, toxic, and painful. It takes away their voices to come out as victims themselves, and re-impresses to ALL victims that, unless their abuse was at the hands of a male, they just shouldn’t come forward. Abuse perpetrated by women has been responded to in a wildly different way. Some have even said it’s “not the time for those stories because we’re trying to help women right now”. No. No, we aren’t. We’re trying to help victims of sexual assault. Humans. That includes men. That includes those who were hurt by women. It means little boys, teens, children and little girls. It means we fight for those hurt by family members, those with multiple perpetrators, whose abuse lasted for years, and those who’ve been trafficked, who are poor, who have nothing to their name, and those with no power elsewhere.
THIS IS NOT A WOMEN’S MOVEMENT. IT’S NOT A POWERFUL-WOMEN EXCLUSIVE movement. IT IS NOT A MOVEMENT AGAINST MEN.
This is a movement for survivors of sexual assault. And, to exclude any group is to abuse them again. To say their voices aren’t important, their stories insignificant, motives impure, or not as glamorous a story for a magazine cover, is inexcusable. Being selective with the voices we lift up, and when, says to everyone else, “You don’t fit our agenda, your story is too messy or hard to hear, you can wait your turn”. Only, their turn won’t ever come if no one takes a stand for them. They cannot just be expected to talk amongst themselves indefinitely and expect anything to change. They need the world to see them, understand them, to HELP them.
More Evidence of Inequity
We currently have the largest criminal case of sex abuse against children, teens and adults that the U.S. has seen in decades. The number of girls who've survived the abuse of Larry Nassar - former team doctor within USA Gymnastics, Michigan State University and club gym Twistars - surpasses the number of Sandusky, Weinstein and Bill Cosby victims combined. Yet, somehow, even in the era of #MeToo, it’s gotten a fraction of the coverage as each of those cases independently. Over one-hundred and forty girls [update: currently over 200 girls and the addition of a male as of January 23, 2018] and women were hurt by one man (as well as the organizations that employed him, and specific individuals who enabled his abuse), over the span of 3 decades, with many reports against him that went ignored or were hidden -- but somehow, the story and all of its lessons has struggled to have any lasting power in the media or public discourse. Is it because many were children and teens when they were hurt? Because it wasn’t sexual harassment, or abuse against independent women, and seen as off-topic? Was it just too difficult to hear? Too unbelievable? Was it because these precious survivors weren't wealthy, didn't have a current platform or large following, or were mostly just strangers from Michigan? In truth, it is because of all those reasons and more. Some of the more ludicrous-sounding posits even have evidence behind them. There only was a sudden uptake in interest, after an entire year of coverage and legal proceedings, once McKayla Maroney, Aly Raisman, Gabby Douglas, Simone Biles and, most recently, Jordyn Weiber, each stepped forward in the case against Larry. Only then was attention given to this beyond the walls of the gymnastics community. You can even witness the trend yourself. The week Simone Biles came forward is when coverage took off, but then it took celebrities offering monetary support to McKayla Maroney; 156 of the 200+ victims sharing their impact statements in court, to Larry and anyone who would listen; and Aly Raisman's testimony and forceful words being specifically picked up and featured in the New York Times, just to keep it there. To further update: it actually took sassy, fiery, gif-worthy Judge Aquilina to thrust the story into the real spotlight -- I mean, look at those numbers since the case broke. Many deemed her their new hero, but it seems they forgot who the real heroes in this case are.
This deeply disheartening trend in media coverage and public interest sent a very, very loud and clear message to the 135+ non-famous little girls, teens and women who originally csme forward in the last 2 years: that they alone weren't important enough for the public to care. Their abuse, suffering and stories of survival weren’t something people wanted to hear about or learn from unless they were already emotionally invested in them as a fan. Several of these remarkable girls were even vocal about how much that hurt. They weren't 'marketable' or click-worthy enough by their own accord -- not even in the era of #TimesUp, or as they fought back against the most heinous criminal, and the very powerful organizations, that created the worst case of institutional child endangerment that the U.S. has seen in decades. Once clout, power and celebrity were introduced, publications couldn't be written fast enough. These are the kinds of actions that hurt everyday survivors deeply, and everyday survivors are who this world is made up of. However, even once the brilliant voices of our Olympic gold medalists were added, breathing new life into its visibility, it was clear their fame and power were still inadequate to that of a Hollywood celebrity. They provided a bump in exposure, but only a bump. They, too, were given the message that their fierce, powerful and also heartbreaking voices, after years and years of abuse, weren’t as meaningful as those retelling one night as a Hollywood elite. And, that not only stings and cuts deep to those experiencing the neglect, but to many witnessing it. Because, if that’s true for even them, it begs the question to survivors everywhere, sitting in their nondescript homes, with names no one knows, and traumas deemed “too bad”, “too gross” or “too complex”: “What chance do I have for anyone to care about me? Who will help me? Who will fight for me to make my life safer? Who helps make sure that what I'VE been through never happens to anyone else? Who will help me get the treatment I need to stay alive? When will anyone believe us? WHEN WILL ANYONE JUST HEAR US?!”
If that isn't a repeat dynamic of the questions they asked themselves as children victimized in their own homes, schools, daycares, and sports teams, I’m not sure what it is. #MeToo, #TimesUp, and those championing them the hardest promised to fight for those who couldn't fight for themselves. Who can’t come forward. Who are scared, unseen, and voiceless. But so far, we’ve only witnessed stories of abuse to children, teens and men being pushed out of the discussion in favor of celebrities and those who have power elsewhere in their lives. It hurts. This version of #MeToo hurts. And, I can promise you that was never part of Tarana Burke’s mission statement ten years ago.
Looking Ahead
One thing that we MUST also keep in mind as we continue to spotlight sexual assault and have extremely important conversations about the behavior of those who abuse — is how it invariably pushes those who are actively abusing individuals, especially children, further underground. …which typically involves worsened abuse. Fear of being caught leads to firmer punishments, deeper threats, drilling victims much harder about not telling anyone, convincing them no one will believe them, and instilling the fear of God (or death) into children who might think for even second of telling a loved one or teacher. Teens may be the most vulnerable because their abusers know they have access to the internet and may see these conversations about abuse in the media. They have a unique opportunity like never before to realize “them too” and want to seek help. Unfortunately, those who abuse only care about themselves and will not be scared into inaction; they will only abuse more violently and creatively to further insulate themselves. We need to remember that, while we cannot and should not be quieted just because these individuals exist, we need to do that much more for those presently trapped in abusive environments. If we’re going to have these global conversations — and we MUST — we must also take thoughtful, intentional care of those who are still under threat. Those who are being further endangered by our mission to deconstruct the institutions that make abuse so prevalent deserve better. And, despite beliefs to the contrary, there are absolutely things that we can do on this front. There are actions we can take. We just need to remember to explore them and that this is not just about us sharing our stories and letting people know it’s an issue, but going out of our way to protect others from future victimization as well as rescuing those still in its vice grip.
Above all, we must remember the most vulnerable. A movement FOR the broken, should not leave anyone more broken. Children and most teens are the truly voiceless. They cannot say #MeToo. They cannot put a post on social media and be enveloped in support and care. They may not even know what’s happening to them is even wrong yet. They’re terrified and afraid, just as so many who are now adults but hurt as children remain. Yet, they’re the ones left out of the global effort to create a better world for survivors right now. We must remember them always. And, we must remember men. The men who’ve been violated but still told to hush up and just listen. The men who were hurt as adults, as little boys, who were trafficked, and men who were hurt by women. We must think about anyone who’s EVER been hurt at the hands of a female — who is struggling with that independently, let alone in the public sphere. We must think of those who are not wealthy, who are disabled, who don’t have jobs, who cannot go to court, who are not safe, who cannot even share their story. We must keep in mind every survivor who is too scared to speak against someone more powerful than them because having their motives questioned, being told they’re lying for attention, or are only seeking justice because they want money/fame is too great an assault on their character and integrity to bear. They've been assaulted enough. They don't need one more against the core of who they are. We must keep in mind every survivor whose trauma was severe, unpretty, chronic and whose abuse left them with severe mental health issues. They are not crazy, they are not weak, they are not ‘bad’ or ‘gross’, they are not lesser than. They are just as important as anyone else with a trauma history they never asked to own.
We need to get up close and personal with the fact that #MeToo is meant for everyone. Sexual assault is a human issue. And, if your movement doesn’t include those who are affected by it most, then it’s causing more harm to those already hurting than good. But it does not have to remain that way.
Our Commitment
We want to re-confirm our stance to fight for women, men, children and teens today until forever — regardless of race, income level, ability, mental illness or severity of one's story. We will never stop fighting for you or trying to create a better world for us all. That includes helping those already victimized to be seen as whole and complete individuals, and to get them the treatment and care they deserve. It also includes taking every step within our power to educate the public and clinicians on trauma, particularly complex trauma, and to prevent this from continuing. We have faith that this movement CAN shift in the right direction once more. These conversations are desperately important. They are invaluable, and the strength of each and every person who dared utter the words MeToo, as well as those who bear witness, can not be understated. But, we need to see this opportunity be extended to everyone. We believe that’s respectful, responsible and entirely realistic. We also believe the hope we were initially ignited with can be rekindled.
We are honored to be a part of this fight with you, and we will hold each and every hand - big and small - through the journey.
MORE POSTS YOU MAY FIND HELPFUL:
- Did You Know?: 8 Things We Should All Know about C-PTSD and DID
- DID Myths: Dispelling Common Misconceptions about Dissociative identity Disorder
- Grounding 101: 101 Grounding Techniques
- Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
- Imagery 101: Healing Pool and Healing Light
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DID Myths and Misconceptions
DID MYTHS AND MISCONCEPTIONS
Dissociative Identity Disorder is by far one of the least understood mental illnesses out there. It is enshrouded in misinformation, outdated coursework (for students and practicing clinicians alike), and a seemingly unending barrage of defamation attempts. The latter sounds ridiculous, but probably shouldn't come as too much of a surprise once you consider that DID is caused by longterm, recurrent trauma in childhood - most often abuse. There is ample motivation for entire organizations to want to squash its credibility or deny its existence, particularly when some of the founders of such organizations were accused of child sexual misconduct themselves. But, that is NO excuse. In fact, it's a massive reason why we exist at all and why we are so passionate about getting solid, credible information out there to everyone.
There will be no shortage of information here on what DID is not, coupled with clarifications on what it is, but let's at least provide a brief summary for those of you unfamiliar so that you can better follow along. DID is a dissociative trauma disorder in which a survivor has undergone longterm, repeated trauma in early childhood. This trauma, combined with other factors, results in a rather dramatic interruption of psychological development -- particularly as it pertains to identity. Through a process known as dissociation, this thwarted development results in "differentiated self-states" (also known as alters/parts) who may each think, act, and feel considerably different from one another. These parts of the mind - who may have their own name, age and personality - are able to take executive control of the body, leaving the survivor without any awareness for the time they were gone. These amnesic gaps in memory can be for just a few moments, a few days, or even entire chunks of one's childhood. The alters in a DID mind exist to help the survivor cope with deeply painful and unconscionable trauma, holding it outside their awareness to the best of their ability. However, often once the survivor begins to find safety and/or enter adulthood, this once supremely creative and protective mechanism can turn into a maladaptive trait causing real life consequences. Additionally, all of these experiences can be, and often are, happening alongside the symptoms of PTSD (eg. flashbacks, nightmares, hypervigilance, insomnia, etc), as well as symptoms of other co-occurring disorders commonly seen in trauma survivors.
So, now that you know a bit more about the basics of DID, LETS GO DEBUNK SOME MYTHS! Since this is a lengthy one, we divided them into three parts: myths the general public tends to believe, misconceptions that even those familiar with the condition still hold onto, annnnnd then some of the truly bonkers ;) Let's do this!
Part One: The General Public
✘ Myth: DID is very rare.
Not even close. Its yearly prevalence rate (~1.5%) is actually more common than young women with bulimia and even on par with well-known conditions like OCD. While it is very hard to gather statistics on a community of trauma survivors built on secrecy; who can be afraid to receive such a stigmatizing diagnosis, have or have had therapists untrained to recognize their condition, are riddled with amnesia (leading many to be unaware anything is even "wrong”), and whose self-preservation often includes intense denial of trauma — it's still inarguable that DID is anything but rare. It is a major mental health issue.
[Update: More studies on the prevalence of DID: x, x, x, x, x, x ]
✘ Myth: People with DID are dangerous, villainous killers or have alters who do extreme harm.
Contrary to popular belief, survivors with DID are no more dangerous than those with any other mental health condition or the general public. The crime rate, violent use of weapons, domestic disturbances, etc. are no greater than (and often less than) the general population. In fact, due to survivors' prolonged exposure to trauma and violence, it is far more common for those with DID to be re-victimized, on the receiving end of violence and/or abuse, than to perpetrate it. Many even take very staunch stances on pacifism after a lifetime of aggression and pain.
✘ Myth: DID isn’t real. It’s a condition created by therapists / exaggerated BPD / attention-seeking / actually HPD and compulsive lying / etc.
Research begs to differ. DID has distinct markers that separate it from all other disorders already in the DSM and it’s conclusive that DID results from longterm childhood trauma - nothing else. It’s the only condition that has such pronounced amnesic gaps ("missing time"), differentiated personality states, as well as exposure to extensive trauma; it did not just materialize from thin air or without solid precedent. Iatrogenic cases (“therapist created”) do not present the same as authentic DID and can be distinguished, just as malingerers and factitious presentations can be separated. (For more information on those: here.) More very valuable research here on DID validity: ✓, ✓, ✓, ✓, ✓.
As for the idea of it being “just attention-seeking”: It should be observed that ALL disorders, even physical illnesses, have groups of individuals who will pretend to have them. DID, however, has no higher rates of this than other conditions, and there is even a specific set of criteria that clinicians can use to confidently determine if someone is feigning the condition. But, primarily, there are far easier, more believable, more profitable, and more "rewarding" conditions to fake for attention (or to garner sympathy) than DID. DID is a condition riddled with stigma, vitriol, and people from all corners of the world eager to call you a liar, say it's not real, or (even if they do believe you) hurl a bunch of insults at you just for the complex trauma you've been through. This is not what most are looking for when it comes to cultivating sympathy or attention. While some do try, many tire very quickly once they realize how many small quirks and minor details about their alters they must be able to recall and maintain seamlessly, and most are not trained actors to manage this. Furthermore, there are even greater hurdles to clear for anyone trying to seek treatment or therapy for DID (as opposed to just claiming it in their personal lives or online) - so most do not.
We do not disbelieve the outright existence of eating disorders, cancer, or OCD merely because some people fake having them, do we? (...even though the rates of malingering or factitious disorders for those conditions are higher.) Why should DID be any different?
✘ Myth: If you have DID, you can’t know you have it. You don’t know about your alters or what happened to you.
While it is a common trait for host parts of a DID system to initially have no awareness of their trauma, or the inside chatterings of their mind, self-awareness is possible at any age. Once starting therapy, receiving a diagnosis, or becoming familiar with the condition, the entire path to healing relies on gaining access to all of that information, as well as establishing communication with parts inside. But, even without therapy, some can be aware of a few traumatic experiences, be able to recognize the signs of switching, or learn about themselves through old journal entries, photos, their wardrobe, reading old letters they don’t recall writing, and more.
✘ Myth: Switches in DID will be dramatic, obvious, detectable, or involving parts who want to wear different clothes/makeup, etc. / “If you really had DID, everyone would know it.”
*buzzer noise* False. Only a very, very small percentage of the DID population has an overt presentation of their alters or switches (5-6%). While some hints of detection can be seen amongst friends and therapists, most changes are passable as completely normal human behavior. DID is a disorder structured around concealment. Dramatic switches or changes in one's behavior or physical appearance would attract far too much attention, which could be dangerous for the survivor. Alters learn how to blend in, and many who do have considerably different personality traits, mannerisms, accents, etc., often try their VERY best to mirror the host's presentation.
For some, in the presence of loved ones or others “in the know”, some of these acts of concealment can fall away and their alters may feel more free to express themselves individually - but it still won’t be anything like what you’ve seen on TV. Child alters, however, are sometimes the most distinct when fronting in survivors who are very "adult". They've even been know to win over some the most stern of DID-doubters. But! This is one of the primary reasons that DID systems tend to keep these parts away from the front at all costs, especially in public settings. As for the act of switching itself, it can often look like an inconspicuous fluttering of the eyelids, a little muscle twitch or facial tic, or some other small movement of the body that looks like anyone repositioning themselves (or, y’know, just breathing). Switches can be detected if paying very close attention and while being aware of the condition, but it’s very, very rare for strangers or acquaintances to recognize one themselves. They’d sooner assume something else entirely.
✘ Myth: DID is a disorder of “multiple personalities”, and that is what's "wrong" with the person afflicted or is what makes it an illness.
Having separate identities is merely the byproduct of something greater, not the sole disorder. The real dysfunction lies in the complex trauma and the countless effects it had on the child’s mind and their neurology -- including flashbacks, nightmares, hypervigilance, dissociative amnesia ('losing time'), depersonalization/derealization, emotion dysregulation, somatic symptoms, and heightened vulnerability to a long list of other medical and mental health disorders. Most of the healing from DID revolves around the processing of traumatic memories and sifting through the layers and layers of pain, sadness, anger, betrayal, grief and trauma that each alter holds. Yes, therapy does also address the very unique, distinct challenges of having alters -- from how to get along with one another and work cohesively, to keeping the body safe when individual parts are struggling with self-harm, to how to keep child parts from popping forward whenever you pass the toy section at a store -- but DID is ultimately a trauma disorder, NOT a disorder of personality.
✘ Myth: DID happens because the mind is so traumatized that it splits into tons of alters. The mind just shatters into pieces under all the pressure of trauma.
This was a long-believed model for DID, and one still held by many therapists today who have not updated themselves with the current understanding of dissociation and identity development. The Theory of Structural Dissociation states that DID results from a failure to integrate into one identity, NOT a whole that breaks, shatters or splits. We have a more detailed (but also very “layman-friendly”) explanation here: You Did Not Shatter.
✘ Myth: DID can develop at any age.
DID only develops in early childhood, no later. Current research suggests before the ages of 6-9 (while other papers list even as early as age 4). Prolonged, repeated trauma later in life (particularly that which is at the sole control of another person, or breaks down a person’s psyche and self-perception) may result in Complex PTSD - which does have overlapping symptoms - but they will not develop DID.
It should be noted there are also other dissociative disorders, some that even mirror DID very closely (most notably OSDD and its subtypes), and age may be a very slight influencing factor in the lessened alter differentiation and/or amnesia experienced there. However, most with those presentations were quite young for their trauma as well. There are also many reasons that one may present more as an OSDD-type system instead of a DID system, but they’re a conversation for another day! Understanding DID is tough enough for most! Still, many of these myths will also apply to many of the symptoms, systems and experiences of OSDD survivors, too.
✘ Myth: Survivors with DID can just switch on demand if needed for a task or if someone simply asks for them.
Plainly put, this is just not possible. Sure, for some there are absolutely moments where they can call upon specific alters for certain tasks, but there are no guarantees or absolutes (and, for any number of reasons). When it comes to outsiders trying to call upon parts, this could range anywhere from "sometimes possible" (particularly in therapy or in extremely safe relationships where that boundary has been established beforehand), to "hit-or-miss" (dependent on the person, their intent, the state of things inside, being triggered forward but not actually wanting to be there, and so forth), to "never" (it’s either completely inappropriate and uncalled for, it's unsafe, they have a highly protective reason for staying inside, they can’t even hear you, they don't know how to come forward on their own, or some other very important reason). Survivors with DID are not a magic trick.
NOTE: DO NOT TRY TO CALL PARTS FORWARD UNLESS YOU ARE A TRAINED PROFESSIONAL OR HAVE THE SYSTEM’S IMPLICIT PERMISSION TO DO SO IN NECESSARY SITUATIONS.
To not obey this is a serious violation of psychological and emotional boundaries.
✘ Myth: Communication with alters happens by seeing them outside of you and talking with them just like regular people -- a hallucination. (We can thank The United States of Tara for this one.)
Nope, not so much. While there are exceptions, this is a very rare, inefficient, and an extremely conspicuous means of communication. It also relies on a visual hallucination, which is typically a psychotic symptom that most with DID do not have. However, it IS a possibility, and some do experience this; but it's mainly the result of extreme dissociation combined with mental visualization that feels incredibly real on the outside (as opposed to a true external hallucination of an alter).
For most survivors with DID, "seeing" and speaking to their alters happens internally - inside the mind - often including a landscape called an "internal world". Communication may happen through passively-influenced thoughts, face-to-face (in each other's respective bodies, via the internal world), or through “voice” communication heard in the mind. This is why DID diagnoses can get so commonly mixed up with schizophrenia; these discussions and differently 'voiced' thoughts can seem like “hearing voices”, particularly if you don't know what an auditory hallucination would sound like or have better language to describe your experience. But, in DID, these voices and conversations are not actual auditory hallucinations (again, barring very rare exception). They are more like very “loud” versions of one’s own thoughts (versus, say, hearing the radio or a tea cup talking, or voices of those whom you know do NOT belong to you or share your life story). Alter communication is very much a part of you and stems from somewhere in your conscious mind - even if the thoughts, ideas, and tones are considerably different from your own inner monologue.
Other frequent means of communication are things like: journaling, art, post-it notes, non-dominant hand writing, pictures; and, now more commonly, things like online blogging, social media, voice recordings, videos, and more.
✘ Myth: Parts in a DID system are all just variations of the host at different traumatized ages of their life.
Nope. Parts can be any age, gender, or personality type. They can have entirely different outlooks on the world, faiths, sexual orientations, political views, etc. Many are even associated with no specific trauma at all but still have a very important and necessary role inside the mind. Alters are NOT merely “frozen” or “stunted” aspects of the host, marked by when a trauma took place. (Not to mention that trauma 'took place' every single day, for a lot of years, for a lot of people). This can be the case for some - and their parts’ names may even all be similar or variations of the survivor’s name - but even they typically show great variation from what the survivor was actually like at those ages.
Personality differentiation is a hallmark of the condition. Without it, it's not DID.
✘ Myth: Because 'x' person lied about having DID, they’re probably all lying.
Generalizations have never gotten us anywhere in life. Do some people lie about having DID? Yep. Do some ignorantly use it as a crutch to try and excuse bad behavior? Sure do. Does that mean the millions who are struggling every day just to go on after an entire childhood of trauma -- who are fighting an uphill battle of perseverance to overcome sky-high suicide rates, while warring against heartless stigma and lack of access to basic care -- they're just all lying? No, no annnd no. Does it instead make the people who lied the ones we should be shaming? ..the terrible jerks who appropriated someone else’s suffering for their own gain? Definitely.
✘ Myth: People with DID will inevitably cheat on you/be unfaithful because their parts will just go be with someone else.
I know it’s hard for many to believe, but everyone is different. What one person does, their system does, or television leads you to believe is inevitable will not apply to everyone. Many exist in highly exclusive, monogamous relationships and are instead the ones living in fear of being cheated on, becoming inadequate, burdensome, or dissatisfactory to their partners; and, too often, they are the ones who are left. DID survivors tend to be more concerned with simply finding a healthy, non-abusive, communicative relationship than to "go wild" with the "promiscuous alters" (but more on them later). Flippantly suggesting otherwise is degrading.
✘ Myth: You can treat DID with medication.
There are zero medications to treat DID. There are, however, medications that can be helpful in managing some of the symptoms of PTSD or other comorbid conditions. Medications to calm extreme anxiety, alleviate depression, lessen nightmares, stabilize mood, help with compulsions, quell severe insomnia, etc. can all be helpful at various points in a survivor’s treatment. But nothing exists to help the symptoms associated with DID, and many can even make them much worse. Be extremely wary of anyone suggesting they can help with your dissociative symptoms or switching through a medication or infusion regimen. They are most likely misinformed, but may also be lying to you or seeking to cause you harm.
✘ Myth: Integration is a “must”, or is everyone’s goal in therapy.
Callback to our theme: everyone is different. Complete integration into a single, individualized identity - also known as final fusion - is the goal for some. But it is not, and does not have to be, for everyone. It is possible to achieve full healing by processing memories, establishing communication across the whole mind, lowering dissociative barriers, and increasing aptitude by everyone working toward a common goal - all without experiencing the fusion of any parts at all. Some may choose to integrate a few alters or aspects of self with one another or themselves - or "downsize" - but still leave a small system to go about their lives. Others may begin the process, discover it’s truly not for them, and separate again - either spontaneously or with intention. There are many, many reasons why someone may choose any of the above. But becoming singular is NOT a must, and anyone insisting that it is or refuses to accept your decision to remain distinct identities, does not have your best interests in mind and heart.
✘ Myth: Folks with DID are incapable of being successful or living normal lives. They’re dependent on the system and just cycle in and out of hospitals unable to do things for themselves.
Absolutely false. While success is defined differently by everyone, there are survivors with DID doing extraordinary things - all at varying levels of function, system size, memory integration, and therapeutic care as they’re doing them, We have folks who are CEOs of million dollar companies, professional athletes, high-ranking members of government, leaders of prestigious non-profits, as well as trauma surgeons, lawyers, military servicemen, professional actors, entrepreneurs, college professors, and even therapists — all with dissociative identity disorder. We know many with PhDs, masters degrees, small businesses, and brilliant technology patents. For some, their DID helped them succeed, with different system members able to take on separate tasks, memorize notes, rotate sleep schedules, or offer new creative solutions;. Others found it an obstacle, but more because of how they were treated or inhibited by those around them. While some found success after reaching a place of more complete stability, others were still in therapy twice a week, wrestling with difficult flashbacks and alter switches, but still excelled nonetheless and were content with their choice to do so at that time.
But, more importantly, success isn’t required, nor necessary for anyone with DID. And there is nothing wrong nor shameful about requiring assistance or needing hospitalization. For many, after a life of such severe, chronic, and painful trauma; followed by a litany of symptoms, stigma, treatment, disbelief, and endless barriers to accessing the same life everyone else was awarded — a boring life is the goal. That is the success. No adventure, no high-stakes, no demands, no chaos. Just peace. Just average. A mundane, quiet, unremarkable life, in harmony with their communities and mind, can be the richest reward for so many. But, what each individual person wants for their life, or has fought tirelessly hard for, says nothing about what the broader collective of DID survivors are, or should be, capable of. Having DID is not what will influence a survivor’s success, lack of safety, support and resources is.
Part Two: Supporters, Therapists/Clinicians and Survivors Themselves
✘ Myth: The term alter stands for "alter ego".
Alter [most likely] stands for "alternate states of consciousness" or "alternate personality", though there has been confusion about the original phrasing, including the rare-but-existing use of "altered state of consciousness". In the professionals we’ve worked with, the first term was used in their literature, education and in patient charts of their trauma disorders units. The second is seen most often in journals, sources online and by the majority of second wave dissociative researchers. The third attempts to compare it with trauma-related dissociation, but not label the actual trauma-related dissociation itself. The absolute origin of the term alter is hard to pinpoint, particularly when some publications are no longer in print (which may explain why the former made its way into psychiatric trauma hospitals and research papers of many pioneers without having an identifiable date to timeline it). But, the most currently accepted term we see cited is 'alternate personality'. However, "states of consciousness" is a term used interchangeably for alter/personality in various therapeutic circles. So, the first two are none too dissimilar.
"Alter ego", however, has zero relevance in DID whatsoever. That one can stay with Beyonce and Fight Club.
✘ Myth: People with DID only have a few alters.
Some can only have a couple or a few, but it's more common to be around the teens. It's also extremely common to only be aware of a few for some time, and then discover many many more as therapy progresses and it is safe for them to be known by the others. Systems in the 30s and 40s are not uncommon either. For those with backgrounds of human trafficking, organized violence, ritual abuse, or mind control, it's well-observed for systems to be well into the hundreds, or even impossible to count. System size does not validate or invalidate a survivor. There is also no direct correlation to system size and severity of trauma.
✘ Myth: All systems have specific types of alters (i.e. “The Rebel Teen”, “The Promiscuous Alter”, “The Loving Mother”, “The Adorable Child”, “The Evil Introject”, etc.)
Sure, some do have these alters, and it’s often for good reason and due to themes that exist in abuse, not necessarily themes within the disorder. Many will have none of these alters, others have completely reversed takes on them, and so forth. While it makes for easy book and film-writing - and some survivors absolutely do find themes within their system and another's - there is no universal recipe for a DID system. Additionally, getting too specific or trying to categorize alters into specific role subtypes can be quite damaging and lead to a whole host of new issues (none too dissimilar to the complications that arise from trying to fit regular humans into boxes or “types”).
✘ Myth: All alters will be (or should be) the same gender/race/sexuality as the survivor.
As mentioned before, different genders, sexualities, and even races may exist within one system. Sometimes this happens at complete random, others develop from positive childhood influences, and then other times these changes were bred out of traumatic necessity. (Unfortunately, this also means some alters become who they are because of stigmatizing belief systems fed to the child about folks that are different from them. In these instances, these potentially toxic or discriminatory identities can be worked on in therapy and eventually transformed into healthier, more authentic self-concepts - free of harmful stereotypes, caricatures, or even bigoted projections.)
✘ Myth: Inhuman alters are impossible (robots, wolves, ghosts, cats, etc).
Not impossible at all and instead very common. For many children, being a human is scary. It gets them hurt. Being invisible or incapable of feeling, becoming a terrifying entity, a loving creature, or even a shapeshifter can feel infinitely safer and more protective of the whole than fragile humanity. Note: Alters do not come about by conscious choice or planning. They happen within a child’s mind, through their understanding of the universe at the time, unconsciously, and by way of a heavily dissociated surreality. Anything that seems even moderately safer than their current state is fair game inside their survival escapism. Just as human alters can be deaf, blind or have no voice to speak, even within an able-bodied system, inhuman alters who are unable to do similar tasks are just as real, valid and important as the humans. They are protective and significant, not weird or unbelievable.
✘ Myth: All “littles” are broken and damaged. Or, Inversely, all littles are happy, bubbly kids that hold the survivor's “innocence”.
*re-accessing our theme here* All humans, systems, and alters are different. Some child parts are deeply traumatized and hardly able to function. While, others' kid parts are the most innocent, endearing, and happy little angels. But there is also every shade in between, and some systems have TONS of kids - up to hundreds even - each vastly different from the other. Happy, sad, energetic, daring, lonely, scared, adventurous, genius, precocious, disabled, shy, athletic, mean, messy, giggly, pristine, posturing, infantile, newborn, brave, hidden, exuberant…the possibilities are endless in child parts, including their capacity to grow, change and transform.
✘ Myth: “Introjects” are inherently evil and are just like the abuser(s) in that person’s life.
The word introject refers to any alter who is modeled off an outside individual - mirroring their personality, behavior and sometimes even taking on the same name and visual presentation. These individuals may be positive or negative influences in the survivor's life; some are even fictional characters. (Remember: Alter development is not a conscious process and takes place within a young, traumatized child's mind. Pulling from fiction makes complete sense to little minds.) Most notably, though, are abuser introjects -- alters who are so prevalent in DID systems that the term introject itself has nearly become synonymous with “the bad guys”. That said, it is extremely important to remember that these introjects serve a very important, valuable purpose, and(!) they are NOT the actual abuser. They are a victim, a single part within a large beautiful mind, bred from the survivor's essence. They are just copying behaviors shown to them by bad people, not harboring the intent, sadism or immorality of the actual perpetrators. Most are even trying to protect the system at large. Antithetical as it sounds, these introjects can truly believe that hurting the body or internal system members, can still be ultimately protective, misguided as that is.
Let's learn why.
Introjects are only able to model outside individuals so well because they’ve spent copious amounts of time with them. So, in the case of abuser introjects, it typically means that those alters were the most abused by them. By “becoming them”, they not only get to deliver themselves from that powerless dejection, they get to decide what is allowed and what is not. They write the rules. Their intimidation, bullying and posturing as the voice you fear most in this world can make you far less likely to talk in therapy, to tell a family member or friend, seek justice, file a report, go back to school/work, and more. …anything your real abuser threatened great harm against you for even considering. Introjects' verbal insults may leave you timid and embarrassed, afraid to “put yourself out there”. They may feel this is the only way to protect you from the 'inevitable' pain, rejection, betrayal or loss that comes from making connections. Even healing from your trauma can feel too threatening or unsafe. By being a relentless, menacing part who terrorizes your mind and body, you stay sick, which keeps you safe from whatever those "threats" are. ...but, unfortunately, only by adding new threats to your safety. Helping them see this paradox can be the first step in getting them to take pause, and eventually become an alter you can work with instead of fearing implicitly. Some of these introjects are even extremely young child parts who just posture as these ‘big bad adults’ for some semblance of control and power. It's helpful to keep all of this in mind when you're under siege.
It is especially important to remember that they are not evil. They’re usually extremely traumatized and were given a highly manipulated understanding of safety and love. But also, YOU as a whole are not evil just because these parts live inside of you. They are not the actual abuser and they are just reenacting behaviors/thought patterns that were taught to them by bad people for years and years. It's all they know. But, the difference is that deep down they believe they are keeping you safe from something they believe to be absolutely unbearable. You just need to figure out what that is.
✘ Myth: Alters who persecute (via bodily self-harm or harm to other parts inside) are bad and should be tamed/gotten rid of/ignored/killed/etc.
In a similar vein, most of these parts are doing these things for a reason - a reason they feel is extremely important or keeps everyone safer (even if that just means safe from having to feel any PAIN if they're profoundly suicidal).It’s important to keep in mind that just because these things may not make sense to YOU (since you can clearly see all the destruction and harm it's causing elsewhere in life), they aren’t working with the same information, life experiences, or emotional connections to the world as you. If you were locked in a dissociative barrier for years, only able to pull from a select number of life experiences (most that were utterly horrifying), you might not be the most empathic or understanding person either. Moreover, many system members adopted their concepts of “safety” when the body was a child. ..a traumatized child. What they consider safe isn't always going to make sense.
Ignoring them, trying to shut them up or restrain them, punishing them, or any of the various attempts at “getting rid of them” will not only never work (their needs will only become greater and louder), they’ll become more and more traumatized as you confirm to them their every belief about the world. You can’t actually “get rid of them” anyway, so it’s far better to try and understand them.
✘ Myth: You can kill alters.
Even if mock deaths or temporary experiences of alters “dying” from old age (or other means) have been acted out in some systems, they aren’t actually dying. You cannot kill off a collective part of the conscious mind like you can a person. Their thoughts, memories, emotions will all still be there, so they must be as well. The part may have gone into extreme hiding, been momentarily immobilized, or merged with another part of the mind, but they most assuredly did not and can not disappear entirely or “be killed”.
Above all: THIS IS EXTREMELY DANGEROUS AND TRAUMATIC TO EVEN ATTEMPT. Do not do it.
✘ Myth: Alters can’t have their own mental health issues if the main survivor doesn’t have them.
They actually can, and many do. It’s extremely common for individual alters to battle depression, anxiety, OCD, bipolar, eating disorders, self harm, etc., while other members of the system experience no such thing. Some extremely differentiated systems may even need that system member to come forward and take medications that the rest of the system does not need and will not get. ..and their brain’s neurology responds accordingly.
One note about some disorders, however. Non-verbal, poor eye contact, savant-like, or sensory-processing-disorder alters can be extremely common traits in DID systems. However, it’s important not to just jump to calling these parts “autistic” if the system as a whole is not autistic. It’s possible for alters to behave in ways that mimic their understanding of SYMPTOMS in other disorders they know about, while not actually possessing the neurology for them. This is a complicated subject we could try to elaborate more on at some point, but it’s just an encouragement to pause and not automatically label some parts as having certain conditions just because they show a few traits of them. It can cause a great deal of conflation and misrepresentation of those illnesses. It may also be purely based on discriminatory or uneducated stereotypes of those conditions that were adopted into a young child’s mind. So, it’s just helpful to check for that possibility first!
But, make no mistake, most expressions of mental illness amongst alters are incredibly real and valid and should be treated as such.
✘ Myth: It’s impossible for alters to have different vision, health conditions, talents, and so on. "Those are physical. Even if the mind is different, the body stays the same."
Not impossible at all, and instead, extremely normal. We must remember that the mind and body are not only extremely connected, but that DID also isn’t just “in the mind”. There are all kinds of changes that take place neurologically to encourage these harsh separations. Some alters can operate on entirely different neural pathways of the brain, and that determines a lot of what the rest of the body will experience, feel and tells the other organs to do. This may mean allergies to different foods, different glasses/contacts prescriptions, over- or under-production of various hormones, and so forth. The brain is incredibly powerful; it not only tells the rest of the body how and when to operate, but it can completely change how the body interprets and responds to cues, sensations and feedback based on which areas of the brain are most active at the time. Much of this is still being studied because it's so fascinating, but there's no shortage of anecdotal examples and several others already within published research.
✘ Myth: Anyone can treat a DID patient. All trauma-informed therapists are capable of seeing a DID client through to healing.
DID is extreeeeemely complex. Even specialists can struggle with the sheer volume of curveballs and knowing they must remain vigilant to any and all unforeseen complications. Most psychology curriculums that lead to a degree in clinical practice only spend about a week or two on DID and other dissociative disorders. To add insult to injury, the majority of the information is out-of-date. Trauma-informed classes rare enough and are something most passionate MH professionals must go out of their way to find. Then, they invest extra time, coursework and continued education just to be able to competently and confidently treat a trauma survivor. Depending on the program, many of these folks are still unfamiliar with the nuances of dissociation, personality differentiation, system dynamics, common pitfalls of therapy, memory-processing, and alter fusion (if that’s what a patient desires). While a clinician who's missing these skills may still be able to bring a PTSD patient through to wellness, these are an absolute must when it comes to rehabilitating a patient with DID.
When patient safety is often in jeopardy (either due to self-harm, eating disorders, drug/alcohol use, or ongoing abuse), and suicide attempts occur as frequently as they do in this population, there is limited room for error. And, just sitting with that knowledge can be extremely (and justifiably) upsetting for many therapists. This may leave them feeling anxious, desperate, or even becoming quite protective over their client - which only increases the opportunity for unintended mistakes. Specific training in DID, or at the very least a sincere dedication to learning it (and quickly) while working with a patient, is highly advised. Not just anyone can treat this condition, and trying to do so ill-equipped can be catastrophic.
Part Three: The Bizarre and the Out-There
✘ Myth: People use DID as an excuse to get away with crimes -or- people with DID can commit all the crimes they want and just blame it on an alter.
Very rarely is this ever used as a criminal defense, and when it is, it’s almost always publicized because it’s preposterous. Despite what Primal Fear may have taught you, no, people don’t really lie about DID just to get away with crimes (if for no other reason than it’s very easy to prove they don’t truly have the condition, nor do they demonstrate any of the behavior consistently). But, wait! There's an even bigger reason: this is not a viable defense in a court of law. DID is NOT insanity. Regardless of what any alter does outside of one’s awareness, the whole person is still responsible for their crimes and will be prosecuted accordingly. If someone uses that as their defense, it will fail them.
✘ Myth: People with DID are possessed by demons.
This sounds like something to laugh at, but one short gander in DID communities online and you will find all KINDS of people who firmly believe this and will offer unsolicited advice and/or demands for survivors to be exorcised. Regardless of your faith, this is NOT what is happening in DID, and research has provided a complete explanation of what is happening inside the mind and why. Demonic possession, even if you believe, would not present in such a highly organized, specific, and intelligent way, while also happening to meet all the criteria for a well-documented mental health condition. And attempts at exorcisms, “praying it away”, or even the mere suggestion of something more sinister existing within them can be extraordinarily damaging and traumatic to the already-suffering survivor. This was a somewhat understandable explanation in like, the 1600 or 1700s — but in 2017, this projection onto survivors who simply switched? Is absolutely inexcusable.
✘ Myth: This is just something the Americans made up.
Patently false. It’s been found worldwide, and some of the leading research in the field has come from countries that are not the United States.
✘ Myth: DID and schizophrenia are the same thing.
Not even a little bit. There aren’t really even any universally overlapping symptoms from person to person. Schizophrenia is a biologic, neurocognitive, and in some cases, neurodegenerative, disorder (frequently labeled a psychotic disorder - which carries its own unfair stigma to overcome). Dissociative Identity Disorder is a trauma disorder. Without trauma, it could not organically develop. It is PREVENTABLE. No medication can “treat it” in isolation. This mix-up causes harm to both communities.
✘ Myth: Films like Split, Sybil, Three Faces of Eve, and Frankie and Alice taught me everything I need to know about DID! The United States of Tara is amazing representation!
Hardly shocking that media can be extremely inaccurate, but when it comes to Split, Sybil, Three Faces of Eve, Frankie and Alice, etc, you'd think that most would intuitively know they're pretty awful. ...but, just one look around and you'll find that disproven rather swiftly. These films are not only abysmal in terms of representation, they severely damage and inhibit the public's understanding of DID. And, sadly, it’s not just the general public who seem unsure of their accuracy. I recently heard a mental health professional, who treats both C-PTSD and DID, refer to some of these as “good” and “informative” — a reference point for those who are new to the condition. Disappointingly, knowing just how harmful they are is not a given, even in the MH community.
When it comes to The United States of Tara, while it is absolutely better than the others, it is not “good representation” by any stretch. Yes, it did touch on some important topics, but most of those are moot when it also displayed the most commonly stigmatizing and damaging tropes in excess, and got so dark by the end that many with trauma histories couldn’t even finish it. A simple scroll back through these myths and you’ll find MOST of them in the show. (She was violent to strangers, abusive to her family, cheated on her husband, and was deemed unsafe to even be around children. Her switches were SUPER dramatic, alter differentiation was the most extreme, and they used very predictable tropes for her alter characterization. She introjected a therapist without any trauma or major life event to necessitate the addition, sought extremely toxic "therapy" without the show ever defining it as such, and safety was dealt with so irresponsibly that it was disturbing. There is much more to add.)
We could write an entire article on this alone (and we may even do so one day), but for now, let’s just squash the myth that USoT is “positive representation”. I know that as survivors we tend to think of anything that isn’t actively hurting or abusing us as being GREAT! But, just because something isn’t a total disaster or has some redeeming qualities does not mean that it’s positive. At all. And we shouldn’t accept it as such. USoT is great for some laughs and entertainment, but it is not good DID representation. We save our choice words more for films like Split, but hey, we even managed to exercise some restraint there while discussing it in this article here! :)
No doubt there are far more myths than this. We encourage you to add some of the most wild things you've heard in the comments. What are some misconceptions you held onto or believed when you first heard of the condition? What are some things you still hear from those around you or online? ...possibly even from clinicians? While none of these are a laughing matter, and we hope that we've educated significantly, it's still okay to get a laugh from things now and then, especially when they're so absurd. If we didn't, we'd all go a little bonkers
We sincerely hope this was very useful to you, and we hope to see you sharing it with anyone who needs some clarity!
MORE POSTS YOU MAY FIND HELPFUL:
✧ Grounding 101: 101 Grounding Techniques
✧ Distraction 101: 101 Distraction Tools
✧ Self-Care 101: 101 Techniques for Self-Care
✧ Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
✧ Imagery 101: Healing Pool and Healing Light
✧ Did You Know?: 8 Things We Should All Know about C-PTSD and DID
✧ Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
❖ Article Index ❖
FIND US ON SOCIAL MEDIA:
*WE ARE SO SAD TO SHARE WE’VE HAD TO TURN THE COMMENTS OFF THIS POST*
Unforunately, someone had been nefariously using the comment section - within which were hundreds of beautifully helpful comments, research-sharing, and personal support - to seek out vulnerable trauma survivors. Because of this, it is unlikely they will return, but we may make a different choice in the future!
While this is deeply disappointing (and we’ve been handling these types of incidents with law enforcement), it does supply a great reminder of the unique risks of any public, mental health forum. Exercising strong boundaries when disclosing to the public your life experiences and/or medical information is a great skill to sharpen. We’d love to talk more about this with anyone for whom this is a new consideration! Please reach out if you need any support, have questions, or, of course, to let us know if you experienced any targeting by this individual.
Did You Know?: C-PTSD and DID Edition
No matter the topic, misinformation and lack of understanding is everywhere. When errors are made or false ideas get perpetuated, they tend to go unchecked and unchallenged usually because most of us just plainly don't know enough to even realize it needed to be corrected or looked into. And, this is completely understandable, right? We can't be expected to be informed on nearly every subject and struggle of humanity. We can try our best, but there will always be things we are still woefully ignorant on. Access to education, reliable resources, and just knowing where to even look for more information on any given topic is so hard. We're left to take our cues from those claiming to be knowledgable, go along with the basic understanding held by the general public and our loved ones, and/or just let it be and invest our attention elsewhere. When it comes to mental health, no doubt, all of these issues collide head on - multiple times over. We unconsciously acquire so much misinformation about psychological disorders by the time we're only kids - and just by casually picking things up in conversations, media, and comedy, we also tend to adopt some heftily stigmatizing ideas as well. And, if this is true even for those expressing no real interest in mental health, imagine the damage when people who do try to learn from the professionals are met with uninformed practitioners or those grossly misleading the public, their colleagues, and even their patients. This is how Complex PTSD, and most especially Dissociative Identity Disorder, have been treated for decades. We would like to start changing that.
Little by little, bit by bit, we want to undo some of that damage and raise more accurate awareness for both C-PTSD and DID. You can read more about the conditions themselves here (individual DID page coming soon!), but we also think it important to touch on what survivors with these disorders are currently going through just to obtain treatment. After all, they wouldn't be struggling to get care so badly if those in the field had more of a vested interest in them - becoming at the very least trauma-informed, or better-equipped themselves to treat a client with complex trauma. This will be an ongoing series no doubt - with many myths to debunk and important notes to impress! So, to start chipping away at that iceberg, here are 8 things we should all know about Complex PTSD and Dissociative Disorders, and the survivors who have them.
With as vast as the United States is, this is supremely disappointing. You can find the current list of those facilities here on our website. Even within those 9, many keep relocating or downsizing, some have a very small number of beds or are restricted to only certain age groups, others have had all their additional programs (like PHP/IOP) cut entirely or are so underfunded they don't run smoothly. Overall, the standard of care for trauma patients nationwide is very low.
Finding a trauma-informed unit at all is pretty scarce, but the greater drawback is that many who claim to be able to take Complex PTSD or DID patients offer them no therapeutic tools or classes designed to address their unique needs and have them intermingled with the rest of the mental health population. This might not sound like an issue, but due to the nature of a trauma patient in crisis and their high susceptibility for flashbacks, panic attacks, switching, and self-harm, being surrounded by unpredictable and sometimes volatile patients is unreasonable and unsafe. Staff also need to be heavily trained in what is an acceptable and safe way to engage with a severely traumatized patient - particularly if they are in flashback, a dissociated self-state, or critically unsafe. Units remain safest (from perpetrators and potential flight-risks) when they are locked, but an understanding that this can be also be extremely distressing for other patients is something staff need to be able to empathize with and negotiate. In short, the nuance of care required for complex trauma patients is unlike that of any other mental health condition. And yet we have less than 10 places we can safely send individuals, and many of those 10 even have their shortcomings. A couple even continue to produce more negative reviews than positive, and some of the leading facilities have proven time and again they are fantastic with some patients but are not equipped to handle ritual abuse patients. Greater education, as well as funding to produce more units in existing psychiatric hospitals is a MUST.
As a side note, there are a handful of residential facilities cropping up in various places throughout the U.S. Residential treatment centers, while valuable and a potentially great resource (especially when there's nowhere else to turn), are typically not equipped to handle clients who need stabilization or are struggling with safety. They are also more unregulated, therapy modalities can be harder to discern, units are not locked, insurance rarely participates, and they tend to be extremely small in bed-availability. While they are often very beautiful and relaxed, and nothing like an inpatient setting - they can be extremely expensive, with limited staffing, and tough to guarantee quality of treatment. And again, while they may be able to facilitate a chronically traumatized patient through a rough patch in their healing, they are often not trained or equipped to aid in crisis stabilization, and are usually far from a hospital should the need arise.
As it turns out, averages can be tough. Research in this field is still limited, and even where it exists, trauma patients aren't typically the most eager to participate in a study. However, despite research on treatment length being slightly dated, and the fact we are getting more practitioners better-able to facilitate a patient through their recovery, as well as those who can at least make an informed diagnosis more quickly -- we are still grossly behind. So, while some may want to argue this estimate is too high based only on what they see in their well-trained offices, others who have patients working well into their 15-20th year of therapy would argue it's still much too low. Regardless of the exact specificity, this is a very reasonable estimate at the moment, and is witnessed to be valid by many, many clinicians, patients, and communities of survivors fighting this battle. Now, this does not always mean 10 years of consecutive therapy - though it absolutely can and does for many. It's quite common for patients to have to stop and re-start therapy multiple times - for myriad reasons. Finances, inadequate treatment, personal unreadiness, a geographic move, unavailability of clinicians, and/or feeling stable at one point but needing to return as more things surface later - these are all very common factors for a more drawn out therapeutic journey.
Ultimately, treatment of complex trauma takes a very, very long time in even the best of circumstances. It can be extremely daunting and feel outrageously unfair to the survivor. The average of several misdiagnoses before arriving at a proper one alone, then coupled with misguided therapy, not only adds more years to the recovery but also risks turning clients away from therapy altogether. It's even been a traumatic experience for far too many. We need compassion and understanding for these survivors. To support them through this long process, no matter how many years it may take or how many times they need to stop and try again. Recovery from trauma is scary. They need our love and support, not added obstacles.
As mentioned earlier, inpatient care for complex trauma is extremely scarce. It requires a specialized unit and, for many, that will be out-of-state. Insurances rarely cover beyond their state's borders and non-participating provider agreements can be very tough to come by - let alone something we should ever expect a survivor to have to fight for themselves while in a terrible, terrible place. Because of this, many of them have to pay tens- to even hundreds-of-thousands of dollars out of pocket for care. Many facilities will not let you pay once you get in and settled and can think clearly. They often require a sizable sum up-front, before you even enter the unit. And, again, coming up with thousands and thousands of dollars that most don't have to begin with, particularly while in crisis, is a feat many just cannot accomplish. Needless to say, most go without.
How many people in the world do you know with red hair? There are at least that many people with DID in the world - though, more than likely a lot more than that. Due to fear, stigma, high rates of suicide, misdiagnoses, lack of public education, and countless other reasons, most who have DID aren't even accounted for yet. But, the bottom line is that this is NOT a rare disorder. It's only rarely talked about. And, when it is, it's very rarely talked about in a positive, empathic light. Most refuse to confront the reality of its prevalence rate, because to do that would mean having to confront causality. And, what causes DID? It's most always man's inhumanity to one another and the cruel callousness of the world. No one wants to acknowledge that or accept how rampant it is, so they sweep the survivors of such under the rug (while others go so far as to actively paint them as dangerous or truly insane, especially in media). DID is not rare. It's not a one-in-a-million case you'll never see. It is everywhere. And those suffering with it just want someone to help them after years and years of abuse, pain and neglect.
This is another fact that is just so very sad. Complex trauma and dissociative disorders are hard enough on their own, but so are depression, anxiety, OCD, addiction, eating disorders, self-harm. To have a collection of many of these at once just seems grossly unfair - yet that's the insidious nature of trauma. The ever sadder part is how many of these aching, traumatized souls find themselves in eating disorder facilities or drug/alcohol rehabs (or even jail) for the more overt or destructive symptoms, but never receive trauma-informed care of any kind. Care that is specific to complex trauma or the uniqueness that DID can play in some of these more addictive or self-sabotaging behaviors is even more rare in places like these. Additionally, when you try to "fix" an addiction or eating disorder through traditional means, without addressing the way its delicately woven and spun around the trauma, you can make them dramatically worse. This, like all bad treatment, can turn them away from therapy (or help in general) forever - or more devastatingly, push them to lose their battle before they ever had a real fighting chance.
It may be a broken record, but there is no place that the abundance of misinformation, redirection of resources, or ignorance of childhood trauma doesn't touch. PTSD in any form is brutal and terrible and all-consuming. But it's sad that in 2017, the first group of people that comes to mind for most whenever you mention trauma or PTSD, is still veterans. If our "war flashbacks" and "triggered" memes online are any indication, people really do not understand the severity of the condition at all, nor do they even attribute it to the population struggling with it the most. There is absolutely a way to keep the very real and VERY valid suffering of war veterans and those who've served in the military very present in our minds, hearts, and resource initiatives, while ALSO lifting up childhood trauma survivors and victims of sex crimes considerably higher than they currently are. They need our attention and visibility. And fast.
I bet if you call to mind any trauma survivor you know, they've also got at least one chronic (or "mystery") illness - maybe even several. In fact, it's probably several if they've survived prolonged trauma. Migraines, fibromyalgia, asthma, autoimmune disorders, rheumatoid arthritis, severe allergies, eczema, dysautonomia, POTS, EDS, neurologic disorders, chronic fatigue, or possibly even the highly insulting [and inaccurate] label of "conversion disorder". These are all seen to coexist alongside trauma in abundance. This list is by no means exhaustive, and - just like diagnoses for C-PTSD and dissociative disorders - many are still trying to just figure OUT what is wrong. They know they have a chronic illness, they just don't know which one, and every avenue they explore seems to point toward a dead end.
We may have a helpful answer to you. In reality, trauma affects absolutely every part of the body - especially the autonomic nervous system (which then affects everything else). This can cause all sorts of havoc and in ways we are only just beginning to more fully understand. It's been well-observed for awhile that trauma and physical illness go hand-in-hand, but it's only more recent that we've been able to see how, why, and where more specifically. Because of this, and the fact it's a very lengthy topic, we cannot recommend the book The Body Keeps the Score by Bessel van der Kolk enough. Or, at the very least, if you aren't interested in reading, maybe peruse some of his work online. It'll be something you definitely won't regret, and supplies a well-studied introduction to all the ails, aches and pains, and mysterious illnesses you or a loved one have been suffering with for what seems like forever.
Finally, in the same vein as so many of these facts but on a slightly different wavelength - traumatized children are seeing some of the most ludicrous misdiagnoses we've seen in quite some time. The lack of understanding of what children who are being actively hurt (or just recently were) are "supposed to look like" in terms of their symptoms, is staggering. Instead of traditional PTSD symptoms that we observe in adults, most kids are demonstrating all of the behavior one might expect from a child presently terrified, scared, shut down to numb, avoidant or afraid to attach, feeling under threat, trying to seek control and a voice, and who doesn't know what to do with all that adrenaline and nervous energy coursing through their tiny, terrorized little bodies. Sure, traumatized children can present in a variety of extremes, and that can be tough to distinguish at face value - but it's not too difficult to learn. And it's not acceptable to take the response of "No, no one's hurt me." as gospel in a child who's still in danger and never pursue it further - especially when all their symptoms are telling you otherwise.
Jumping to the opposition-defiant, mood-dysregulated, ADHD, autistic, etc labels/misdiagnoses can be so harmful and even lead to more abuse at home. Not to mention, they can follow them around forever, reshaping who they think they are or believe to be "wrong" with them. It can make them feel broken or defective - particularly when the treatment for these suggested conditions can make them so much worse. In reality, they are just traumatized children who did nothing wrong, but are being wronged by all the caregiving adults in their lives. They're trying to communicate their suffering to you in any way they know how, but most of those "listening" are all too eager to villainize, label, or neglect them instead. That is not helping them. We need to do better.
There are so many, many more things we all need to know and recognize about Complex PTSD, dissociative disorders, and the survivors who have them. We will absolutely be continuing this list and adding more to the conversation. What are some of YOUR greatest misconceptions about trauma disorders, or details you really wish people knew about the process of healing from them? Please share them below!
MORE RESOURCE POSTS YOU MAY FIND HELPFUL:
- Grounding 101: 101 Grounding Techniques
- Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
- Imagery 101: Healing Pool and Healing Light
- Coping with Toxic/Abusive Families During the Holidays