Engaging Multiple Personalities: Contextual Case Histories

185 Pages·2014·0.99 MB·English

by  David Yeung

Copyright © 2014
by David Yeung
All rights reserved
ISBN 978-1496154217
BISAC: Psychology / Psychopathology / Dissociative Identity Disorder
Dedication
My patients all taught me so much, both about therapy and life itself.
This book is dedicated to all those I was able to help and to those, to my
regret, that did not benefit from my efforts.
Contents
Preface
Introduction
Chapter 1 – Joan – The Superwoman
Chapter 2 – General Introduction to Dissociation and Multiple
Personality Disorder
Chapter 3 – Sandra - Recognizing DID
Chapter 4 – Leila - A House Divided
Chapter 5 – Ruth – Trapped in Misdiagnoses
Chapter 6 – Melanie – The Most Unwanted
Chapter 7 – Victoria - Long Distance Treatment
Chapter 8 – Carla - External Obstacles to Healing
Chapter 9 – Doris - Non-Directive Therapy
Chapter 10 – Limited Successes and Failures
Chapter 11 – Laura - My Last Patient, Summary on Treatment
Afterword
Appendix 1 – Dissociation as an Asset
Appendix 2 – Debates, and Controversies, False Memory, and PTSD
Appendix 3 – Reading List
Preface
Cases of Multiple Personality Disorder (MPD), also known as
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Dissociative Identity Disorder (DID) , have always been regarded as rare
in mainstream psychiatry. In fact, many mental health professionals have
chosen to deny its very existence. News media reports generally include
a disclaimer that characterizes it as a controversial diagnosis. This
facilitates a dismissal of both the disorder as well as of the individuals
afflicted by this condition.
The general public is bewildered and fascinated by DID. Through
entertainment media, including books, television and movies, a distorted
view of DID is often presented. While it may make for good
entertainment, it fails to truly present the depth and intensity of the
inherent trauma.
The two volumes in this series are not concerned with proving or
disproving the existence of DID. My experience with a few dozen cases
in one locale would not pass the vigorous scientific scrutiny required for
establishing the clinical validity of any disorder. However, although
retired, I remain concerned about the response of psychiatrists if and
when a dissociative fragment of personality appears in the consulting
room. I remain concerned about those patients presenting symptoms of
depression, panic attacks, substance abuse, bulimia and anorexia who
may be frightened to reveal a fragmented mind. Such practical
considerations should be the foremost concern of every clinician.
Failure to consider the phenomenon of trauma and dissociation will
lead to hopelessly yet tenaciously treating the presenting symptoms
while ignoring the underlying problem. It will only prolong a patient's
disability and suffering.
If inner conflicts are minimized, DID alters can learn to cooperate
like a well-coordinated soccer team; where all the players work together
for a common goal. Each member of a soccer team has a particular
position, using a specific skill set. This is directly analogous to a
cooperating DID system.
Over the course of more than four decades of practicing psychiatry, I
acquired some skill in the recognition and treatment of DID. This series
documents and distills the clinical experience gained on that journey. It is
my hope that it will be of assistance to therapists working with DID so as
to improve the care given to patients.
Engaging Multiple Personalities was also written to give confidence
to individuals dealing with DID, so that they may gain their own insights
to help support the healing process.
The case histories presented here are taken unembellished from my
patient files. Nevertheless, I consciously refrained from presenting
details that might trigger flashbacks in susceptible readers.
One should always keep in mind that ignoring past trauma simply
will not help a patient. Therapists must gently assist the patient in safely
engaging in trauma therapy, encouraging this whether or not the patient
so wishes. DID patients can successfully engage in and profit from
therapy, and by processing the impact of their past traumatic memory,
they may reclaim their present.
Finally, when individuals suffering from DID are misdiagnosed, they
utilize an extremely disproportionate share of social, health, police and
other services. Through these case histories, it is hoped that government
authorities will perceive the enormous economic as well as social benefits
of the correct diagnosis and treatment of DID.
Warning
If you know or suspect that you have experienced childhood abuse,
please make sure you have a good network of support to turn to when
exploring such a past. Please stop and ask for help if you feel any
emotional turmoil arising when reading this book. While every effort has
been made to omit materials that might trigger traumatic memory, the
best protection is to have the support of a competent therapist to help
process any such turmoil.
Acknowledgments
Ken Smith contributed insights gained from another side of DID; the
spousal experience. This perspective further informed and supported the
organization of this work. He has also provided various aspects of
technical assistance. Sue Anne Cairns offered invaluable help in editing.
Finally, my wife Moira, with her extensive experience in writing and
editing, has given me much moral support and technical help.
Introduction
Dissociative Identity Disorder is a psychiatric diagnosis included in
2 3
the DSM 5 . It is also included in the ICD 10 under the name Multiple
Personality Disorder, as used in DSMs published before 1994. These
inclusions confirm that experts in the field worldwide regard DID/MPD
as a mental health disorder that requires proper diagnosis and treatment.
After graduating from medical school in Hong Kong in the early
1960s, I received further training in psychiatry at preeminent hospitals in
London, England. I then came to Canada and practiced psychiatry in a
variety of settings: a veterans’ hospital, a teaching hospital, an old-
fashioned 2,000 patient mental hospital, a short-stay residential crisis
intervention facility, a general hospital, and an outpatient clinic. I finally
settled into private practice.
In the beginning of my career, despite my education, training, and
qualifications, I was ignorant about MPD. Through years of trial and
error, I learned to recognize and treat patients with multiple
personalities. It was a long and lonely journey of discovery.
I hope that by sharing my clinical experience through this series, new
generations of therapists will come to understand the importance of
correctly diagnosing DID and treating it appropriately.
Many DID patients display a ubiquitous depression, a thick smoke
screen hiding the pathology of trauma and dissociation.
Once diagnosed as suffering from major depression or other mood
disorders, they are quickly given prescriptions for anti-depressant
medications. When there is little to no improvement, other anti-
depressants are prescribed. Diagnosticians can easily end up
characterizing their disorder as “treatment resistant depression.”
Treatment resistant depression is a misnomer in this context. The
depression is not a disease in itself but a symptom of DID. The result is
therapeutic failure which is a consequence of attempting to treat the
symptom rather than the core pathology. Labelling DID patients with
treatment resistant depression leads to chemical based treatments, but
DID related depression can indeed be treated. Effective treatment deals
with the core issues of past unresolved trauma.
The result is therapeutic failure which is a consequence of attempting
to treat the symptom rather than the core pathology. We must not
confuse depression as a symptom with depression as the primary
disease. Depression can be a normal emotional response to difficult life
situations one may encounter. Depression can also be caused by many
different illnesses. Finally, it can be a primary mood disorder. Proper
treatment requires identifying the nature and cause of the depression.
Fixating on eliminating depression while leaving the core pathology
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untouched does not help the patient.
The heart of DID therapy is engaging the alters on their own terms.
This is what is detailed in each of the case histories.
I learned far more from my DID patients about identifying and
treating the disorder than is ever taught in psychiatric training. It is my
sincerest wish to preserve and pass on those insights. I have chosen to do
so through the medium of a representative set of their case histories.
These case histories are not amalgamations of several patients into one to
prove particular points. Each is the actual history of a specific DID
patient, taken directly from my notes of patient therapeutic sessions. The
only substantive changes are the alteration of personally identifying
features in order to protect the privacy of the individual patients.
I do not present only successful cases because the reality is harsh:
Treatment was not always successful. However, each patient's case
history adds to the collective understanding of the disorder. The
presentations of DID differ in every case and, as a result, the therapeutic
journey for each has different characteristics.
Each case history demonstrates different methods and approaches to
DID therapy in general. They are presented within the case histories in
order to show their real-time practical application.