By Judy Springer [Judy Steele]
This year’s thesis-award winner offers a new approach to multiple personality disorder and to understanding mental health.
SEVERAL YEARS AGO, I FOUND MYSELF WORKING WITH MY FIRST multiple-personality client, an experience that not only led me on a remarkable journey of personal discovery but also yielded a new model of health and illness. This conceptualization offers transpersonally oriented therapists a larger framework for assessment and for structuring treatment. In addition, it has been helpful to me and to other therapists in our own personal growth.
Multiple-personality disorder (MPD) is a disorder of adaptation, in which natural defense mechanisms called up under past extreme conditions of abuse and vulnerability persist into the present. The condition is now more commonly known as dissociative identity disorder (DID), because the personalities are understood to be separated from one another as though by impermeable walls. The personalities may not know of one another’s existence, except insofar as they accumulate evidence of blackouts, new clothes in the closet that they have never seen, lovers they don’t remember knowing, phone calls about incidents they don’t recall, food they don’t like in the refrigerator, unremembered suicide attempts that land them in the hospital, and other incomprehensible phenomena. DID personalities, known as “alters,” may even have different biochemistries.
A typical DID client is a woman who has been severely abused physically and sexually from early childhood by one or more family members. She may have any number of alters, including at least one and perhaps several abused and hurting children of different ages, perhaps some teenagers, and some adults. These personalities may vary in gender, sexual preference, and degree of assertiveness. Some may be addicts, some are probably suicidal, some may be self-mutilating, some may be sexually promiscuous, and some may have eating disorders. Many are depressed and/or anxious. At the same time, there typically are other alters who are talented, resourceful, and/or competent. One may hold all of the system’s math ability, while another may paint. One may be a responsible mother who watches out for the children in the system. Another may hold all of the secrets of how the system is organized. Access to these “resource alters” is essential to the client’s healing.
As I worked with one such client, I found myself comparing her present partitioned functioning to my own. After all, I had some symptoms of posttraumatic stress disorder (PTSD) myself, and PTSD is also characterized by dissociation. I am not sure of the exact origin of my PTSD, although my younger brother’s sudden death when I was five and a half is one important component. My symptoms have included hypervigilance, exaggerated startle response, a feeling of detachment from others, ongoing expectation of the sudden death of loved ones, and an inability to recall most of my childhood (I am dissociated from the memories). The dissociation of PTSD, however, is by no means as elaborate as that of DID. I began to wonder what “normal” might look like with regard to this strange phenomenon of dissociation, as well as what constituted “health.”
Many of us without DID are aware that we also have “parts” that are developed as responses to our experiences. (In the Freudian or Jungian systems, these parts would be called “complexes.”) For example, the “inner child” is a part, as are the parent, adult, and child in transactional analysis. We usually have parts that play our roles—such as “executive,” “playboy,” “teacher,” or “artist”—or that represent habitual affects, like “the rageful one,” “the suicidal one,” or “the sincere one.”
We also all dissociate at times—we may be so intensely focused on a creative activity that we lose track of our physical and social needs, we may be driving under the influence of alcohol or of simple “highway hypnosis,” or we may have conveniently disconnected from our bodies while in the dentist’s chair. We also may go into violent, uncontrollable rages, or we may be so disconnected from our emotions that we don’t believe we have any. Thus, some of our dissociation is useful, some is dysfunctional, and some is neutral.
Comparing the DID condition with my own case, I immediately noticed an important difference. When I pay attention “inside,” I can get in touch, at least half-consciously, with many of my other parts. In other words, I have, or can have, awareness of their existence. They do not go out and buy clothes without my knowledge, no matter how compulsive my shopping may be. There is what is known as an “executive function” in my psyche that observes what is going on, and I am in touch with it. Therefore, I am not in the frightening situation of not knowing where I have been, who I have been, what I have done, or who might be in charge of my body tomorrow. So it would appear that developing this “observer” function is critical in the treatment of DID—and helpful to all those who lack it.
My client with MPD/DID knew that she had other personalities, but she had no awareness of them in real time. She also had no way of accessing them—but then it had never occurred to her that she might want to. She believed she was trapped in her private nightmare, and that she had no choice in the matter. She continued to live as a victim of the condition that her psyche had developed to protect her.
When I looked inside myself, I knew that access was a problem for me as well, although I had some awareness and did not have DID. I had struggled with a kind of writer’s block for many years. I was aware that I had a “writer part,” and I remembered times when it had been out and functioning, but getting it to perform when needed had often seemed impossible. The long delays in completing my graduate-school papers and my thesis were only the most recent evidence of how serious this problem had been for me. For many years I had felt a victim of this situation, that I had no choice.
I theorized, therefore, that three elements were needed for healthy functioning: awareness, access, and a sense of choice. I initially defined awareness in this context as perception and memory of the existence and activity of one’s different parts and functions. Eventually I came to define it much more broadly, in the context of the meditative traditions, as consciousness of what is occurring in one’s inner world. Access, initially defined as the ability to “get to” another part of oneself, eventually became the ability to move one’s awareness freely from one dimension to another and along the continuums of association and dissociation. Choice, originally a simple affirmation of free will with regard to one’s experience, became in this context the ability to choose not only one’s focus but also one’s degree of association with it.
I began to keep my initial simple model in mind while working with my client. Using the presupposition that, although choice had not been available to her in the past, it was available to her now, I began to assist her in developing awareness of her alters and her access to them. I also took the position that all of her parts were important and that none needed to “die.” I stressed growth and development of all the alters, as well as increasing cooperation among them.
Concurrently, I was wondering about the dimensions in which one can dissociate. Bennett Braun’s “BASK” model (1988) identifies four dimensions of dissociation: behavior, affect, sensation, and knowledge. My client demonstrated these four dimensions well: She (the primary or “host” personality) was dissociated from many of “her” behaviors; they were performed by other personalities. She was dissociated from affect; although she remembered cognitively most of the abuse she endured as a child (many do not), she did not have the emotions associated with that abuse—the missing feelings were divided among the alters. She was also dissociated from many physical sensations in the present; much of her self-mutilation was for the purpose of “feeling real.” Finally, she did not have current knowledge, or memory, of the activities of the alters.
But it seemed to me, in view of my own experience and that of my other clients and friends, that there could be more dimensions of dissociation than these four, and that experience of the BASK dimensions (although usually in less severe form) was not confined to people with DID. In fact, I had experienced dissociation of behavior, affect, sensation, and knowledge myself. Again I wondered: What is health with regard to dissociation? And what are the varieties of illness in this respect? If mental or emotional illness is conceived as a deficiency or limitation, what are the areas in which a person can be limited by being “disconnected”?
In addition, there was the matter of association—was it always healthy? Can we be just as unhealthy by being “too connected”? And how did my transpersonal view of wholeness relate to these issues? As I continued to notice areas in which either dissociation or overassociation limited people’s freedom and growth, the model grew and developed.
Eventually I identified 11 important dimensions. (See Figure 1.) [Figures are not yet available on this website; they are coming soon.] The BASK dimensions became my “behavior,” “body/sexuality,” “emotions/affect,” and “thoughts and memories” dimensions. I added a “will” dimension, because people often live in a dependent, passive or victimized mode, cut off from their own volition. I added a “capabilities and creativity” dimension, based on my own experience of inability to access my “writer part.” Feeling that the phenomenon of multiple parts or personalities was more than the sum of the BASK dimensions, I added a “personal identity and multiplicity” dimension. After an experience with a physically abused client who had given up her claim to life because of her own guilt, I added a “claim to life and safety” dimension. Aware of how being cut off from spiritual sustenance can leave any of us weak and limited, I added the “sky” (spiritual) dimension. Thinking of how disconnected any of us can be from the natural world that sustains us, I added the “earth” dimension. (The labels “earth” and “sky” were chosen to represent the Native American concepts of Mother Earth and Father Sky.) Finally, thinking of isolation, alienation, and enmeshment, I added the “other people” dimension. The last three of these are transpersonal dimensions.
As a result of a strong and persistent challenge from one of my thesis-committee members, the relationship of dissociation and association came into focus for me. It wasn’t simply that dissociation was unhealthy and association healthy. In the “other people” dimension, for example, a person who is enmeshed is not by definition healthier than one who is isolated. Dissociation could be either healthy or unhealthy, and the same was true for association. It became apparent to me that in each dimension two continuums are required: one for dissociation and one for association. The “health” end of each continuum is understood to require awareness, access, and choice.
It now remained to flesh out the four ends of the continuums in each dimension. Figure 2 [coming] shows as examples the “other people” and “behavior” dimensions, with their dissociation and association continuums. These, and the three other dimensions that follow, are only suggestive of the directions in which each dimension can be elaborated; they are not comprehensive.
Other People: In this dimension, sociopathy, alienation, and isolation belong at the “illness” end of the dissociation continuum, and the ability to detach with love appears at the “health” end of that continuum. Identification with an abuser; overidentification with a parent, partner, child, guru, or cult; codependence; and enmeshment belong at the “illness” end of the association continuum. The ability to choose freely to connect with other people appears at the “health” end of that continuum.
Behavior: Unhealthy dissociation in the “behavior” dimension includes blackouts (amnesia for behavior) and neglect of children. (Highway hypnosis, also a form of behavior dissociation, is normal and usually neutral.) Healthy dissociation in this dimension is exemplified by the freedom not to act. Unhealthy association includes compulsive behaviors, addictions, and unstoppable rages; healthy association is basically the freedom to act at will, with awareness.
Sky: In the “sky” dimension, unhealthy dissociation includes the inability to access the spiritual dimension of life. Healthy dissociation includes the ability to split awareness or to reduce spiritual association enough to carry out mundane activities. Unhealthy association is exemplified by the inability to accomplish everyday tasks because one’s head is in the clouds. Healthy association might include meditation, prayer, mystical experiences, and intuition.
Thoughts and Memories: In this dimension, unhealthy dissociation includes psychogenic amnesia, difficulty in concentrating, and fuzzy thinking. Healthy dissociation is basically the ability to “leave” a thought at will. Unhealthy association includes obsessive thinking, flashbacks, and recurrent, distressing dreams of traumatic events. Healthy association is clear memories and clear thinking, both accessible at will.
Emotions/Affect: In this dimension, dysfunctional dissociation includes the numbing of emotions, restricted range or lack of affect, and psychogenic amnesia for emotions. Healthy dissociation includes the ability to “leave” a feeling at will as well as therapeutic dissociation techniques such as those described by Nancy Napier in her book Getting Through the Day: Strategies for Adults Hurt as Children. Dysfunctional association to feelings includes depression, bipolar disorder, and panic attacks. Healthy association includes the ability to experience a feeling at will and therapeutic association techniques such as “focusing,” as developed by Eugene Gendlin and described in his book Focusing.
This multidimensional model informs my practice by serving as a mental template for assessment and goal setting. It also jogs my memory of useful techniques related to each category and focuses my work on a fundamental therapeutic goal: psychological health and wholeness as freedom from the perception of limitation.
What of my client? As with other DID clients, her road is a long and rocky one. Her overall improvement has been remarkably rapid, however, as her sense of awareness, access, and choice in various dimensions has increased and the communication among her alters has improved.
I have also benefited personally, by reclaiming many important parts of myself—including the part that writes.
Common Boundary’s panel of judges* selected Judy Springer’s essay as the winner of this year’s  national dissertation/thesis award. It was chosen from more than 40 applicants for its originality, insight, and applicability to the practice of psychotherapy.
*The panel of judges was composed of Daniel Goleman, Ph.D., Frances Vaughan, Ph.D., Miles Vich, Belleruth Naparstek, L.I.S.W., B.C.D., and John McDargh, Ph.D.