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Yet Elyse also contends that DID does not present serious problems for her anymore. On the contrary, she views DID as a mostly positive force that frequently helps her mitigate the harmful impacts of her other mental illnesses, which do get in the way of her life.
Elyse said that as a result of her past abuse, she also suffers from posttraumatic stress disorder, anxiety, depression, insomnia, and other mental health problems. Those conditions create numerous obstacles in her day-to-day life and come with some fairly debilitating symptoms. She also suffers from chronic physical pain, which her mother suspects is a byproduct of her childhood trauma.
It is the panic attacks, night terrors, and anxiety that need to be addressed through therapy — not Elyse's DID or alters, Renee said. "Watching her go through physical pain and emotional pain, as a mom, it just kills me to see her suffer," Renee said. "I want to be able to take it away and I can't." That's where Renee hopes that therapy will make a difference for Elyse: "When she gets all that stuff talked out until she can't talk about it no more — and it may take years, I don't know — I'm really hoping it's going to take a lot of that pain away, too."
Debates about DID models aside, Elyse and her mother's perspective on her disorder raises a more complex question about therapy and treatment. Can someone lead a functional life with DID? Or is integration — that is, the fusion of different alters into one identity — the only long-term solution? For Elyse and her alters, the answer is clear.
"We've never wanted to integrate. ... That's completely not an option for us," Mae said during one of our interviews. "It would be like killing everyone in your family ... and being alone. No one is going to do that. We're all friends and family in here."
Elyse said that she, Mae, and the other alters are constantly working toward the best form of "peaceful cohabitation" that they can achieve — that is, effective communication and harmony among all of them.
While the DID therapists I interviewed told me that the central goal of therapy is often integration, many said they also recognized that this is not always possible, and for some, may not be necessary. Integration may be unrealistic for DID patients, because of the chronic and serious stress they endure or the unresolved painful memories they have of their trauma, or because they lack financial resources for long-term treatment, according to the International Society for the Study of Trauma and Dissociation's DID treatment guidelines.
"It's incredibly threatening to a whole system when you begin to ask that system that helped preserve that human to find a new way. It's kind of an epic battle," said Salah, the Berkeley-based DID therapist, adding that "at the heart of dissociation is the conflict to know or not to know." In other words, for some DID patients, moving toward integration or "peaceful cohabitation" often means confronting intensely painful memories that certain alters may have.
And at its core, therapy is really about moving toward greater mental stability and developing and maintaining strong relationships in one's life. The path to those goals can be very different for each DID patient. Some people's dissociation or system of alters may prevent them from holding down a steady job due to memory loss, for example. For others, however, having a system of alters may not be an obstacle to everyday living.
Brand said she would not try to force integration on a DID patient — for the same reasons it would be wrong to pressure someone to adopt a certain sexual orientation or gender identity. But she said if she thinks that the merging of parts will help a patient with his or her life — making it easier for that person to develop meaningful friendships or achieve career goals, for example — she will try to help guide the patient toward integration. It's never easy. She said one of her older patients often tells her, '"this is who I have been for forty years. If I lose parts by integrating them, I lose who I am. I lose my friends.'"
Cathy Rose, a 42-year-old Maryland woman living with DID — and a Towson University graduate, who has been a guest speaker for Brand's classes — told me that her goal is not to be integrated, but rather to be grounded in the present. That means having the different parts of her system working together and not getting stuck in the past. "I'm learning how DID can be healthy ... and I can be healthy with it," she said.
Rose, who works as an analyst at a bank, said her mind is like an orchestra with a lot of different instruments, and she, as a conductor, is trying to direct all instruments to sound harmonious and play the same song.
Rose's friend, Rachel Elise, another Towson University graduate with DID — who studied fine art and now does paintings about her disorder — said she would eventually like to integrate, but recognizes that it won't be easy. "I go to a lot of therapy ... and it's just really hard work," said Elise, 37. One of the challenges, she explained, is that different parts of her hold different memories of the abuse she suffered — and sometimes have very different perspectives on her past — making it difficult to merge them into a single identity.