Dissociative Identity Disorder: Treatment Perspective - Part 8

The integration of truncated memory nodes within our memory system remains complex as it involves how our intricate cognitive and emotive brain structures code our experiences, specifically trauma related. What is observed among dissociated (DID) patients is a coding differential between normal and traumatic memories. However, not everyone reacts similarly; some traumatized individuals seem to be able to process their memories effectively to by-pass a dissociated memory coding experience. It appears that most DID individuals begin their trauma laden experiences during childhood, when the brain is developing, and cognitive processing abilities are still maturing. Hence, the simplest route for a child to cope with such challenging scenarios is to ‘blank out’ or ‘break-up’ their memory nodes, i.e., very simply, separate the emotive trauma memory from the cognitive part of it. Hence, they may feel an event but have no memory of it, or vice versa. Note that this is just one of several memory nodes coding the totality of an experience.

Up to this point in the treatment regime, the extent of several dissociated memories would have been revealed, and the counsellor would have spoken with nearly all the alters inherent within the patient’s memory system. What this implies is that the patient and her alters have trusted the psychologist sufficiently to surface and carry on a reasonable conversation in divulging the dissociated memories that they have been keeping. All these sessions had been conducted under hypnosis. 

How is the process initiated to recover and integrate their disjointed memories? In brief, prior to the commencement of this segment of treatment, an extended process of orientation is required, so the patient understands and is prepared to cooperate in the healing sequence. 

Alters of related truncated memories are required to communicate with one another; this indicates that a channel is required to be created for them to listen and hear each other, which was not possible previously. They have remained separated for perhaps years, and therefore, do not always consider themselves as belonging to one another but seem to be independent of each other. They then express themselves as dissociated parts when they come forward to speak or act for themselves when the individual is triggered or is under undue stress. Occasionally, alters will vehemently object to talking to each other or with the real individual, and this is especially poignant when the trauma involves strong emotions or violent actions; for example, rape, sexual or physical assaults, infidelities or adulteries. Long term dialogues may be necessary between the individual, the alters and the counsellor, to breach the differences and to assist the personality parts to accept that they are part of the same person, existing in the same body. Parts will only talk to each other either when they are co-conscious, or they individually give permission to each other towards discussing the traumatic issue(s) that preoccupy them separately. Once permission has been secured, this process is simplified and hypnosis is the gateway towards their reconciliation and integration.

It is not unusual for alters to not want to integrate. They had lived in this condition for many years since their creation, and cannot visualise themselves being integrated. Forcing them to do so will not solve their dissociation. In fact, they will remain dissociated for a longer period of time and possibly become distrustful of the counsellor, which will inevitably complicate further the treatment process. They will need time to think through the reality of an alter disappearing forever, after a successful integration. Internally, the parts will discuss among themselves whether they would submit to the process. Some dissociated individuals, as a result of their alters, hear voices talking among themselves in their heads. This is unlike the normal thinking process which is linear in approach. The dissociated individual’s discussion would be circular - back and forth among the alters; and if co-consciousness exists, then the individual is able to hear the discussions.

​To Be Continued…..