Thursday, January 23, 2020

Psychiatric Casualties of Mass Marathon Trainings

This is the second in a series of articles on the psychiatric casualties of thought reform programs. The first, "Psychiatric Casualties of Thought Reform Programs," was published here almost two years ago and remains available for viewing. It was developed from Margaret Thaler Singer's and Richard Ofshe's paper, Thought Reform Programs and the Production of Psychiatric Casualties, originally published in Psychiatric Annals in April 1990. The following article was developed from an excerpt from Dr. Philip Cushman's "The Politics of Transformation: Recruitment - Indoctrination Processes in a Mass Marathon Psychology Organization," published by St. Martin's Press of New York City in 1993, and retrieved from Rick Allen Ross's Cult Education Forum at this address. The original text by Dr. Cushman is in black; my comments are in dark red.

Mass marathon training is usually based on the belief that it is a universal truth that all human beings will have problems in life until they develop deep cathartic psychological insight, experience completely their every feeling, and live only in the present moment (see Brewer, 1975; Bry, 1976; Rhinehart, 1976). According to this ideology all defenses are bad and must be destroyed. They shape their group exercises in order to uncover and intensify the participants' underlying conflicts and deficits. Everyone must be exposed to these exercises; there are no exceptions. When all defenses are destroyed, they claim there is literally no limit to what each individual can accomplish.

The phrase "great ideas badly delivered" hit me right between the eyes many years ago. So many of the concepts described and examined in the MM/LGATs that came from humanism and the human potential movement of the mid-2oth century are now part and parcel of highly effect, third-wave, mindfulness-based cognitive psychotherapies and fourth-wave, mind-body psychotherapies (like DBT, ACT and MBCT among the former, as well as MBBTSEPt and SP4T among the latter). But for many who still associate those techniques with the suffering of their (usually later) cult experiences, such therapies are too often re-triggering and intolerable.

The mass marathon trainings (aka "large group awareness trainings" or LGATs) discussed in Cushman's work are pretty clearly of the sort popular in the 1970s and '80s, including the following (with all of which I am personally familiar):

Werner Erhard's est Training (later known as The Forum, and the Landmark Forum)

John Hanley Sr's Lifespring (which may be the particular example used in the material in the link at the end of this article though there is also a very strong -- but not 100% -- resemblance to what I experienced in several est trainings in the 1970s)

Tom (and later, Jane) Wilhite's PSI

Stewart Emery's Actualizations

Alexander Everett's Mind Dynamics

Justin Sterling's Sterling Institute of Relationship

(This is where I began to run into multiple, cross-platform, reformatting problems. Blogger is a very intolerant, early "cloud" platform. I will do my best here. Sigh.)

Yet there is research that contradicts this universal claim. Applebaum (1976) reported on the results of the Psychotherapy Research Project of the Henninger Foundation, which attempted to better understand the effects of psychological insight in the treatment of patients who had ego-function difficulties and severe characterological problems. After insight-oriented treatment. a substantial number of patients were found to have changed for the worse. The data confirmed that the "screened-off aspects of one's self" are hidden for a reason; for some types of people the conflicts that necessitated the screening off should remain hidden.  

People diagnosed with obvious schizophreniform, bipolar and other psychotics disorders appeared to have been generally excluded from est, Actualizations (whose head man had been one of the first est trainers), PSI and Lifespring. I cannot say that for sure about the other two. But, insofar as I could tell, the rooms were full of people with various, pretty evident traits of Diagnostic & Statistical Manual IV, Axis II "personality disorders," including schizoid, paranoid, narcissistic, histrionic, anti-social, passive-aggressive, obsessive-compulsive, masochistic, dependent and depressive disorders. I do not recall seeing (or otherwise sensing) any sadistic, schizotypal or grossly nihilistic traits.

Psychology, Applebaum argued, has to recognize the factors, which impinge upon whether, when, how much, and what kind of insight a particular person in particular circumstances should be helped to achieve. We need to know . . . the patient's capacities in order to design the best amount, kind, and timing of insight. (1976, pp. 205-206)

Most of the better psychotherapists and addiction counselors I have known over the past 30+ years assert that, "One size does NOT fit all," and that "One needs to meet the patient where the patient is."  

The data demonstrated Applebaum's contention that differential diagnosis and a differential treatment plan is crucial in effective psychotherapy. This conclusion challenges the universal and absolutist claims of insight oriented mass marathon groups. Applebaum warned that

· "Until we give up the pipe dream of insight as a universal good or a universal bad, we and our patients will, at times, be injured by its dangerous edge." (1976. p. 206)

Just as Applebaum criticized those who considered the indiscriminate use of insight a universal therapeutic panaceas so too did Hampden-Turner (1976) attack those who treat human growth like a consumer product, indiscriminately applying certain techniques to every customer who appears with a blank check. He vigorously disagreed with the ethics of

· "The pop supermarket, the idea that you can purchase a "peak" here and a "high" there, and go psycho-shopping for prepackaged experiences…in fact human growth is not like a product at all, and we vitiate it utterly by pandering to the consumer ethos." (1976, p. 3)

While "psycho-shopping" or "peak-seeking" was not a pop-psych pandemic in the early '70s, it certainly began to look  that way in the '80s. Many of the recruits by then talked about the various LGATs they'd "done" pretty much like the drugs they'd done.

His critique focused particularly upon the highly structured, authoritarian, insight-oriented marathon workshops. Some aspects of humanistic psychology, he argued, seem

· "…to have almost forgotten that our most precious human values are achieved by indirection as opposed to the means ends rationality of industrial production. . . I seriously question any high that has been programmed in advance." (1976, pp. 1-2)

The rise of the MM/LGATs coincided with (or, at least shortly followed) the rise of the "human potential movement."  And things fairly quickly got screwy there, as we all know.

He voiced his disagreement with psychological ideologies that discount or deny the significance of the sociohistorical and economic realities of the situation in which the client lives. These ideologies instead argue for the grandiose delusion of the ultimate limitlessness of the individual. To the organizations that teach this ideology he posed a provoking question:

· "If we are not aware of what the economy does to us, are we self aware at all? Any genuine search for truth must remind us of the things we cannot change." (1576, P. 3)

In this way Hampden-Turner raised an issue that Sampson (1981) expanded upon. Sampson criticized cognitive psychology (the single most prominent aspect of the ideology of many mass marathon organizations) for its "subjectivist reduction." By this he meant the regressive tendency to discount the nonsubjective world by considering it to be either a hallucination or subject to the total control of the individual. According to some mass marathon organizations, human fetuses choose their parents, female victims choose to be raped, and Vietnamese children chose to be bombed. The regressive aspects of this ideology seem to be readily apparent.

Sampson demonstrated how a regressive psychological doctrine can impact on political activity. He argued that an ideology both accurately expresses the "zeitgeist" of the era and may also inaccurately distort the facts in order to serve the ruling elite. He explained how cognitivism as an ideology serves the status quo of power and privilege in American society by teaching individuals to reinterpret their internal response to a painful experience rather than to work at rearranging the external situation so that it could better facilitate personal and communal well being.

The sadly dichotomistic battle between the mostly pop psych proponents of internalizing vs. externalizing raged on for a good 30 or 40 years. It was always a case of going "black & white" and "all good vs. all bad" when it would better have been framed as "too much of a good thing may not be" in more Taoist and dialectical fashion. But the legions who claimed to understand Lao Tsu and even Marsha Linehan really didn't. (The embers are still hot, even in the era of Asian-influenced mind-body psychotherapies like Linehan's DBT, the Blocks' MBBT, Levine's SEPt,  and Ogden's SP4T. Sigh.) 

Humanistic psychology owes much to Lewin's "laboratory movement, " which originally developed the encounter-group format at the Bethel Institute. Mass marathon psychotherapy organizations claim that they are within the legitimate tradition of this movement. They claim that their training techniques, which include severe milieu control and a rigid ideology, are taken directly from the encounter movement of years past.

By the late '60s, most of the cognoscenti in the Bay Area and El Lay's West Side knew the place to go to get laid by the world-class faces and bods was the weekend encounter group. I did several of Psychology of Self-Esteem author Nathaniel Branden's (which were not like the MM/LGAT's in terms of intentionally setting up the participants to work their way up any cultic pyramids). They were "artists & models" balls. 

And yet Gottschalk and Pattison's (1969) study of the history of T-groups and the laboratory movement appears to refute that claim. They found that the laboratory movement was originally an attempt to encourage democracy within community action groups. It was composed of three types of groups: T-groups, task-oriented groups dedicated to teaching about group process, and intervention labs whose goals were action-oriented community improvement programs. The authors found that the original unified effort diverged into an increasing number of activities, each with different philosophical foundations and agendas. The shift in the 1950s to "individual growth. . . . self knowledge, to actualization and maturation" (1969, p. 4) was a clear deviation from the founding philosophy.

They reported that T-group participants sometimes complained of the hidden agendas, group norms, and covert values of charismatic group leaders and their loyal followers.

"Hidden agendas" in human potential cults? Heavens! (The newcomer to all this may ask, "Well, what hidden agendas?" In my experience, all of the MM/LGATs were in fact recruiting and conditioning devices meant to indoctrinate, instruct, socialize, habituate and normalize as many of the participants as possible to the cult's beliefs and values so as to sell them on further involvement including unpaid service as volunteer recruiters, office workers and training personnel, as well as purchasers of downline trainings.) 

They found that the trainer and various group members are calling upon them to stop certain ways of behaving, talking, thinking, and feeling, and that different ways of behaving are being prescribed. (p. 12)

Also the T-group was found to consciously evoke dramatic reactions in the participants, which often involved an exaggeration of impulsive traits and personality styles.

Gottschalk and Pattison isolated 13 liabilities of encounter groups, some of which are similar to characteristics of most current mass marathon psychotherapy training sessions:

They lack adequate participant-selection criteria.

They lack reliable norms, supervision, and adequate training for leaders.

They lack clearly defined responsibility.

They sometimes foster pseudoauthenticity and pseudoreality.

Think "Tony Robbins and Joel Osteen on technological steroids."

They sometimes foster inappropriate patterns of relationships.

They sometimes ignore the necessity and utility of ego defenses.

They sometimes teach the covert value of total exposure instead of valuing personal differences.

They sometimes foster impulsive personality styles and behavioral strategies.

They sometimes devalue critical thinking in favor of "experiencing" without self-analysis or reflection.

Many MM/LGATs actually packaged and promoted their products as "critical thinking," which had a huge appeal to liberal arts majors at UCLA, Stanford and Berkeley at the time. While college students were not necessarily seen in large numbers among the basic training participants, graduates were.  

They sometimes ignore stated goals, misrepresent their actual techniques, and obfuscate their real agenda.

"Misrepresent(ing) their actual techniques" is fundamental in this world. "Enlightenment" means "enslavement" here. (Have a look at Cult Membership as a Behavioral Addiction ...  18 Examples of Baiting & Biting ... Chicken S--t vs. Chicken Salad ... The Effects of Double Binding ... Hypnotic Regression ... Groomed into Learned Helplessness ... The Abuse of Narrow Focus Meditation ... and The Typical Path. Decide for yourself.)  

They sometimes focus too much on structural self-awareness techniques and misplace the goal of democratic education; as a result participants may learn more about themselves and less about group process.

They pay inadequate attention to decisions regarding time limitations. This may lead to increased pressure on some participants to unconsciously "fabricate" a cure.

I can't say I saw a lot of this in the lower level populations of the MM/LGATs, but I sure saw a lot of it in the medium-level hierarchy of the Church of Scientology... and levels five and up on the cultic pyramids of the MM/LGATs. 

They fail to adequately consider the "psychonoxious" or deleterious effects of group participation.... (1969, p. 13)

While this could be the case in the few situations where trainees were allowed to cross-talk during the trainings, it was farrrrrrrrrrrr more widespread phenomenon among the mid-level (fives to eights) on the pyramids for sure. Wholesale public humiliation was relentless at those levels, and used as a shaming device by the trainers in the trainings after the first two days or relative "playing nice." To be a staff member or training volunteer was to be a masochist in training

As a result, participants and leaders may unconsciously distort their feelings and responses when reporting to researchers about the group or recruiting for future groups. This might result in a deceptive "oversell" that could undermine informed consent and lead to unrealistic regressive expectations in new recruits, the specific type of problems that have been found to lead to psychological casualties (see Yalom & Lieberman, 1972, below). Since these liabilities are so similar to the techniques used in some mass marathon training's, they may also cause psychological damage in that setting as well.

In a significant study with far-reaching consequences for the study of mass marathon training's, Yalom and Lieberman (1972) observed in 209 undergraduate subjects the negative effects of participation in an encounter group. Over the course of 10 weeks, 18 groups met for 30 hours; there were also 150 fifty control subjects who did not attend any group.

Each group was run by a leader who was chosen because he was an excellent representative of one of 10 ideological schools of encounter (T-groups, Gestalt, Rogerian-marathon, psychodrama, psychoanalytic, Transactional Analysis, sensory awareness, Synanon, personal growth, black-white encounter, and leaderless). Each was given complete freedom.
Yalom and Lieberman's primary interest was in assessing the types and causes of psychiatric "casualties." The operational definition of a casualty was "an enduring, significant, negative outcome which . . . was caused by…participation in the group" (1972, p. 223). 

There is little doubt that the careful, conservative manner in which the study was conducted tended to minimize negative results and reduce the risk to subjects (1972, p. 228). The authors developed a system for identifying subjects who were harmed. Their definition of this subsample and their means of locating it were characteristically conservative. Subjects were included in the casualty subsample only when they had experienced "enduring" negative change and

· "…as a direct result of . . . [their] experience in the encounter group became more psychologically distressed and/or employed more maladaptive mechanisms of defense." (1972. p. 228)

Also, the experience must have been proven to be the responsible element in the psychological decompensation. For example, one subject committed suicide during the study and was not counted as a casualty because the suicide could have been caused from past encounter group experiences.

In a startling finding, Yalom and Lieberman reported that 9.4% of the subjects met their stringent criteria and were therefore identified as casualties. The authors viewed this as a serious challenge to the entire movement.

The authors also determined that it was neither the psychological traits of the subjects (i.e., predispositional factors) nor the ideology of the leaders (i.e., doctrinal factors) that determined the casualty rate. Instead, surprisingly, it was the style of leadership that was primary. Leaders who were aggressive, stimulating, intrusive, confrontive, challenging, personally revealing, and authoritarian were the leaders who caused the casualties.

Specifically these leaders often unilaterally structured the group's events. Their focus was on the individual rather than group process. They provided a comprehensive intellectual framework with which to understand one's self and one's world. They exercised firm control and were "ready, willing and able" to take over for participants and guide them to "enlightenment" (1972, p. 236). They were people who were charismatic leaders: they had a universal message to deliver, a foolproof technique to use, and a cause to recruit for. They were uninhibited in their attempts to convert all the participants in their group. These characteristics are clearly duplicated by many mass marathon trainers. The findings corroborated Gottschalk and Pattison's 1969 conclusions and again call into question many tactics used by mass marathon organizations.

Of the categories that caused casualties, "rejection" was the most damaging. "Failure to achieve unrealistic goals" was the second most dangerous category. Each of these subjects reported being pressed for a breakthrough without being able to deliver. "Leader attack"-"group attack" tied for third. The fact that participants were restrained from leaving, that they had "no place to hide," was thought to be a crucial element. [As is the case in any form of conditioning to "learned helplessness."] "Group pressure to experience and express feelings" also caused casualties. When subjects couldn't comply, they felt a "sense of hollowness" which led to a "deficient or empty self-image" (1972, p. 243).

Interestingly, many subjects who demographically resembled the casualty subsample didn't have negative experiences. Yalom and Lieberman found that they had more realistic expectations for the experience, they were not lonely or depressed, they remained uninvolved (i.e. "…they did not enter into a public confessional and therefore maintained their objectivity and their 'observing ego'"), they dropped out of the group, they depended on a positive self-concept when they were negatively criticized by the group, or they used an outside reference group to bolster their own beliefs when in conflict with a group norm.
The authors suggested that a questionnaire that detects unrealistic expectations would be a helpful counterindicator when attempting to predict which potential participants would be at risk. In summary, Yalom and Lieberman stressed that casualties were caused by the style and techniques of the leader, and by recruitment and selection practices.

The groups were determined to be dangerous when:

Leaders had rigid, unbending beliefs about what participants should experience and believe, how they should behave in the group, and when they should change.

Leaders had no sense of differential diagnosis and assessment skills, valued cathartic emotional breakthroughs as the ultimate therapeutic experience, and sadistically pressed to create or force a breakthrough in every participant.

Leaders had an evangelical system of belief that was the one single pathway to salvation.

Leaders were true believers and sealed their doctrine off from discomforting data or disquieting results and tended to discount a poor result by, "blaming the victim."

Yalom and Lieberman concluded by again emphasizing the crucial importance of informed consent. "Our best means of prevention," they maintained, remains the type of group the subject enters, and our best means for prevention is self-selection. If responsible public education can teach prospective encounter group members about what they can expect in terms of process, risks, and profits from a certain type of group, then and only then can they make an informed decision about membership. (p. 253)

It is instructive to note that many mass marathon organizations are conducting their training in the exact manner found by Yalom and Lieberman to cause the greatest number of psychiatric casualties. 

In my own experience, as well as encounters with other MM/LGAT participants after the fact, there's an even worse, long-term upshot: Many people emerge from their long-term experiences moving up the side of the cultic pyramid to the sixth through eighth levels where the abuse is the worst stuck with powerful associations between the actual (mostly existential) facts delivered during the sessions and the abuse. And that association often precludes ever using those facts for the psychotherapeutic purpose for which those facts were originally intended: Escape from the common cultural concensus trance to which most people have been conditioned, etc., by the messages and modeling of a much larger "commercial cult." Several exitors I know who came to understand and work their way out of the CT, have told me that that was what they were hoping to find when they bought their ticket for the MM/LGAT to begin with. 

Note: For a detailed, day-by-day overview of the training process see a "Description of the Behavioral Structure of the Training."

Commentator's References & Resources

Connecting the Dots from Abuse... to Compensation... to Dissociated, Diverse Identities

I was cogitating about my own experiences of dissociation all the way back to my earliest memories of "splitting off" into "more comfortable head spaces" in light of Erik Erikson's widely publicized and research-supported notion of eight developmental stages and the application of those notions to psychotherapeutic Re-Development as I wove through twilight sleep this morning on the way to "waking up."
(I could go way off into that topic for sure, but suffice it to say that twilight sleep presents us all with opportunities to see, hear, feel and sense what IS beyond the barriers of our conditioning, in-doctrine-ation, instruction, socialization, habituation and normalization if we develop sufficient self-awareness to do so.)
I saw that even though they rarely carry my "sense" (actually not, but we'll get to that later) of "self" off into Learned Helplessness, Dread & the Victim Identity, my own disparate personas (or "alters") continue to drive me to distraction in well-developed fantasies of one thing and another that have been rehearsed, rewound, replayed, rewarded and reinforced for decades. The most "evolved" and self-aware of all these Internal Family Systems Model characters can see, hear, feel and sense all the others as "characters." Moreover as personas constructed decades ago to be IFSM "protectors" via the same sort of childlike "magical thinking" that is the action of Piagetian-inspired, "fantasy operational processing" (which, IME observing hundreds of "adult children" occurs between his "pre-operational" and "concrete operational" stages of cognitive development). Rehearsed, habituated and normalized over time, these "entities" come to be taken for granted and UNconsciously accepted as -- while not quite "actual" -- elements of the collective self... or Eriksonian Identity.
So, I thought, "Can all this be boiled down to a manageable encapsulation I can use in the future as a working title for conceptual 'lens' through which to observe this phenomenon?" Here's what I came up with (for the time being): Childhood Trauma may drive Fantasy Operational Compensations into Separate Paths to Separate Identities leading to Dissociative Identity Disorder.
And I turned on the computer here and went looking for corroborative scholarship. I found a lot of useful stuff via NCBI, but only one paper thus far (from an author in Istanbul, Turkey, which has been a hotbed of research on both DID and BPD for many years; and NOT, IMO, at all surprisingly in a town where European sophistication interfaces daily with normalized, old-world abuse of -- especially female -- children). Here's the citation and abstract:
V. Sar (at the Koc University School of Medicine): Parallel-Distinct Structures of Internal World and External Reality: Disavowing and Re-Claiming the Self-Identity in the Aftermath of Trauma-Generated Dissociation, in Frontiers in Psychology, Vol. 8, February 2017. (doi: 10.3389/fpsyg.2017.00216 ; abstract at this link.)
The nature of consciousness and the autonomy of the individual's mind have been a focus of interest throughout the past century and inspired many theories and models. Revival of studies on psychological trauma and dissociation, which remained outside mainstream psychiatry, psychology, and psychoanalysis for the most part of the past century, has provided a new opportunity to revisit this intellectual and scientific endeavor. This paper attempts to integrate a series of empirical and theoretical studies on psychological consequences of developmental traumatization, which may yield further insight into factors which threaten the integrity of human consciousness. The paper proposes that an individual's experience of distorted reality and betrayal precipitates a cyclical dynamic between the individual and the external world by disrupting the developmental function of mutuality which is essential for maintenance of the integrity of the internal world while this inner world is in turn regulated vis-à-vis external reality. Dissociation -- the common factor in all types of post-traumatic syndromes -- is facilitated by violation of boundaries by relational omission and intrusion as represented by distinct effects and consequences of childhood neglect and abuse. Recent research conducted on clinical and non-clinical populations shows both bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response. These seem to reflect "parallel-distinct structures" that control separate networks covering sensori-motor and cognitive-emotional systems. This understanding provides a conceptual framework to assist explanation of diverse post-traumatic mental trajectories which culminate in a common final pathway comprised of partly overlapping clinical syndromes such as complex PTSD, dissociative depression, dissociative identity disorder (DID), or "borderline" phenomena. Of crucial theoretical and clinical importance is that these maladaptive post-traumatic psychological formations are regarded as processes in their own right rather than as a personality disorder innate to the individual. Such mental division may perform in that internal detachment can serve to preserve the genuine aspects of the subject until such time as they can be reclaimed via psychotherapy. The paper attempts to integrate these ideas with reference to the previously proposed theory of the "Functional Dissociation of Self" (Şar and Öztürk, 2007).
These are the phrases in that abstract that caught my eye right off:
  1. "...factors which threaten the integrity of human consciousness."
  2. "...bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response."
  3. "...'parallel-distinct structures' that control separate networks covering sensori-motor and cognitive-emotional systems."
  4. "This understanding provides a conceptual framework to assist explanation of diverse post-traumatic mental trajectories which culminate in a common final pathway comprised of partly overlapping clinical syndromes such as complex PTSD, dissociative depression, dissociative identity disorder (DID), or "borderline" phenomena."
And here's why: Having dived deeply into Bessel van der Kolk's big swimming pool of neurobiological stress (via such as his Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society (1996) and The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma) I ran into people like Bruce McEwen, Sonya Lupien, Robert Sapolsky and old faves like Hans Selye, Joseph Wolpe and Herbert Benson on the way down to the "bottom" and Stephen Porges and Pat Ogden. Sar's paper wastes no time in going straight into all that material on the Fight / Flight / Freeze / Faint / Feign (or Fawn) Responses that can lead to sustained Fry and Freak in the General Adaptation Syndrome. Stay there for even a short time and the mind will start scrambling to find The Way Out... including...
And when that happens, "...factors which threaten the integrity of human consciousness" start to FRAGMENT consciousness into discrete compartments -- or "vaults" -- where intolerable affective states can be "locked away" behind compensatory masques of alternate identities. The child can fantasize being capacious, capable and competent in various ways to offset the "fact" of an crushed ego crushed (or "DEcompensated into Learned Helplessness & the Victim Identity from having been repeatedly neglected, ignored, abandoned, discounted, disclaimed, and rejected, as well as invalidated, confused, betrayed, insulted, criticized, judged, blamed, shamed, ridiculed, embarrassed, humiliated, denigrated, derogated, set up to screw up, victimized, demonized, persecuted, picked on, vilified, dumped on, bullied, gaslighted, scapegoated, emotionally blackmailed and/or otherwise abused by others upon whom they depended for survival in early life. (This abuse can occur later in life, e.g.: in lengthy cult immersion or in a career path where "success" is impossible.)
That "...bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response" and "...'parallel-distinct structures' that control separate networks covering sensori-motor and cognitive-emotional systems" occur in DID seems about as plain as the nose on my face. (To me, anyway.) Which, IMO, "provides a conceptual framework to assist explanation of diverse post-traumatic mental trajectories" that are patently obvious in "dissociative identity disorder (DID), or 'borderline' phenomena."
"No one is born crazy. They are taught to be," wrote social psychologist Jules Henry more than 50 years ago. IME, the form of "crazy" we call "dissociation" is just the result of one more -- admittedly complex -- form of conditioning, in-doctrine-ation, instruction, socialization, habituation and normalization that compels children to come up with some scheme of compensatory narcissistic self-protection to prevent complete destabilization and decompensation into something like the floridly psychotic, schizophreniform disorders.
Identity-switching dissociation may confuse the hell out of the patient and most of the people with whom he or she comes in regular contact, but it's a far "better" alternative than wholesale delusion with NO evident ability to deal with life on life's terms whatsoever.
References & Resources
Abramowitz, J.: the stress less workbook: Simple Strategies to Relieve Pressure, Manage Commitments and Minimize Conflicts; New York: The Guilford Press, 2012.
Agarwal, N.: fMRI Shows Trauma Affects Neural Circuitry, in Clinical Psychiatry News, Vol. 37, No. 3, March 2009.
Alanen, Y.: The Family in the Pathogenesis of Schizophrenic and Neurotic Disorders, in Scandinavian Archives of Psychiatry, No. 42, 1966.
Andersen, S.; Teicher, M.: Desperately Driven and No Brakes: Developmental Stress Exposure and Subsequent Risk for Substance Abuse, in Neuroscience of Behavior Review, Vol. 33, No. 4, April 2009.
Andrianarisoa, M.; Boyer. L.; Godin, O.; et al: Childhood trauma, depression and negative symptoms are independently associated with impaired quality of life in schizophrenia. Results from the national FACE-SZ cohort, in Schizophrenia Research, Vol. 170, No. 1, January 2016. doi: 10.1016/j.schres.2016.12.02
Bateson, G.; Jackson, D.; Haley, J.; Weakland, J.: Toward a Theory of Schizophrenia, in Journal of Behavioral Science, Vol. 1, 1956.
Benson, H.: The Relaxation Response, New York: Morrow, 1975.
Berger, M. D., ed.: Beyond the Double Bind: Communication and Family Systems, Theories, and Techniques with Schizophrenics, New York: Bruner/Mazel, 1978.
Bowen, M.: A Family Concept of Schizophrenia, in Jackson, D., ed.: The Etiology of Schizophrenia, London: Basic Books, 1960.
Burgo, J.: Why Do I Do That?: Psychological Defense Mechanisms and the Hidden Ways they Shape our Lives, Chapel Hill, NC: New Rise Press, 2012.
Burrow, T.: The Social Basis of Consciousness, New York: Harcourt, Brace, 1927.
Carlson, N.: Physiology of Behavior, 7th Ed., Boston: Allyn and Bacon, 2001.
Centers for Disease Control and Prevention: The Effects of Childhood Stress Across the Lifespan, Atlanta, GA: CDC, 2008.
Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.
Copeland, W.; Keeler, G.; et al: Traumatic events and posttraumatic stress in childhood, in Archives of General Psychiatry, Vol. 64, 2007.
Courtois, C.: It's Not You: It's What Happened to You: Complex Trauma and Treatment, Dublin, OH: Telemachus Press, 2014.
Cullen, A.; Zunszain, P.; et al: Cortisol awakening response and diurnal cortisol among children at elevated risk for schizophrenia: Relationship to psychosocial stress and cognition, in Psychoneuroendocrinology, Vol. 46, Aug 2014.
Dacey, J.; Travers, J.: Human Development, 4th Ed., Boston: McGraw-Hill, 1999.
Damasio, A.: The Feeling of What Happens: Body and Emotion in the Making of Consciousness, New York: Harcourt, 1999.
Damasio, A.: Self Comes to Mind: Constructing the Conscious Brain, New York: Pantheon, 2010.
DeBellis, M.: Developmental Traumatology: Neurobiological Development in Maltreated Children with PTSD, in Psychiatric Times, Vol. 16, No. 11, 1999.
Dworsky, O., Pargament, K.; et al: Suppressing spiritual struggles: The role of experiential avoidance in mental health, in Journal of Contextual Behavioral Science, Vol. 5, No. 4, 2016.
From here on, I'm just going to list the cited references in the text. The purpose of the references listed above is simply to indicate the volume of material that -- IMO -- supports the assertions in the text above. If a reader wants further references and resources to develop a grad school level paper on this topic, they are welcome to contact me for that.
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