Thursday, January 23, 2020

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...
Dissociation.
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
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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.
Kluft, R.; et al: Childhood Antecedents of Multiple Personality Disorder, Washington DC: American Psychiatric Press, 1985.
Lupien, S., Gaudreau, S., Tchiteya, B., Maheu, F., Sharma, S., Nair, N., et al: Stress-Induced Declarative Memory Impairment in Healthy Elderly Subjects: Relationship to Cortisol Reactivity, in Journal of Clinical Endocrinology & Metabolism, Vol. 82, No. 7, 1997.
Lupien, S.; Evans, A.; et al: Hippocampal Volume is as Variable in Young as in Older Adults: Implications for the Notion of Hippocampal Atrophy in Humans, in Neuroimage, Vol. 34, No. 2, 2007.
Lupien, S.; Maheu, F.; et al: The Effects of Stress and Stress Hormones on Human Cognition: Implications for the Field of Brain and Cognition, in Brain & Cognition, Vol. 65, No. 3, 2007.
Lupien, S.: Brains Under Stress, in Canadian Journal of Psychiatry / Revue Canadienne De Psychiatrie, Vol. 54, No. 1, 2009.
Lupien, S.; McEwen, B.; Gunnar, M.; Heim, C.: Effects of stress throughout the lifespan on the brain, behaviour and cognition, in Nature Reviews - Neurosciences, April 29, 2009.
McEwen, B.; Seeman, T.: Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load, in Annals of the New York Academy of Sciences, Vol. 896, 1999.
McEwen, B: Mood Disorders and Allostatic Load, in Journal of Biological Psychiatry, Vol. 54, 2003.
McEwen, B.; Lasley, E. N.: The End of Stress as We Know It, Washington, DC: The Dana Press, 2003.
Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October 2000.
Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.
Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015.
Porges, S.: The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system, in Cleveland Clinical Medical Journal, No. 76, April 2009.
Porges, S.: The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology), New York: W. W. Norton, 2015.
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Putnam, F.: Dissociation in Children and Adolescents: A Developmental Perspective, New York: The Guilford Press, 1997.
Sapolsky, R.: Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases and Coping, 3rd Ed., New York: Holt, 2004.
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Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.
Van der Hart, O.; Nijenhuis, E.; Steele, K.: The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, New York: W.W. Norton, 2006.
Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.
Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.
Van der Kolk, B.: Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016, in Journal of Child Psychology and Psychiatry, Vol. 57, No. 3, March 2016.
Wolpe, J.: Psychotherapy by Reciprocal Inhibition, Palo Alto, CA: Stanford University Press, 1958.
Wolpe, J.; Wolpe, D.: Life Without Fear: Anxiety and Its Cure, Boston: Houghton Mifflin, 1981, and Oakland, CA: New Harbinger, 1987.

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