DID: The ACE Study

A new and profoundly important paradigm for understanding overwhelming emotional pain has emerged over the last few years, with the potential to change the way we conceptualize human suffering across the whole spectrum of mental health difficulties. It is an evidence-based synthesis of findings from trauma studies, attachment theory and neuroscience, which offers new hope for recovery. It also presents a powerful challenge to the biomedical model of psychiatry in that it is based on scientific evidence that substantiates and attests to what many individuals with first-hand experience of mental health problems have always known — that the bad things that happen to you can drive you mad.

A New Paradigm for Understanding Severe Mental Distress

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study revolutionizes the way we think about the body and mind.

The ACE Study settles the question of whether we are shaped by genetics or the environment: we are shaped by both.  Nature Versus Nurture: Where We Are in 2017

The ACE study proves that child abuse causes enduring neurological damage that can affect a person’s health and quality of life throughout the lifespan.

The body of a frightened child floods with hormones and prepares to fight, run, or die.

In less than an instant, the amygdala sends an alarm to the hippocampus, which tells the adrenal glands to release adrenaline.

Adrenaline increases heart rate and breathing, oxygen goes to the muscles and brain, which increases hearing and sharpens eyesight.

Adrenaline wears off and cortisol takes over; cortisol is a longer acting stress hormone designed keep the body alert.

Illustration from Harvard Medical School
Understanding The Stress Response, Harvard Medical School

If a child fears for his life, he may freeze and go numb.

For a prey animal in the wild, numbing is a blessing.

For abuse survivors, it means gaps in memory

During the fight, flight or freeze response the brain inhibits the prefrontal cortex.

The prefrontal cortex is responsible for retrieving memories. 

The memory is there but the brain can’t retrieve it.

A chronically abused child lives in fear which damages the structure and
functioning of a the brain. Harvard University

The toll of chronic fear on physical health includes:

  • Immune system dysfunction
  • Endocrine system dysfunction
  • Autonomic nervous system alterations
  • Sleep/wake cycle disruption
  • Eating disorders

The toll of chronic fear on emotional health includes

The Pyramid of effects of abuse on the lifecycle
Abuse Affects the Life-cycle

It takes nine months for the fetus to become a baby that can survive beyond
the womb.

Between birth and the age of two, we have no words; for the first ten years of our  lives, we are helplessly dependent on our parents and communities for our physical and psychological well being.

Child abuse is a betrayal of unconditional trust.

You don’t just ‘get over it’.

People with dissociative disorders report the highest occurrence of abuse and childhood neglect among all psychiatric disorders. This suggests dissociation is the ultimate reaction to significant trauma. Links between Trauma, PTSD, and Dissociative Disorders

A 2018 review found changes in the structure of the brain in people with DID. These changes are complex and  include decreased limbic activity, increased frontal lobe activity, and changes in communication between these two regions.

An illustration depicting a little boy glaring at his drunken mother, passed out on the floor
Child Abuse Lasts a Lifetime

DID is something done to you, like the rapes and daily beatings.

One must accept what happened and make peace with it.

Acceptance means seeing what might have been and grieving the loss.

Acceptance means letting go of the idea that I brought it on myself, that I am shameful and not good enough, and it means not letting the dismissive arrogance I sometimes encounter gnaw at my soul.

Acceptance means holding abusers accountable for the messes they make.

Acceptance means believing the abuse will end.

I am not completely there.

How do I accept the evil of child abuse when the abuse never ends?

For now, broken but better is the best I can do.

DID: When Everything is a Trigger

Get Your ACE Score

(C)Rob Goldstein 2019

‘Child Abuse Lasts Forever” (C) Rob Goldstein 2019

All other graphics were found online and are used here for educational purposes.

Dissociative Identity Disorder: A Week in the Valley of Shadows

This article is also published on Surviving My Past

Repulsion and Trauma

First posted 2/24/2016-Revised October 2018

Decompensation: Psychology, a loss of ability to keep up normal psychological defenses, sometimes resulting in depression, anxiety, or delusions. Dictionary.com

A favorite literary description of a psychiatric decompensation is in the 1933 short story, Miss Lonely Hearts by Nathanael West.

Miss Lonelyhearts is an advice columnist who slowly loses his mind from the suffering he reads. This passage is toward the close of the story:

“After a long night and morning, towards noon, Miss Lonelyhearts welcomed the arrival of fever. It promised heat and mentally unmotivated violence. The promise was soon fulfilled; the rock became a furnace.

He fastened his eyes on the Christ that hung on the wall opposite his bed.

As he stared at it, it became a bright fly, spinning with quick grace on a background of blood velvet sprinkled with tiny nerve stars.

Everything else in the room was dead–chairs, table, pencils, clothes, books. He thought of this black world of things as a fish. And he was right, for it suddenly rose to the bright bait on the wall. It rose with a splash of music and he saw its shining silver belly.

Christ is life and light.

“Christ! Christ!” This shout echoed through the innermost cells of his body.

He moved his head to a cooler spot on the pillow and the vein in his forehead became less swollen. He felt clean and fresh. His heart was a rose and in his skull another rose bloomed.

The room was full of grace. A sweet, clean grace, not washed clean, but clean as the inner sides of the inner petals of a newly forced rosebud.

Delight was also in the room. It was like a gentle wind, and his nerves rippled under it like small blue flowers in a pasture.

He was conscious of two rhythms that were slowly becoming one. When they became one, his identification with God was complete. His heart was the one heart, the heart of God. And his brain was likewise God’s.

God said, “Will you accept it, now?

And he replied, “I accept, I accept.”

He immediately began to plan a new life and his future conduct as Miss Lonelyhearts.

He submitted drafts of his column to God and God approved them. God approved his every thought.”

Miss Lonleyhearts by Nathanael West

My episodes are less dramatic, but no less frightening.

It’s frightening to lose the ability to sleep and concentrate.

It’s frightening to lose the ability to distinguish between reality and fantasy.

It’s frightening to wake-up tired and hopeless, thinking that it never gets better.

Decompensation is not necessarily a bad thing if it is part of the therapeutic process.

“…anxiety and panic symptoms are almost invariably “feeling flashbacks” triggered by a relatively benign event in the here-and-now, such as being alone in a room at twilight.” The Work of Stabilization In Trauma Treatment

The basic skills a trauma patient needs are these:

  • Grounding and centering techniques

  • Coping strategies for dealing with suicidal and self-abusive impulses

  • Contracting for safety with themselves and others

  • Learn to anticipate stressful or triggering events

  • Learn  to calm the body and mind

  • Learn to distinguish past from present reality and how to stay “in the present”

The Work of Stabilization In Trauma Treatment

If trauma symptoms include dissociative alters, the alters must know about and communicate with each other.

This is not easy, and recent attempts to communicate broke through memory barriers and lead to this most recent period of decomposition and regression.

Regression is an unconscious defensive process by which the patient reverts to a previous level of functioning, usually to a certain infantile or juvenile stage.”

One of the best portrayals of regressive decomposition is in the film Repulsion by Roman Polanski.

Catherine Deneuve portrays Carol, a sexually conflicted young Belgian woman.

Carol lives in London with her older sister. .

The film suggests that either Carol’s father or some other man sexually abused her as a child.

I first saw Repulsion when I was in my 20’s.

Watching it again this week during an episode of decompesation was a revelation.

Polanski shows us Carol’s anguish and her rapid decline with brilliant accuracy; when her Sister leaves for a week-long holiday we enter the territory of Carol’s mind.


“…the most common effect of sexual abuse is Post Traumatic Stress Disorder. Symptoms can extend far into adulthood and can include withdrawn behavior, reenactment of the traumatic event, avoidance of circumstances that remind one of the event, and physiological hyper-reactivity.” Psychology Today

We see these symptoms when Carol’s boyfriend tries to kiss her. She reacts with disgust, runs into her apartment in a panic and obsessively brushes her teeth.

Among the trauma symptoms depicted in Repulsion is loss of time
which begins almost as soon as Carol is alone.

We see her increased sense of disconnection from her environment.

Later, as her paranoia and hyper-vigilance escalates Carol re-lives her assault.

By the end of the week Carol is lost to herself and the film closes with a snapshot of Carol as a child, gazing angrily at her Father.

Kim Morgan of the Huffington Post calls Repulsion one of the most frightening studies of madness ever filmed.

My emotions were everywhere this week.

My decompensation was not as dramatic as Carol’s; it certainly doesn’t
have the narrative edge.

It involved lost time and laying in bed watching Repulsion followed by
non-stop episodes MST3K.

Thank God for that show and for the part of me that comes out to watch it.

The most difficult thing about surviving is surviving.

If you have a counselor or psychotherapist let that person know what is happening if you think you entering a crisis.

You can also call the National Suicide Prevention Hotline: 1-800-273-8255

Remind yourself that memories are just memories; it is more normal to remember a trauma than forget it.

When you have a panic attack stop and pace your breathing.

If you start to relive the past remind yourself of the present.

When you can’t sleep don’t lie in bed thinking or worrying; get up
and enjoy something soothing or pleasant.

If you have difficulty concentrating, give yourself time to focus on what
you need to do.

People with PTSD and CPTSD also have depressive episodes.

If the acuity lasts for more than a few days seek help.

If you think you are a danger to yourself or others call 911 or go to an emergency room.

Rob Goldstein 2016 revised October 2018

Video clips and still shots are from the film Repulsion and used here for educational purposes.

Disclaimer: I am not a mental health professional. I write about my personal experience. What works for me may not work for you. If you think you are having a psychiatric episode please see a professional.

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Lies and Confabulations

I wrote this post in June of 2015 when Rachel Dolezal was in the news.

Rachel Dolezal is the White woman claims that she’s African-American.

When I read Rachel Dolezal’s story I wondered if she dissociates.

If Rachel Dolezal believes she’s African-American she’s not lying.

When is a lie not a lie?

When it is a confabulation.

Confabulation is defined as the spontaneous production of false memories: either memories for events that never occurred, or memories of real events that are displaced in space or time. These memories may be elaborate and detailed. Some may be obviously bizarre, as a memory of a ride in an alien spaceship; others are quite mundane, as a memory of having eggs for breakfast, so that only a close family member can confirm that the memory is in fact false.

Confabulation is not lying and people who confabulate are not deliberately trying to mislead other people. In fact, patients are generally quite unaware that their memories are inaccurate, and they may argue strenuously that they are telling the truth. Neither should confabulation be confused with false memory syndrome, the phenomenon whereby otherwise normal people suddenly “remember” supposedly repressed incidents of childhood abuse or other trauma. Confabulation is a clinical syndrome resulting from injury to the brain.  Memory Loss Online

The primary function of the brain is the survival of the organism.

To that end, the brain will use all of its resources.

I did a Google search for Rachel Dolezal and got pages of outraged commentary along with video of her recent interview with Matt Lauer.

This was the second hit: The Nightly Show Goes in on “Crazypants White Lady” Rachel Dolezal.

Crazypants is a descriptive word that means weird or insane, not insane in the sense that it means cool as in crazy cool or that’s totally insane! Crazypants means insane as in a mental illness.  The Urban Dictionary

Crazypants is an N-Word for people with mental illness

This was the third hit: Rachel Dolezal’s parents: We taught our kids ‘always be honest’

Dolezal’s parents on TODAY denied charges they were abusive parents, calling the claims a “dramatic change” to what they knew of Rachel growing up, who always wanted to introduce them to her friends.

“We still hold out hope that we’ll be able to be reconciled someday,” Lawrence Dolezal said.

His wife added, “And we hope that Rachel will get the help that she needs to deal with her identity issues. Of course we love her, and we hope that she will come to a place where she knows and believes and speaks the truth.”

They say they were not abusive and they hope that she gets help with her identity.

How curious.

I decided to experiment and Googled Rachel Dolezal Abuse.

The first hit: Rachel Dolezal’s brother, author Joshua Dolezal, faces trial for alleged sexual abuse of a black child

Within that story is this nugget: Hours after their daughter told NBC’s “Today” show that she identifies as black, Rachel Dolezal’s white parents went on Fox News to dispute several elements of her interview. For starters, Ruthanne Dolezal told the cable news channel that her 37-year-old daughter’s claim that she self-identified as black starting at a very young age is a “fabrication.”

Rachel Dolezal told “Today’s” Matt Lauer that as a young child, she “was drawing self-portraits with the brown crayon instead of the peach crayon and the black curly hair. That was how I was portraying myself.”

The 37-year-old said she began to identify with the black experience at age five.

Her parents went on Fox News to accuse their daughter of fabricating the way she remembers her childhood drawings.

Did you show everything you drew as a child to your parents?

image of a child with a caption that reads there was no one to tell and no place to hide
There is no safety for children with abusive parents-Image found on Pinterest

This is where the story becomes painfully familiar:

According to reports, Rachel Dolezal’s biological brother raped an adopted sibling:

“In 2013, Joshua was charged with four felony counts of sex abuse of a minor. The incidents, according to an affidavit obtained by the Post, happened at his parents’ home in Colorado “in 2001 or 2002.” The victim “was 6 or 7 years old,” and Joshua Dolezal was “19 years older.” Dolezal allegedly made the victim perform oral sex on him twice and he performed oral sex on the victim “7 or 8” times, allegedly telling the victim “Don’t tell anyone or I’ll hurt you.” The affidavit also lists another allegation of abuse in 1991 of another victim that had a racial element.”

According to a police report obtained by People, the alleged victim told Ruthanne that Josh was abusing her, but Ruthanne “did not believe her and told her to stop telling lies.”

Joshua is an English professor at Central College in Pella, Iowa.

The same article describes the family from Joshua Dolezal’s autobiography, Down from the Mountaintop: from Belief to Belonging:

“Joshua Dolezal watches his mother praying while listening to his father read an entire chapter of the Bible before dinner, “as is customary.”

“Down from the Mountaintop chronicles a quest for belonging. Raised in northwestern Montana by Pentecostal homesteaders whose twenty-year experiment in subsistence living was closely tied to their faith, Joshua Dolezal experienced a childhood marked equally by his parents’ quest for spiritual transcendence and the surrounding Rocky Mountain landscape.” WorldCat

When I read Joshua Dolezal’s author comments, I felt that something terrible must have happened to him as well:

“From my earliest school days, when I wore handmade clothes to kindergarten and carried a fringed leather lunch satchel, I knew that my childhood experience in the mountains of Montana was different from everyone else’s. I write essays as experiments in explanation, efforts to make what was and is foreign in my life comprehensible, maybe even familiar, to a reader. In Down from the Mountaintop, like many memoirists, I try to make sense of my past.” Iowa Center for the Book

“What was and is foreign in my life.”

That’s an odd choice of words.

In an interview, Rachel Dolezal’s Mother states that the sibling that Joshua Dolezal is accused of abusing suffers from Reactive Attachment Disorder:

“… A condition in which a child can’t bond with a parent or caregiver, and “seeks to cause trouble in the family.”

She goes on to say she never left the child alone with her son.

“The aligning with Rachel on this is a very bad combination,” she says. “Our son wasn’t even home a lot of the time it was alleged it was happening,” she says, “and I was a stay-at-home mother and very attentive to the kids because of her disorder. I never left her at home with our son or anything like that.” People.

Why would Ruthanne Dolezal be that specific?

Why insinuate that the child is “disordered” and “out to make trouble”?

She says she was a stay at home Mom and attentive to all the kids because of this one child’s “disorder.”

She never left the child at home with her Son.  Why?

Why does she describe the child as aligning with Rachel?

It all sounds so damned familiar because these were the kind of lies told
in my family.

The strategies survivors use to survive seem normal to us; even the act of becoming a different race is normal and possible for an abused child of five with an active imagination.

“Alters within the same patient may be of different ages, genders, races, and even species, including lobsters, ducks, and gorillas. There have even been reported alters of unicorns, Mr. Spock of Star Trek, God, the bride of Satan, and Madonna. Moreover, some practitioner’s claim that alters can be identified by distinct characteristics, including distinct handwriting, voice patterns, eyeglass prescriptions, and allergies. Proponents of the idea of multiple personalities have also performed controlled studies of biological differences among alters, revealing that they may differ in respiration rate, brain-wave patterns and skin conductance, the last being an accepted measure of arousal.” The Scientific American

If I told you my name is Mateo and I am a Black, would you call me a lying crazypants?

Probably.

It sounds to me as if Rachel and Josh Dolezal are trying to make sense of a past that they can’t fully remember, understand, or escape.

Rob Goldstein 2015-2017

 

 

 

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