Mental health and “coolness”

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Had a few conversaions recsetly about people faking mental illnesses, specifially people faking DID. Now whenever these topics come up the first thing I think is “why would anyone fake this?” and the most common reply is “attention” or “be look cool”. Now ok the attention one I sort of get, but to look cool? really? How exactly is essentially saying “so ye, I was raped and abused as in infant and so my mind sort of split as a defence mechanism, so now I don’t remember large chunks of my life, I get awful headaches, doctors don’t trust me with medication, I can’t hold down a job and I get confused by really simple stuff” cool? Maybe I am just out of the loop and misunderstand the meaning of the word “cool” but to me the fact that a person was ABUSED is not a “cool” thing :/ and pretending that you were abused just so that you have something to say when conersations start to die is also not a “cool” thing.

I don’t know, I just don’t get it… living with this is HELL 90% of the time. The constant noise, the never knowing what day it is, the never being able to plan anything as you’ve no idea if you are going to be functional let alone “you” on any given day, the “waking up” in unknown places and haing to go into a shop to ask “excuse me, thais may sound like an odd question, ut what city is this?”, not to mention the flashbacks, the nightmares, the insomnia, the “flashes” that make nosense, the fact that no therapist will touch you with a barge pole so you are constantly being bumped from one psych to another, etc…

Just some thoughts… Also if anyone I’ve been talking about this with reads this: none of this is a critism or anything like that, it’s just basically me thinking out loud and wanting to get some peoples opinions in order to help me to understand.

Common mis-diagnosis’s and co-mobidies of DID

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On average a multiple will be in the mental health system for 7 years prior to diagnosis and during this time may receive several varying diagnosis’s. They often include:

Temporal lobe epilepsy’

Dissociation is more common in patients with temporal lobe epilepsy than in any other neurologic disorder. The clinician should refer patients with dissociative symptoms for a thorough neurologic workup to rule out the presence of temporal lobe epilepsy or other organic processes. The standard EEG is of little help in distinguishing MPD from temporal lobe epilepsy because a high rate of nonspecific abnormalities has been detected in patients with MPD, most commonly bilateral temporal lobe slowing.

Schizophrenic disorders

The differentiation between dissociation identity disorder and schizophrenia can be made along several lines.

Patients with schizophrenia hear voices emanating from the external world, whereas patients with dissociation identity disorder hear voices originating from within the individual’s own head.

Patients with schizophrenia may experience visual hallucinations, although they are less well formed than those observed with certain other brain disorders. Patients with MPD occasionally experience hypnagogic phenomena.

Poor reality testing is observed with schizophrenia, whereas patients with MPD have essentially intact reality testing.

Tangential or loose associations accompanied by inappropriate affect are commonly observed with schizophrenia. Patients with dissociation identity disorder may have circumstantial association with appropriate affect.

Borderline personality disorder

Borderline personality disorder has been diagnosed in 70% of a sample of 33 patients with dissociative disorder and in 23% of 70 patients with dissociative disorder. Putnam acknowledged that a large number of his cases resembled Briquet syndrome or somatization disorder, but, like other investigators, he proposed that once the diagnostic criteria for MPD are satisfied, MPD should be considered the superordinate diagnosis because working with the alternates can provide a therapeutic device that cannot be used in the unified individual.

Malingering

Malingering is said to be an important differential diagnosis in times when an obvious gain may result from mental health intervention. Malingering is the deliberate and fraudulent production of false and exaggerated symptoms to deceive observers for secondary gain that is recognizable with an understanding of the individual’s circumstances.

Dissociative amnesic disorder

MPD may prove difficult to distinguish from other dissociative amnesic disorders. With other dissociative amnesic disorders, behavior may be complex, but recovery is often complete, recurrences are less common, and the onset of amnesic spells may be intimately related to stressful events or to ingestion or intoxication.

The worst thing about DID

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the worst thing is not the loss of time, not the headaches, nor the feeling of being unreal. The worst thing is not the finding yourself in random places, or covered in random injuries. It’s not the constant chatter in your head, nor the inability to plan ahead as you have no idea if you will even be pressent or not at any given time. It’s not even the flashbacks, the lack of a memory or the way it messes up the way you think and learn making you feel asif you’ve basically become stupid…

nope… the worst thing is that in any given conversation where it is brought up there is about a 60% chance that someone there will claim that it’s not a real disorder, that alters are not real, that essentially you are faking.

If I wanted to fake a disorder (and god only knows why anyone would) then surely I would have picked an easier one to do so than DID???

Freud and dissociative identity disorder ( DID )

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The majority of patients in Josef Breuer and Sigmund Freud’s book Studies on Hysteria (Breuer & Freud, 1895/1983) were described as having been victims of sexual abuse and up until 1895 Freud considered that the majority of his patients were suffering from the aftermath of sexual abuse in childhood.

Freud then rejected this idea. There has been a great deal of speculation regarding this decision. Freud’s biographer, Ernest Jones (Jones, 1953), proposed that given many of the fathers of his patients were part of his own social circle, it would have been difficult for Freud to publicly state that his patients had been sexually abused as children.

to then explain the symptoms of his patients, in the absence of any real trauma, Freud produced a socially acceptable theory that denied the reality of childhood sexual abuse. Once the memories of sexual abuse reported by personalities were rejected by Freud as not being memories of true events, then the interpretation of the nature of these additional, or ‘alter’ personalities had to change.

Whereas others, such as Morton Prince (Prince, 1905/1978), had embraced the idea that there could be parallel rational conscious activity which could be described as “subconscious” or “co-conscious”, Freud rejected this idea and invented his unconscious (Freud, 1915/1995). From this point onward Freud referred only to an unconscious as distinct from a subconscious (Ellenberger, 1970.).

The unconscious of Freud, therefore, was not able to hold accurate memories, assume rational control of the body, or to think as would a rational adult. If the sexual abuse was not seen to be true, then the alter personalities (or the “unconscious” for Freud) must be irrational.

Despite the many great contributions made by Freud, this theory and the acceptance of his theory meant that many victims of sexual abuse were not believed and many patients with multiple personalities (or Dissociative Identity Disorder – DID) were to be misdiagnosed. For most of the twentieth-century the reality of many DID patient’s condition was also rejected as their appearance did not fit accepted theory.

Ritual abuse. What is it? (potentially triggering)

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Many people with DID suffered some form of ritual abuse either in a cult or in some other organisation during childhood. As such I thought it might be a topic I should touch upon in this blog…

A cult is a group of people who share an obsessive devotion to a person or idea. Some cults use violent tactics to recruit, indoctrinate, and keep members. Ritual abuse is defined as the emotionally, physically, and sexually abusive acts preformed by violent cults, many of these cults do not openly express their beliefs and practices, often living separately from the general public, isolating and alienating their members from outside influences.
Some victims of ritual abuse are children abused outside of the home by non-family members, often in public settings such as day care centres and Sunday schools. Other victims are children and teenagers who are forced by their parents, or other family members, to witness and participate in violent rituals. Adult ritual abuse victims often include these grown children who were forced from childhood to be members of the group. Other adult and teenage victims are people who unwittingly joined and organisation or social group that slowly manipulated and blackmailed them into becoming permanent members of the group. All cases of ritual abuse, no matter what age of the victim, involve intense physical and emotional trauma.
Violent cults may sacrifice humans and animals as part of religious rituals. They use torture to silence victims and other unwilling participants. Ritual abuse victims say that they are degraded and humiliated and are often forced to torture, kill, and sexually violate animals or other helpless victims. The purpose of the ritual abuse is usually indoctrination. The cults intend to destroy these victims free will by understanding their sense of safety in the world and by forcing them to hurt others.
In recent years a number of people have been convicted on sexual abuse charges in cases where the victims had reported elements of ritual abuse. These survivors (mainly children) described being raped by groups of adults who were wearing costumes or masks and said that they were forced to witness religious-type rituals in which animals and humans were tortured or killed. In one case, in 1989, the defence introduced in court photographs of the children being abused by the defendants. In another case, the police found tunnels etched with crosses and pentagrams along with stone alters and candles in a cemetery where abuse had been reported. The defendants in this case pleaded guilty to charges of incest, child cruelty, and indecent assault.
There are many myths concerning the parents and children who report ritual abuse. Some people suggest that the whole idea of ritual abuse is nothing more than “mass hysteria”. They say that the parents of these children who report ritual abuse are often just on a “witch hunt”. These sceptics claim that the parents fear Satanists and used their knowledge of the Black Mass (a historically well-known sexualised ritual in which animals and humans are sacrificed) to brainwash their children into saying that they have been ritually abused by Satanists.

The practice of ritual abuse is a difficult topic for many to confront or even comprehend. The children are tortured and brainwashed in order to assure compliance and loyalty to the group. The memories of ritual abuse survivors are often so graphic and perverse that some people question whether any of the stories could be true. Yet ritual abuse survivors experience overwhelming pain and trauma related symptoms as they remember the abuse: flashbacks; body memories; dissociation; anxiety; fear; etc. all of which are also seen in torture victims from wartime incidents, prisoners of war and war crimes.

Ritual abuse is a real, systematic and brutal practice happening today

what is DDNOS?

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disorders in which the predominant feature is a dissociative symptom (i.e., a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment) that does not meet the criteria for any specific Dissociative Disorder. Examples include

1. Clinical presentations similar to Dissociative Identity Disorder that fail to meet full criteria for this disorder. Examples include presentations in which a) there are not two or more distinct personality states, or b) amnesia for important personal information does not occur.

2. Derealization unaccompanied by depersonalization in adults.

3. States of dissociation that occur in individuals who have been subjected to periods of prolonged and intense coercive persuasion (e.g., brainwashing, thought reform, or indoctrination while captive).

4. Dissociative trance disorder: single or episodic disturbances in the state of consciousness, identity, or memory that are indigenous to particular locations and cultures. Dissociative trance involves narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one’s control. Possession trance involves replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity, or other person, and associated with stereotyped “involuntary” movements or amnesia and is perhaps the most common Dissociative Disorder in Asia. Examples include amok (Indonesia), bebainan (Indonesia), latah (Malaysia), pibloktoq (Arctic), ataque de nervios (Latin America), and possession (India). The dissociative or trance disorder is not a normal part of a broadly accepted collective cultural or religious practice. (See Appendix B in DSM-IV-TR for suggested research criteria.)

5. Loss of consciousness, stupor, or coma not attributable to a general medical condition.

6. Ganser syndrome: the giving of approximate answers to questions(e.g., “2 plus 2 equals 5”) when not associated with Dissociative Amnesia or Dissociative Fugue

From the DSM-IV

Dissociative Disorder Not Otherwise Specified (DDNOS) is an inclusive category for classifying dissociative syndromes that do not meet the full criteria of any of the other dissociative disorders. A person diagnosed with Dissociative Disorder Not Otherwise Specified (DDNOS) typically displays characteristics very similar to some of the other discussed dissociative disorders, but not severe enough to receive their diagnoses. DDNOS includes variants of Dissociative Identity Disorder in which personality “states” may take over consciousness and behavior but are not sufficiently distinct, varients where alters are present but either do not take over consciousness or only ever do so in a co-consiouss mannor with the host, or variants of Dissociative identity disorder in which there is no amnesia for personal information. Other forms of DDNOS include possession and trance states, Ganser’s syndrome, derealization unaccompanied by depersonalization, dissociated states in people who have undergone intense coercive persuasion (e.g., brainwashing, kidnapping), and loss of consciousness not attributed to a medical condition.

DDNOS occurs primarily in men (80%) and is currently regarded as a dissociative means of withdrawal from a traumatic or stressful circumstance. It is characterized by absurd or approximate responses to interview dialogue, a dazed or clouded level of consciousness, somatic conversion symptoms (eg, pseudoparalysis), hallucinations, and, frequently, anterograde amnesia regarding the episode.

Trauma, Memory and the Brain

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Trauma changes our brains on a fundamental level, the psychologically traumatised brain causes inscrutable eccentricities which can (and do) cause it to overreact – or misreact – to stimulus and the realities of life. These neurological “misreactions” become established in part due to the effect that trauma has on the release of certain stress-responsive hormones, such as norepinephrine, along with the effect upon various areas of the brain involved in memory – particularly the amygdale and the hippocampus.

The amygdale is the part of the brain responsible for communicating the emotional importance and evaluation, via the thalamus, of sensory information to the hippocampus. In accordance with the amygdales evaluation the hippocampus will activate to a greater or lesser degree, and functions to organise this information and integrate it with previous similar sensory events. Under a normal range of situations and conditions this system works well and effectively to consolidate memories according to their emotional priority and content. However, at the extreme upper end of this hormonal activation, as with traumatic situations, a breakdown occurs. Overwhelming emotional significance registered by the amygdale actually leads to a decrease in hippocampal activation, this results in some of the traumatic input not being organised properly, not being stored as a unified whole, and not being integrated with other memories. This results in isolated sensory images and bodily sensations that are not localised in time or even in situation, nor integrated with other events. In effect these fragments of memory float about in the mind, ready to reappear at any moment.

To make matters even more complex, trauma may temporarily such down Brocas area, the region of the brain which translates experience into language, the means that we more often use to relate our experience and feelings to others and even to ourselves.

Regular memories are formed and are subject to meaningful modification, they can be retrieved when needed and can be conveyed to others through language and expression. In contrast, traumatic memories include chaotic fragments, which are sealed off from modification or modulation. Such memory fragments are wordless, placeless, and eternal. Long after the trauma has receded into the past the brains record of them may remain a fractured mass of isolated and confused emotion, images and sensations which can ring through the person like an alarm at any moment.

These sensations and feelings may not be labelled as part as belonging to memories from long ago, in fact they may not be labelled at all, as they may have been formed without language. They merely are, they come forward to take over the body giving no explanation, no narrative, no place or time, they are free-form and ineffable.

The traumatised brain has, effectively, a broken warning device in its limbic system. A bit like an old fuse box where the fuses tend to melt for no reason, reacting to an emergency when there is none.

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