Safe Support for Survivors

Since joining the blogging community on this topic, I have made some very nice friends in the survivor community. Through those friends, I was made aware of several online support groups for those with DID. A link list is provided to the right for those who wish to explore them.

Safety is a priority for all three groups. I know the administrators of two of the groups (an online relationship). They are healing, sharing, and providing the resource of others providing support to all who would like a safe place to go.

While I have not yet participated in iSurvive, it is highly recommended by several as a place to share and garner support during rough times. They have a stringent screening process before accepting new members which I highly commend.

Hidden Shadows maintains a closeknit group. It is a well monitored site by a compassionate and caring survivor.

Ivory Gardens feels like an oasis of safety and support to enter. Much effort is made to keep it safe. A special area is set aside for littles and there are features to promote discussion such a topic of the week and even fun participation for the bigs.

Understand that in choosing a support group, there is always a chance of someone joining under false pretenses to make life difficult for those trying to heal. That is one element that is closely monitored. Unfortunately, the bad guys holding onto their goal of not allowing survivors to heal, do try to wreak havoc. They target respected support groups and launch propaganda campaigns to the members to make them fearful to continue.

Just be aware that this happens. Membership has to be "cleaned out" occasionally because of some people out there to undermine places of healing. If your moderator has been fair and supportive and keeping you safe, use your best judgment if you begin to receive negative information about the moderator or support group.

In the same vein, if any support group I recommend appears not to be maintaining the safety needed for it's members, I will remove the name from the list. My decision to support these three groups is based on my own knowledge and has not been influenced by anyone else.

I believe such groups can be extremely helpful in healing, especially when a therapist is away at a conference, on vacation, or otherwise absent. And even more importantly, when a survivor is between therapists. I'm so pleased that there are a number of safe choices since I was last in this community about 10 years ago.

Roadblocks to healing

Let me count the ways society prevents survivors from seeking and/or getting qualified help.

The well-fed propaganda machine that tells the world that delayed memories can't be trusted and those who claim to have such absurd memories are liars or crazy. Rather than focus more on the group promoting the propaganda, I'm providing a website that can guide you through the ways the False Memory Syndrome Foundation misleads.

Wikopedia provides this as part of their definition: The FMSF coined the term false memory syndrome to describe their theory that some adults who belatedly remember instances of sexual abuse from their childhood may be mistaken about the accuracy of their memory. The term does not have wide scientific use. From this, the Foundation hypothesized that the so-called false memories may have been the result of recovered memory therapy, another term coined by the FSMF in the early 1990s.

When memories first begin to surface, survivors are inclined to jump on the internet and see what's going on. Don't we all do that for symptoms of diseases? When I did this for myself, I kept running into false memory information and how some therapists did not believe memories surfacing at a later age. Add to that information that some people trained to be therapists have another allegiance--to report people who are healing to organized pedophilia so actions can be taken to attempt to bring the healing individual "back into the fold". I was terrified to seek help, which I have mentioned before. Thankfully my fear subsided within two years to seek a qualified therapist.

Many resources that were available to those with DID ten years ago are no longer available. The FMSF has taken it's toll. Highly respected experts have been successfully sued and many facilities to help those with DID (beyond what an outpatient therapist could provide) have been closed. I'm sure there is a statistic somewhere, but the number of survivors who actually sue their abusers is quite low. Ethical therapists working with survivors have the goal of healing--not preparing a client for legal action. Yet that is the focus of the propaganda machine.

Another roadblock to healing is the diagnosis. Why weren't there more with DID prior to the "surge" in the 70s and 80s? Mainly because of lack of training to diagnose as well as misdiagnosis of schizophrenia. Hearing voices was schizophrenia and the poor survivor was placed on very high doses of medication that impeded healing. Research is available on this misdiagnosis if you care to research. The latest new diagnosis for DID is Bipolar Disorder. It definitely can appear that a survivor is bipolar because they embody the extreme of every possible emotion. What appears as bipolar may be switching. In addition, there is a higher reimbursement from insurance companies for a diagnosis of bipolar versus DID. An easy to administer screening for level of dissociation is available but not widely used among the greater medical/psychological community.

In the same light, a diagnosis of DID warrants fewer sessions per year typically by insurance over a diagnosis of major depression. Healing from DID initially may require outpatient visits 2-3 times a week and possible hospitalization for survivors who require more than outpatient care. Nationally, there is a lack of education for hospital staff, including psychologists and psychiatrists, who acknowledge or are aware of DID. Because of the reduction of facilities nationally to less than five, that is rarely an option. Medications have limited impact on DID. Other than anxiety and depression, medication doesn't help. Some very small dosages of some potent antipsychotic medications can help stabilize someone with frequent switching, but too few psychiatrists are knowledgeable in such information.

Another Catch 22 to having been abused as a young child to the point of DID, is survivors are as likely as not to have a past history of hospitalizations, emotional turmoil, erratic behavior, and long-term therapy, all of which create a "witness lacking credibility". The pedophiles win no matter what. By virtue of the abuse, they create a human being whose testimony is likely to be dismissed by the U.S. judicial system.

While a war wages on memories of survivors (which only serves to invalidate a survivor's healing), a war has already successfully been waged in the insurance realm. Trying to gain approval for a survivor to gain appropriate care for DID is a nightmare, to say the least.

This is how society treats those children who were horrifically and sadistically abused by sophisticated pedophiles and who managed to survive through DID. How can this be? What is that saying about when good people do nothing? If you didn't know before, and you are a good person, please spread the word. Speaking out--taking this out of the realm of secrecy--is a good first goal.

Prevalence of DID & limited resources to heal

Most texts cite the probability of DID as 1 in 100. In grad school I was taught, "It is highly unlikely you will ever see a case of DID; and if you do, you'll want to transfer the client to another therapist who has special training." Let's look at the facts.

Childabuse.com
Sexual abuse most commonly occurs by an individual known by the victim, parent or other family member (intrafamilial). Rarely is the abuser a stranger. Children who become brave enough to overcome the threats and coercion to remain silent may decide to recant accusations of abuse due to fear of retaliation by the perpetrator or other family members. They may also recant out of fear of losing contact with the perpetrator who is commonly a family member or close friend tied to the family by various social means. (The double bind of "I love you"/"I hate you.")

Incest victims are mostly unreported so are not included in the statistic for reported abuse. Of reported cases:

33% of sexual abuse victims are under age 6
33% are 6-12 years old
33% are 12-18 years old.

RAINN Organization* (Excellent website/resource)
In 1995, local child protection service agencies identified 126,000 children who were victims of either substantiated or indicated sexual abuse.

• Of these, 75% were girls.
• Nearly 30% of child victims were between the age of 4 and 7.

Survivors' Healing Center
Data from 2002 National Child Abuse and Neglect Data System (NCANDS) indicates that approximately 4.6 million children were reported to child protective service agencies as purported victims of child maltreatment. Of that number over 88,000 children were documented as sexually abused.

At the community level, epidemiology studies of adults have found that 15 to 33% of females and 13 to 16% of males were sexually abused in childhood.

Different studies use different methodology for their statistics. The statistic found to be most on target in the community of therapists who treat survivors of sexual abuse, is 1 in 4 women are victims of sexual assault. Even for adults, rape is more often someone known to the victim.

The entirety of incest victims will always be unknown because of the secrecy factor. A statistic cited in this blog's second post is:
Some estimates show 20 million Americans have been victimized by parent incest as children. (Jeffrey Turner, 1996). As cited at the website for The National Center for Victims of Crime.

radKIDS.org
...it is estimated there is one pedophile for every square mile in our country, everywhere from big cities to small rural communities.

Given the enormity of the prevalence of incest survivors and abuse statistics for those under age 12, it is more probable that DID exists in closer to 1 out of every 10-20 incest survivors. In populations such as those seeking counseling through YWCAs and other survivor centers, the statistics are prone to be higher for a therapist to have someone present with DID.

While many therapists claim they have never seen a case of DID, it is more likely the therapist is not trained to identify symptoms and therefore "does not see". In addition, because of lack of training, even if someone did see signs of dissociation, the treating individual might be inclined to treat the person as if dissociation were not present. For those therapists who recommend the patient see someone who does treat dissociation, there are insufficient numbers of therapists in many areas of the country to treat the number of survivors.

Kudos to schools open to education to identify dissociation in children, which is relatively easy to spot in the classroom. Again, however, the societal problem is lack of qualified therapists to treat the child. Part of this unwillingness of therapists to be trained to assess and treat dissociation are the efforts of the media and groups such as the FMSF who have targeted experts in the field for lawsuits and shattered their lives and careers.

On the positive side, excellent training is available through organizations such as ISSTD. Sometimes therapists who first encounter DID are willing to learn as they go. A therapist willing to learn on behalf of the client is how many enter the field of dissociation.

For survivors unsure about whether they might be dissociative, Marlene Steinberg's book, Stranger in the Mirror, has an excellent section of self evaluations. It's a good safe start, although admittedly disarming if you score in the range of likely dissociation. Remember that symptoms may not mean dissociation or DID for you. Symptoms may go with another issue. Don't make any immediate assumptions about yourself until you are able to speak with a qualified therapist.

Falling apart is beginning to heal

Often the individual realizing they are not alone internally says it feels as if she is being sucked into a black hole or falling into an endless pit. The good news is that DID is highly treatable.

Regardless of age, when someone with DID begins to become aware of their dissociation, the typical response is fear and confusion. Noticing the gaps in time; having friends tell you that you behaved "totally out of character" in a recent situation; people claiming they know you from a party or business function and having no memory of the event. The most frightening, in my opinion, are fugue states. I had clients who routinely found themselves in their car miles from home in an unidentified parking lot. Or "someone" went shopping and the person has no memory of the drive or any part of the shopping spree. It's crazy making stuff.

Then what happens? Hopefully the person will seek a therapist experienced in treating DID. That is not so easy. Far too few doctors and mental health professionals acknowledge DID, possibly because it's too complicated and time-consuming to understand, let alone treat. Add to that the propaganda that multiples are fakers and therapists worldwide implant similar memories of childhood abuse into their clients. I would ask, "to what end?" WHY would an ethical therapist even want to implant a memory? If the client is there, she already has issues. I wish someone would answer that question.

If you are a survivor seeking a therapist, a good resource is the ISST-D website where you can look up a therapist by state. Another strategy is to call a number of therapists in your area and ask if they can refer you to someone who treats dissociation. The therapist with the most recommendations is a good start.

Can you imagine...

You are at work in a meeting giving a presentation to your company. Let your mind absorb how you speak, your mannerisms, your responses to others, what it feels like to be in that situation.

Suddenly a secretary rushes in saying your child or other loved one has just been in a serious accident and the hospital is on the phone. How do you respond? Can you feel your pace change? Your voice? Your emotions? Allow yourself to feel that transition from in-control worker to frantic parent, sibling, or friend.

You are in the hospital with your loved one and she is okay but badly hurt. You are speaking to her at her bedside. Feel that transition...in your voice, in your pace, in your emotions.

Internal parts all represent an aspect of yourself, which is why I like the term self states. For someone with DID, all of the above happens, except there is no memory from worker, to frightened adult, to caring mother.

Maybe as you were running out of the conference room at work your boss said "Take as much time as you need. But at least take the rest of the week off." That would have been heard by frantic you rather than work you. You might call later that day or the next morning asking for time off. Your boss will write that off as you were too emotional to hear at the time.

The next time you visit the hospital, worker you is "in charge" because you just spoke to a co-worker on the phone. A hospital employee that you know by name in the "mom state" greets you by your name but you have no knowledge of that person's identity.

People with DID have constant inconsistencies but pretend. They have an internal sense of "somehow I just got here and have to figure out what's going on". That's been their life experience--missing gaps. "Oh right! How could I have forgotten? My mind was focused on something else. Sorry."

Most can't imagine what it's like constantly having memory gaps but for some with DID, it's invisible. The time gaps are dissociated too. Gee, that last four hours sure went by fast. The person may have begun reading a book and ended four hours later reading the book, but another part could have cooked dinner, done the laundry, and vacuumed. That person will not recall having done the chores but will figure she must have done it yesterday and forgot...or something along those lines. And the lack of movement forward in reading will be "I must have fallen asleep."

Life is an unknown puzzle. Each self state is unknown to the others.

Lets talk parts

Any woman might have the roles of mother, daughter, sister, manager or employee, soccer mom, and wife. A man might be policeman, baseball coach, father, son, brother, husband. Don't each of us adapt our personalities in some way depending on who we are at the moment? A man is going to act very differently at work than he is with friends in a bar. And different when he goes home to his wife. These are generally subtle shifts with some crossover for each role we have in life. And of course we remember ourselves in each role. Most of us also can relate to releasing our inner child when we are having fun. In this respect, all of us have parts. We are multiples without amnesia.

When there is a dissociative split to compartmentalize the trauma of a child being hurt by someone who loves them--and the abuse continues--so does the dissociative split. For children with DID (remember this is decided usually by age 6), the personality develops as fragmented. Many roles in the child's life become compartmentalized by amnesia, meaning the child (and later the adult) does not know of this splitting, nor the teenager, nor the adult. Some children may begin to heal when an abuser moves out of the home or is arrested. Safety is a factor for healing.

People with DID spend three to four decades of their lives (on average) before realizing they are dissociative. I can attest to this statistic since most of my clients with DID were between 35 and 45 with some younger and a few older. The survivor art shown at left is what it feels like when someone becomes aware she has DID. For me personally, as a therapist, and in witnessing survivor art and hearing other survivors' stories, this depiction "hits home". Anything leaking through the amnesia is terrifying to feel. It's not uncommon for the person to feel crazy. It doesn't help that society reinforces that message!

Two Worlds - One Face

One split might be dissociative or repressed. The definition of DID is reserved for two or more distinct identities. A child (especially an older child who no longer has access to the gift of dissociation) may repress memories of abuse. While there are varying definitions, I honor the definition that repression is the mind "storing" memories subconsciously as opposed to having an element of amnesia. It is not unknown memory, it is forgotten memory (stored in the subconscious). In my experience, when a repressed memory is uncovered, the client spontaneously remembers the event. Both repression and dissociation involve memories being drawn into the subconscious realm. And both usually result in strong feelings crossing over into consciousness to which the child has no connection.

For both repressed and dissociated childhood memories, that initial split may appear something like this: The child is aware only of the conscious world in which she is not being hurt. She exists in a state of oblivion to the abuse. The switch to "hurt self" is triggered possibly by an incestuous father's knock at the door at night or hearing footsteps near the bed. The trigger would be anything that has come to mean she is about to be hurt. Wherever abuse occurs, triggers will become connected in a child's heightened awareness. These triggers are their saving grace.

During the molestation (or beating or verbal assault), the child must do as told--submits to the caregiver's will. The survivor art shown in the previous post is a collage conceptualizing having one's will bend to another's demands. Once the child is not being harmed, she becomes everyday girl and has no memory of abuse that may have happened only seconds previously. However, she likely will have crossover fear at bedtime, if the abuse occurs at night, which might manifest as fear of the dark, not liking her bed, wanting the safe parent to sleep with her, etc.

I think we have all heard stories of daycare centers where a caregiver was molesting the children. Observant parents reported their child becoming extremely agitated or upset at being taken to the daycare. Even preverbal children have the aversion response to being left with someone who is hurting them. The child's aversion response has thankfully led to some alert parents pulling their children from such centers.

For all children, this division is survival. It might be referred to as a betrayal bond or double bind. A child does not know how to love and hate a parent at the same time.

The ultimate childhood survival mechanism

Dissociation is not a child's choice. The creation of an amnestic self is a survival mechanism of the brain. It allows a child to function in everyday life while at the same time being traumatized repeatedly. Although the child has no memory of the abuse, she may carry over into her "normal" life a strong sense of guilt, shame, secrecy, and fear which will impact her, at the very least, into her adult life.

Dissociation is often discussed as being on a continuum. All of us experience dissociation to some degree. Highway hypnosis is the most common. We drive. We zone out. We snap to and don't remember the last 10 minutes or the last few exits. Going through the spectrum is post-traumatic stress disorder (PTSD) which all victims of long-term childhood abuse are likely to develop. The extreme of the spectrum is Dissociative Identity Disorder (DID). It used to be called multiple personality disorder. Please don't let that stop you from reading further. This is where much of society has been misled and tends to be frightened.

Typically, if a child is going to develop DID, it has been decided subconsciously by age 6 and rarely after age 9. This is cited in the leading authoritative texts on dissociation by the country's experts on dissociation. Some of the books are listed as therapist resources on this blog.

For clarification, DID does not require sexual abuse specifically. It can be the coping mechanism for overwhelming physical, emotional, and/or sexual abuse. Given the inherent double bind of incest, children from incestuous families have a greater likelihood for abuse beginning at a very early age and continuing for a number of years. E. Sue Blume's "Secret Survivors" is an excellent book to learn the dynamics of incest to include victims who are dissociative.

Divided we stand

If you had been a child being molested at will by a parent or other primary caregiver, would you want to know it was happening or not? Children don't get to make that decision. Their mind does it for them.

In the previous post, the great double bind of having to live with a parent who "loves" you and whom you count on for survival and the reality that the parent is hurting you and terrifying you, is usually the first "split" for a child's sanity. The child compartmentalizes what is happening when being hurt from when she is not being hurt. (While both sexes of children are victims, the feminine will be used for references.)

This compartmentalization could be repressed, as in tucking it away for now and being able to retrieve it at a later time. There is no element of amnesia inherent in repressing a memory. It's buried. Another way a child copes with abuse (not by her conscious choice) is to compartmentalize with a wall of amnesia between hurt self and not hurt self. This is called dissociation.

The basics

I want to present this difficult topic in short concepts. What most of us already know may need to be adjusted to accommodate for modifying some assumptions or allowing for new thinking.

Father-daughter and stepfather-daughter incest is most commonly reported, with most of the remaining reports consisting of mother/stepmother-daughter/son incest. Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates show 20 million Americans have been victimized by parent incest as children. (Jeffrey Turner, 1996). As cited at the website for The National Center for Victims of Crime.

Educating young children about good touches and bad touches, how to stay away from strangers, how to get help from an adult, how to say "NO!" is definitely important. Unfortunately, in cases of incest, the child is not being hurt by strangers and must obey parents and other primary caregivers. Saying "No!" is usually not an option and often results in punishment to the child. A child of incest is not allowed to say no. Typically, any child being abused will be threatened with harm--or harm to a loving caregiver, sibling, or pet. Most have had their lives threatened to the point there is no doubt that grave harm will come to them and/or another loved one if they dare to tell. Children of incest are conditioned to feel unempowered, helpless, and damaged. (No one will love you if you tell.)

The most damning for children of incest is their reliance on the very person/persons who are abusing them for their survival. It sets the child up for total confusion about authority: "I love you", "I hate you". "If I don't love you, I will die." They are dependent on their parent or other primary care giver (who may be another family member) for food, shelter, warmth...all security needs...while at the same time being terrified, horrified, and repulsed by what is happening to them.

As if it weren't bad enough...

This blog is an important project for me--to share in hopes others will hear, contemplate, consider, research, reconsider. If anything you gain from this blog causes you to think differently, to make changes, to help educate others, and, most importantly, positively impact the lives of children trapped in a world of abuse and the unhealed adults of childhood sexual abuse, then I have accomplished my objective.

I will be sharing personal knowledge from my own healing as well as knowledge gained from my experience as a psychotherapist working with highly traumatized individuals. Mainly, I just want to speak from my heart and soul and reach out to others. I can't change this part of our society alone. It takes more than a village to help these children and adult survivors of insidious child abuse. I invite you to take this journey with me. It's a rough road that's been avoided for far too long.

Photo courtesy of Monica Palermo.