Chapter 10
Implications for further research and treatment, summary and concluding remarks
Further research
The model of the DCS is eminently suited for computer generated modelling. Although neurology is a science in its infancy, developing advanced models for understanding psychological processes will have many benefits to medicine and psychology alike.
Creating neurological models that integrate the entire body as part of its systemic functioning is long overdue in neurology. Further understanding of the nature and limitations of neurology and its impact on physical and mental health is an appropriate goal for future research.
The diagnostic criteria of Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified are likely catching a very large population, including people who exhibit few signs of pathology. The cross cultural perspective on possession and trance states makes it clear that embodying an alternate identity is not necessarily an unwelcome or pathological event. The evidence on multiplicity points out that if we all live in multiplicity, it is not inherently destructive. The criteria should be adapted to include an ego dystonic requirement for such a diagnosis. This would be more cross culturally appropriate and accommodate individuals who have embodied ego syntonic alternate identities, both people with spontaneously occurring multiplicity and reintegrated abuse survivors who choose to retain multiple consciousnesses.
The whole concept of pathologizing the survivors of abuse is questionable. Defining the survivor as the problem stigmatizes the abused, not the abusers. In seeking help, individuals with multiple identities may find themselves re-traumatized by unwanted interventions. The creation of safe houses, where healing can take place in safety, and where people can go to escape abusive situations, would be an important step in assisting the healing of abuse survivors. Further research into the feasibility of such projects would greatly benefit individuals with multiple identities. It is important to remember that we, as a society, do not simply want to assist survivors in adapting to their abuse, but actually work towards ending child abuse and violence in our society.
Dissociative Identity Disorder should be regarded as not only
a disease that responds well to appropriate treatment, but an
entirely preventable difficulty of living with an unlivable environment.
More research on early intervention techniques, and further political
actions to prevent child abuse are essential. Further research
into the developmental aspects of psychological responses to trauma
are necessary to test the hypotheses put forward in this dissertation.
By examining the environmental and social influences on mental
adaptations, the developmental processes of resisting oppression
may be further uncovered and elaborated. Early intervention with
abused children before the age of 3 years could provide insight
into the earliest developmental stages. This model of research
would also be useful in examining other psychiatric diagnoses
for the contribution of social factors in their etiology and maintenance.
Summary
Dissociative Identity Disorder can only be understood within its social and cultural context. Specifically the integral role of oppression in child abuse and ongoing violence indicates that Dissociative Identity Disorder is not a result of isolated situations of abuse, but part of the systemic violence against children and women.
The embodiment of alternate identities is a normative state for some individuals, although cultural socialization can have a large impact on defining "appropriate" forms of dissociation and autohypnosis, the two mechanisms that underlie the process of embodying alternate identities. Neurological frameworks clearly point to the existence of decentralized, modular processes the define our psychological organization, and plausible neurological mechanisms for embodying alternate identities support the hypothesis that multiplicity is a normative process.
This leads to the need to re-define the "disease" of Dissociative Identity Disorder. Internalized oppression, including self-abuse, forgetting the personal history of abuse, and internalized messages of self-hate and self-destruction, are the true cause of pathology and discomfort among abuse survivors. These negative messages are internalized as a consequence of the abuser colonizing the mind of the child. Dissociative Identity Disorder is a label that pathologizes these effects of abuse. In fact, the underlying mechanism of the multiple identity response, is a coping and healing strategy that optimizes psychological organization to the environment. Changes in the environment allow the multiple identity response to complete its cycle, and activate its capacity to resist internalized oppression.
The common conception of multiple identities as a form of extreme pathology that takes on classical symptomology is false. In fact, the multiple identity response produces a variety of responses throughout its cycle, and takes a wide variety of forms.
Clinically-based studies, which likely represent a narrow
sampling of the total population of individuals with multiple
identities, have probably contributed to this misconception. Survivors
of abuse must be given credit as strategists, working proactively
as well as reactively to escape pain, escape the abuser, provide
self-nurturing and find a path to healing. A political, community
based response to child abuse is needed to truly address the issues
and difficulties of individuals with multiple identities.
Conclusion
The question that I could not resolve, for myself, throughout this dissertation was the basic paradox - how can we be healthy in an unhealthy world? The General Adaptation Syndrome is a model of adaptation, not a clear, philosophical definition of mental illness and mental wellness. Further research into the developmental stages of psychological adaptations may help to bring a greater feminist understanding to mental health. Researching the processes of adaptation, the role of social supports and the search for mentalwellness among abused and oppressed individuals could illuminate some aspect of this question. It may be that the desired goal of healing, and the definition of
mental wellness differ from person to person. How different individuals defined and pursued this goal would be instructive.
This is an uncommon approach if one believes the model of "pathogen and disease". There is little choice involved in being sick or not. However, through understanding the nature of adaptation, we can clarify what choices people do have about their health. By knowing what aspects of health are prioritized, what struggles are endured to pursue the goal of health and what support is needed to accomplish these goals, the mental health profession can learn to be more responsive to the needs of the system users.
Making the link between the body and mind is also an important step for analyzing abuse. Often, the feminist praxis is that "every woman owns her body". Actually, every woman (and person) is their body - what happens to the body happens to the self. The body/mind dichotomy is a heuristic that has long outlived its usefulness. Understanding physical and sexual abuse involves recognizing the complex interactions between the body and the rest of the self. The way physical and sexual abuse use the physical form to colonize the self is a profound violation, which often results in difficulties of embodiment. Further exploration of our physical relationships with ourselves could help explore this complex process.
In developing an understanding of child abuse as an element of systemic violence, it raises the issue of redefining oppression as abuse. For example, the hate-motivated violence of racism needs to be understood as a form of abuse. Systemic discrimination against lesbians and gay men needs to be examined as a form of abuse. What impact does this impersonal, yet systemic and profound violence, isolation, social ostracism and socialized self-hatred have on the mental health of oppressed groups? Understanding how the impersonal systems of oppression create personal experiences of abuse is an important contribution to developing a theoretical nexus of personal and political realities.
The other outstanding question I am left with is what happens to severely abused children who do not have a naturally high dissociative ability? The endemic nature of child abuse, as well as ongoing brutality in adulthood, necessitates an investigation into the role of oppression in all forms of mental functioning, whether they are labelled as illnesses or not. How does violence, or even the everyday fear of violence, influence our mental health? Hopefully, using a developmental model of adaptation will help illuminate the etiology and structure of other outcomes of violence and provide some insight on how social systems can be most responsive to these needs.
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