Chapter 8

Developmental Life History of the MIR

The classic images of Dissociative Identity Disorder, such as those portrayed in the film of "The Three Faces of Eve" and other films which exhibit wild and dramatic changes in personalities, are largely false. Like putting a chameleon in front of a screen that changes colour, the resulting changes may be entertaining and dramatic, but not particularly insightful into the purpose of the adaptation.

The MIR is the process and mechanism that underlies the development of Dissociative Identity Disorder. However, Dissociative Identity Disorder is only one element of the MIR. The MIR is actually a much broader cycle that goes through many stages. It is not an illness of disorder, it is an adaptive strategy. The purpose of the MIR is to adapt and survive. As a response to a divide and conquer strategy of oppression, its response has been to divide and survive. One of the prime functions of the MIR is to respond to the abuser's insistence that the abuse be kept secret, usually on pain of death or torture (Ward, 1984). Abused children are frequently also told that if they reveal their abuse, they will be called crazy (Bass & Davis, 1988).

As such, most forms of MIR are covert and subtle, and present a very different picture than the stereotypical forms that are so commonly portrayed. Kluft (1991) estimates that about 80% of individuals with Dissociative Identity Disorder do not spend the majority of their adult life in an overtly Dissociative Identity Disorder adaptation. Only 1.2% of Dissociative Identity Disorder patients make an "overt and florid" appearance that would easily be recognized. Eight percent could be recognized by a clinician with a "high index of suspicion", 2.8% are overtly Dissociative Identity Disorder for long periods, but they do not seek attention and try to "pass", and another 8% are "very highly disguised indeed, and are usually found only if efforts are made to explore for MPD even in a patient who offers no strong suggestive signs, or as defenses are eroded in the course of therapy" (Kluft, 1991, p.620).

Kluft (1991) described a number of different forms of Dissociative Identity Disorder, viewing them as "atypical" presentations, rather than developmental stages. He used the DSM IIIR criteria, which did not include amnesia. This is helpful because many of these individuals would have been excluded from study under the DSM IV, being classified as Dissociative Disorder Not Otherwise Specified. One of the problems of the rigidity of psychiatric classification systems is that little attention is paid to developmental aspects. Individuals are seen as dropping and out of categories, or going into remission and then re-manifesting symptoms, but longitudinal examination of a life process is rarely described.

In the cycle of the MIR, the stage of alarm involves the creation of new identities. The stage of resistance involves the adaptation of the identities to the external environment and the homeostasis of the MIR. The exhaustion stage would take the form of decompensation and/or death through suicide or stress related illnesses. There is a rough correspondence between these stages and the life cycle. In childhood, identities are simplified, mostly emotionally based states with less definition (Baldwin, 1990). Complex cognitions, internalized oppression, greater resistance to the influence of the abuser and subsystems of identities begin to develop in adolescence (Dell & Eisenhower, 1990). In adulthood, the resistance stage is maintained in homeostasis for decades, but heterostasis can bring on new adaptations, for better or for worse.

The exhaustion phase is more common in older patients, who are more prone to decompensation as adaptive energy is drained (Kluft, 1985b).

Much of the clinical work on Dissociative Identity Disorder revolves around the developmental time frame of early adulthood. For example, the average age for Ross, Norton & Wozney's (1989) study was 31 years old. Some work on Dissociative Identity Disorder in childhood and adolescence has explored the early stages of developing the MIR. However, very little has been done to examine the MIR throughout adulthood. Using a developmental model, I will work through some likely stages in the development of the MIR. At times, it will reflect the elements of Dissociative Identity Disorder that are so familiar, at other times, the MIR takes forms that barely resemble the classical model of Dissociative Identity Disorder. In particular, I hypothesize that the function of healing and reintegration becomes dominant when the individual has left the abusive situation. I also believe that traumatization in adulthood plays a major role in the ongoing presence of the MIR throughout the life cycle. Without ongoing traumatization, the MIR will ultimately result in a healthy, stabilized psychological organization, possibly normative multiplicity or more common forms of psychological systems.

Childhood MIR

The average age at which children first report developing a distinct alternate identity varies from 3 to 6 years of age (Dell & Eisenhower, 1990; Kluft, 1985a; Bliss, 1980; Coons, 1988; Putnam et al., 1986). The MIR in children is less noticeable than in adults. The change is more subtle and may be attributed to the child's changing moods or impulsiveness. Children tend to have fewer identities than adults, averaging about 4 identities, with a range of 2 to 6 (Baldwin, 1990). By comparison, adults have a range of 2 to 100 identities, with an average of 13 (Coons, 1986). Very young children, are less likely to verbally express themselves, but may injure small animals or their dolls, or complain of pain in their bodies. Older children are more likely to verbalize the abuse, but often without the emotions one would expect, sometimes in a lighthearted or joking manner, or with a completely flat affect. It often takes only a few months for children to reintegrate in therapy, while it can take years for adults to do so. However, the abusive situation must end in order for reintegration to take place at all. (Baldwin, 1990).

Depression and somatic complaints are less common in children than adults diagnosed with Dissociative Identity Disorder (Baldwin, 1990), possibly due to fewer total years experiencing abuse (not as many responses to abuse have been used and adaptive energy is not depleted). Baldwin (1990) also reports that children with Dissociative Identity Disorder experience about the same amount of amnesia, indicating this is a process of MIR established early on in life.

The definition of these identities is not a conscious process, but emerges out of the natural emotions responses to the trauma, for example, being scared and angry are both natural responses to abuse. However, while the abuser may permit the fear to show, or even demand it, the anger is punished. The identities in children mostly represent direct emotional states. Dell & Eisenhower (1990) in their study of adolescents with Dissociative Identity Disorder, reported that 82% reported that their first alternate identity emerged as a response to the abuse.

Many identity types found in adulthood are not present in childhood cases. Kluft (1985a) clinical sampling of children found that the children had "no inner persecutors, classic inner self helpers (ISHs), special purpose fragments, or systems of personalities. The identities who expressed either repressed or forbidden impulses rarely were overt about their differences" (p. 214).

Fike (1990a) described child identities as frequently aware of traumatic memories for which other identities are amnesiac. Often, they are shy, sometimes incapable of experiencing pleasure and unable to play. They tend to be compliant and withdrawn. Sometimes specialized child identities are present (Fike, 1990a). These are identities that are presented as children, and possess the cognitive capacity of children, but have specific roles, such as being sexual, performing certain tasks, keeping a lookout for other identities about when it is safe to come out and other functions.

Sometimes angry child identities manifest as persecuting identities (Price, 1988). Often, they are convinced that by punishing the other identities, the abuser will stop hurting them, or that the other identities deserve to be punished.

Self destroying identities are found in cases of ritual abuse. A specific identity may be created to report back to the cult, sabotage therapy, or to injure the body if the secret is revealed.Self-destroyer identities whose only purpose is to kill the body if the secrets are revealed are also only found in survivors of ritual abuse (Braun, 1986).

As childhood progresses, and the abuse continues, identities that have emerged directly on demand to the abuser, or as passive, submissive elements will be balanced by identities which represent resistance. For example, protector identities perform rescuing functions and are conciliatory and nurturing. They provide self-care and even first-aid (Price, 1988).

Kluft (1985a) noted that identity systems (groups of similar identities) are seen in children but are often unsuccessful, however, the systems reported in adulthood are very adaptive. Presumably, developing more complex systems somehow makes resisting the abuse easier, but the response is difficult to develop.

Identities quickly begin to reflect cultural norms and values. Sometimes, the identities begin to take on the characteristics of former imaginary companions. For example, one boy had an identity named Martin who was a fearless and adventurous spaceman (Bliss, 1984). Also, some of the early cross-racial identities are based on the stereotypical or imaginary characteristics of individuals the child has come into contact with. Fike (1990a) describes one woman with a Black identity that was based on a classmate who was described as the toughest child in the school. Wanting the apparent fearlessness of this child, she modeled an identity after her. Gender roles are also assumed early in life, and identities reflect basic gender stereotypes (Rivera, 1989).

The MIR in Adolescence

Identities become more complex and differentiated with subsequent interactions with their environment (Dell & Eisenhower, 1990). Their experiences reinforce their identities, because they are selectively activated to deal with specific situations. Thus, the identity that deals with anger, is always encountering anger. To them, the world is a hostile place, and each experience confirms their preconceptions. This can result in the high degree of conflict between identities, as each identity develops very different world views and has different response to one situation.

The identities also begin to reflect a more cognitive understanding of their abusive situation and social demands. On the whole, the identities of adolescents are very like the ones found in adults. The adolescent patients in Dell & Eisenhower's (1990) study had a high number of alternate identities (24 on average), but only a core group of identities was well defined. Other identities were less defined, came out less frequently and tended to have relatively little knowledge of the patient's life. Complex subsystems and groupings of identities sometimes found in adults were not present in adolescents. The average length of time for reintegration to occur was 29 months. This is significantly more time than for children, who often spontaneously abreact and integrate in a matter of months, yet less than the years of therapy required for adults (Baldwin, 1990).

Dell & Eisenhower (1990) reported that all patients had child identities, scared identities, depressed identities and angry protector identities. More adult-like identities were also found, particularly persecutors and internal helpers were found in 82% of the cases. Violent identities were also present in 64% of the cases, sexualized identities in 55% of the cases and suicidal identities in 50% of the cases.

Persecuting identities can be critical, verbally abusive and physically abusive identities (Fike, 1990a). Sometimes they are manifested as copies of the abusive parent, coming back to punish the child (Price, 1988). These identities tend to have internalized a number of blaming or self-hating cognitions of their abuser (Ross & Gahan, 1988). In 28% of cases, persecuting identities take the form of a demon (Ross et al. 1989). Demonic identities are most common among survivors of ritual abuse in Satanic cults, although mythological gods are sometimes found among individuals from strongly religious backgrounds (Ross & Gahan, 1988; Wilbur, 1984b). In Christian religious traditions, it seems that such identities are more likely to be described as saintly or evil, godlike or demonic (Bowman, et al., 1987), than in cultures where spirit possession is thought to occur by neutral ancestral spirits, reincarnated selves or mischievous spirits (Mulhern, 1991).

The increasing cognitive complexity of the adolescent often results in the internalization of the negative and blaming messages of the abuser. Ross & Gahan (1988) describe some of the common cognitions that emerge out of adolescence, many of which are contradictory and include such messages as:

"I am responsible for the abuse"

"I deserve punishment"

"It is wrong to show anger"

"I can't trust myself or others"

"Good children should love their parents, I don't therefore

I must be bad. I'm bad, which is why I am being punished."

It is likely that these cognitions result from a shifting strategy of the abuser. As the child ages, and the likelihood of exposure of or rebellion against the abuser increases, the abuser will turn to emotional manipulation to control the child (Ward, 1984). Abused children internalize these messages and blame themselves for their abuse, believing it is wrong to express anger, or defiance, criticism, fear...(Ross & Gahan, 1988).

These messages also increase the level of conflict in the DCS. For example, the belief that one identity loves her parents, but the other doesn't; the belief that one identity must protect the others who can't handle the memories, attempts to punish other identities or release them from their misery may result in self abuse (Ross & Gahan, 1988). As the identities have greater cognitive abilities, obvious problems begin to occur. If one identity has no recollection of the abuse, yet is aware of pregnancy resulting from the abuse, how will this identity view or rationalize this event? Isolating ongoing memories of abuse in different identities is a difficult task. The MIR attempts to manage this through maintaining amnesia, however, some conflicts are bound to arise. The level of stress in the DCS is expected to be very high in adolescence, because the abuse is cumulative and ongoing. The stress model predicts that the majority of suicide attempts will occur during adolescence. Further research into suicide and parasuicide may indicate whether or not abused adolescents are particularly at risk for suicidal behaviour.

Inner Self Helpers (ISHs) emerge in adolescence, these identities are sometimes viewed as detached, problem-solving entities who can relate information and give guidance within the system (Price, 1988). Sometimes, they are experienced as divine aspects that have come to help (Comstock, 1991).

Lying about the abuse is more common in adolescence, as the individuals respond to the social demands that they conceal the abuse (Kluft, 1985a). Often, the children are threatened not to reveal the abuse, or they are told that no one will believe them (Herman & Hirschman, 1981). Consequently, many abused individuals lie compulsively, with the untold reality of their abuse being the biggest lie of all (Bass & Davis, 1988). Sometimes this faculty is developed as a form of internal security, to cover over amnesias or inexplicable behaviours. Lying is a presenting symptom in 82% of adolescents with Dissociative Identity Disorder (Dell & Eisenhower, 1990). This contrasts with the behaviour of children, who openly ask to be addressed by a different name and readily admit they are hearing voices (Baldwin, 1990) and adults, who are extremely covert and cautious about revealing their alternate identities to anyone (Kluft, 1985b).

Leaving home

Leaving the abusive situation is an act of resistance with a goal of eliminating the stressor, not just a simple event that happens in the individual's life. A new stage of heterostasis for the DCS is sparked when the individual leaves the initial abusive situation, or the abuser is removed from them. It would not be enough to simply have the abuse end, if it was never discussed or resolved, the initial threats of retribution make the presence of the abuser(s) a continuing danger.

The ending of the abuse is an important stage in the life cycle of the MIR. Unless the abuse is ended, therapeutic attempts at reintegration will inevitably fail (Dell & Eisenhower, 1990; Baldwin, 1990). In Dell & Eisenhower's study of adolescents, detoxifying the home environment was the first step in therapy. Often, even getting the adolescent and the family to agree to therapy involved long negotiations. Sometimes, patients left or were removed from therapy. Only once these terms of safety had been established was it safe enough for therapy to proceed.

Researchers should also not assume that the abuse simply stopped, in many cases leaving the abusive situation is an event planned for and executed by the DCS as an act of resistance. Leaving any kind of abusive situation is difficult, and frequently involves conflict with the abuser(s) who wish to continue their domination (Ward, 1984). More research into the acts of planning and leaving may reveal information about how abused children managed to leave their abusers.

MIR developments in adulthood

This aspect of development in the MIR seems to be largely neglected in the study of Dissociative Identity Disorder. This stage of life offers new opportunities for healing, or new threats of re-traumatization. Once the individual has left the abusive situation, a number of divergent paths can occur in the next stages of development. Leaving the control of the perpetrator weakens their abusive influence. Identities created for resistance can act more openly. Submissive identities will not be elicited as frequently. As the level of stressors drop, the focus of adaptation can shift from maintaining heterostasis and conserving adaptive energy, to a new heterostasis that incorporates changes in the individual's life.

The individual also experiences a change in status from child to adult. More options are available. The shift for males into positions of relative power is greater than that for females upon reaching adulthood (Ward, 1984). New roles have to be assumed to take on this new status, this could lead to the development of new identities or the developmental adaptation of existing ones.

The individual could also be re-traumatized. Many women experience rape and assault in their adult lives (MacLeod, 1987). Even the threat of such brutality may be enough to maintain some of the resistance structures of the MIR throughout adulthood.

Homeostasis

For some individuals, they have little energy left for further adaptations. They may find the world a confusing and unfriendly place (Fike 1990). Threats from the abuser prevent them from telling anyone about the abuse for a long period of time, or when they attempt to disclose the abuse, their stories may be discounted (Bass & Davis, 1988; Herman & Hirschman, 1981).

The colonization process of abuse means that they have internalized the abuser, often in the form of a persecuting or critical identity (Price, 1988). Although the perpetrator is not present, they may have formed identities that are self-destructive and self-critical. As the environment is still neglectful of their situation, little changes are needed in the MIR.

For these individuals, what changes are made are directed at accommodating to the demands of their new life. New identities may be needed for coping with adulthood. A working identity is found especially in high functioning adults, the working identity takes care of all employment related tasks (Kluft, 1986b). Taking emotional refuge in staying busy is a richly rewarded pursuit. This may be a development of some children's intellectualized identities who function in school (Kluft, 1985b), have few personal feelings and little awareness of a personal life. Using previously existing identities is easier than creating new ones (Selye, 1978), and this process would be typical in these individuals.

Heterostasis

For individuals with a more robust MIR, they face new developmental challenges. Resistance-oriented identities can act more overtly. As the presence of the pathogen diminishes, the intensity of the GAS response can also be reduced. This will automatically result in the reduction and eventual elimination of the diseases of adaptation (amnesia and internalized oppression), which are a result of the adaptive process in the presence of the pathogen (abuse).

The changes brought about by leaving the immediately abusive situation call upon the MIR to produce new adaptive responses. The tasks include minimizing conflict within the DCS, reducing the amnesiac barrier, dealing with self destructive behaviour, addressing issues of internalized oppression and allowing awareness of the abuse to surface.

Re-integrative developments

The logical place to first begin reducing amnesia and internal conflict is to make the identities aware of each other. This forces them to begin to interact with each other and work out compromises of behaviour. It also is the beginning stages of abreacting the trauma, as initial clues about the abuse are uncovered. Identities such as the ISH and protector identities are expected to play a large role in determining the pace of the reintegration and seeking support.

The person may slowly become more aware of their inner conflicts and feel deeply divided about their self-concept or paralysed in making decisions (Ross & Gahan, 1988). Abusive incidents will spark old memories and feelings, and these will not be suppressed but come into consciousness (Price, 1988). Flashbacks, body memories, nightmares and other disturbances (Fike, 1990a) result from the increased awareness of the childhood abuse. This may be subjectively disturbing to the individual, but they are part of the healing and reintegration process. Kluft (1991) describes patients "whose alters are generally inactive but are triggered to emerge infrequently by intercurrent stressors, many of which are analogous to, symbolic of or trigger memories of childhood traumata." (p.621)

The signs of this initial healing may not always be experienced in a positive way. More Schneiderian first rank symptoms (such as hearing voices, passive somatic influences and visual hallucinations) may resume, as the blending identities are heard as voices or visual hallucinations. The identities are attempting to influence the DCS without taking full control of the body. Ross et al. (1990) report that in a study of Dissociative Identity Disorder patients in therapy, the average patient experienced 6.4 Schneiderian symptoms, as compared with an average of 1.3 symptoms acknowledged by schizophrenics reported in other studies. The most common Schneiderian symptoms were voices commenting, voices arguing, thoughts ascribed to others, made feelings, acts and impulses. These findings support the hypothesis that the amnesiac barriers between identities are weakening and the DCS is moving towards normative multiplicity. In the Ross et al. study (1990), 94.4% of the patients said they recognized the voices as coming from inside the head, as opposed to schizophrenic voices coming from outside the head.

Kluft (1991) described several "forms" of Dissociative Identity Disorder that seem to represent this stage of reintegration. Covert Dissociative Identity Disorder is a stage where entities contend for control and influence without assuming full executive control.

Passive influence experiences are common. Individuals at this stage are described as experiencing identities who rarely fully emerge, body memories of painful events, intrusive traumatic memories, unexplained strong emotions, sudden inexplicable pains or a sense of unwilled motor acts. This is the beginning stage of reintegration, often experienced as unpleasant. This form of the MIR can be expected to emerge at different times during the reintegration process, and will wax and wane over time. It seems more likely that people will seek out therapy at this stage of the MIR because the symptoms of recovery are so unpleasant. The average age of Dissociative Identity Disorder patients in clinical studies is 31 years old (Ross, Norton & Wozney, 1989) which is an age range that is compatible with this hypothesis. If so, the clinical research may be reflecting larger levels of this stage of MIR than exists in the general population.

Partially integrated MIR

The MIR at this stage can function almost invisibly. High functioning individuals will show less internal conflict, fewer gaps in their recall, more subtle influences of identities and a greater ability to voluntarily manage the MIR (Kluft, 1986b). The MIR at this stage strongly resembles the functioning of the Executive Self, separating personal and public roles, repressing unacceptable memories and generally acting in a manner highly adaptive to the alienated, fragmented and identity-constricting structure of North American society.

Kluft (1991) describes a form of isomorphic Dissociative Identity Disorder, in which a group of identities who are very similar are mainly in control and try to pass as one. Slight unevenness of memory and some skills are the only indications. This indicates that the levels of internal conflict have been greatly reduced as the adaptive responses (both submissive and resistant) are normalizing. It is unclear from Kluft's description, but it is likely that amnesia is still present and may be concealing a fair degree of conflict.

Defensive reintegration

This stage represents integration that is almost complete, but a protecting identity is maintained for defensive or nurturing purposes. Most importantly, conflict has been reduced significantly among the identities. Amnesia is limited to childhood events, if it exists at all. The individual is not "losing time" in their daily life. As the identities are quite ego syntonic, they may remain present for a long time without a concomitant pathology. These stages essentially reflect normative multiplicity, with effective integrative processes and the embodiment of ego syntonic alternative identities.

Adult Imaginary companions

Kluft (1991) describes this as a friendly entity that is co-conscious and co-present, often being supportive and caring. The remnants of the MIR appear to be maintained to assist with self-parenting. This is basically a state of normative multiplicity where the person continues to utilize autohypnosis.

Co-conscious MIR

Kluft (1991) describes this as a system where the identities know about each other and have worked out some type of arrangement.

Whatever amnesia exists becomes apparent only in therapy and is largely related to events in the distant past. It is possible that the amnesia that Kluft found in some of these individuals is simply amnesia, and not related to the existence of a hidden identity. The fact that amnesia for current events is not present indicates an effective reduction of internal conflict and internalized oppression. This is a pragmatic and adaptive mental state. It may be that the individual suffers only from a lack of supportive resources (including time and money) to deal with deep traumas.

Private and Secret MIR

Private MIR is when the identities are aware of each other, and consciously pass as one. Secret MIR is when identities emerge only when the individual is alone. Often, these are found together (Kluft, 1991) in individuals who experience their multiplicity, but like to let everyone out to play once in a while. This basically reflects normative multiplicity. Sometimes there are identities unknown to the rest of the system, which represents a hidden level of amnesia, probably for traumatic past events, that have not been addressed.

Fully reintegrated MIR

Although many of the defensive forms of reintegration are adaptive in a threatening society and can exist without any evidence of pathology, with support and resources a complete reintegration is possible. Believing this can happen involves challenging some commonly held assumptions. There is a persistent unwillingness to believe that mental illness is ever healed, it only ever seems to go into remission (Finkler, 1994). Kluft notes that "at times the alters do little more than persist, having minimal or no appreciable impact on the flow of experience" (Kluft, 1991, p. 609). Kluft (1985b) also says that "most patients who satisfy DSM III criteria for multiple personality disorder at some points in time do not satisfy such criteria at others." However, Kluft does not believe that Dissociative Identity Disorder can ever be cured without therapy, and that this therapy must specifically addresses the issues of Dissociative Identity Disorder to be effective. He states that "the manifest symptoms may wax and wane and appear to be absent, but a diathesis remains and the potential for the recapitulation of the overt pathology persists" (Kluft, 1991, p.610). In examining physical illnesses, physicians recognize that the process of healing is inherent in the body; a broken bone will knit itself together, the immune system can overcome a virus. There is no reason to ignore or deny similarly inherent healing processes in the psyche.

In Selye's model (1978), healing is defined as an internal process, not something that can be externally imposed. Support for healing can help this process take place, but healing itself is the final stage of adaptation that represents successful resistance to the stressor. Acknowledging the strength of resistance and potential for healing in survivors of child abuse is an important step in understanding the complete cycle of the MIR.

Redefining disease

What is illness and what is healing? In adaptive terms, it depends on the purpose. In Selye's (1978) classic example, the body responds to infection by increasing body temperature. This is an (often very effective) attempt to resist the invasion of the pathogen. But this process of healing, is experienced as uncomfortable. In some cases, it may result in a disease of adaptation, where the fever threatens life. Because an excessive fever is a disease of adaptation, medical interventions focus mostly on changing the stressor or the environment. Using penicillin to reduce the presence of the stressor allows the fever response to diminish. In some cases, the fever response can be deliberately suppressed for short periods of time, but it is an essential defense and a part of the body's healing. The appropriate response is to change the environment, not attempt to interfere with a perfectly adaptive response. Suppressing the adaptive response is only necessary in times of crisis, when diseases of adaptation are threatening the life or long-term health of the patient. Early intervention, which is ideal, focuses solely on changing the environment.

Another example of painful healing is the process of abreaction during therapy. Often experienced as extremely painful, and it can disrupt the patient's life and threaten functioning (Fike, 1990b). In therapy, many identities that the person is never aware of in their daily functioning, emerge as a result of the process of uncovering the defensive layers (Kluft, 1991). New identities can develop to cope with the trauma of therapy (Kluft, 1982; Braun, 1984). Yet this manifestation of illness is part of the healing process. A change in environment results in a change in the MIR.

The process of healing in the MIR can take place outside of therapeutic support. Healing is often uncomfortable, everyday functioning seems to be at its lowest point. The process of uncovering memories of abuse and integrating identities is often viewed as evidence of pathology. However, it is a healing process, and just one aspect of a continued response to abuse. The resistance to the abuser, the multiple identity response, is the process of healing. This process will constantly adapt to optimum psychological functioning within the context of the environment.

If the MIR is a consequence of abuse and oppression, survivors of childhood abuse should be recognized as more than victims. The individual with multiple identities has already done the hardest work, surviving the abuse, often with little help from anyone. It does not seem so unlikely to me that such individuals are also capable of healing themselves on their own. However hard the therapist works, it is ultimately the client who is doing the hardest work, reliving their trauma, working through their relationships, facing their fears.

It is unfortunate that little research appears to be carried out to study the potential of self-healing. While studies regularly report a "placebo effect", when the mind heals physical and/or psychological problems, this data is routinely discarded as "noise" that confuses the real purpose of the study. What needs to be acknowledged is that people always heal themselves. To believe that therapy is what is doing the healing is an illusion. It is true that some kind of support, including therapy, is a necessary but not sufficient condition of healing. But, the support for this healing, doesn't have to come from therapy. It can come from other individuals, religious communities and supportive peer groups.

Healing outside the context of therapy

Studies on individuals with Dissociative Identity Disorder are based on clinical populations. Therefore, there is limited evidence to explore whether or not individuals who experience dissociation as a result of childhood abuse are capable of healing independently of therapy. However, there is some anecdotal evidence to indicate this.

Kluft (1986b) notes that the "overt expression of the classic phenomena of MPD is not consistent longitudinally over time" (p. 722). Kluft reports on 12 individuals who fulfilled the diagnostic criteria of Dissociative Identity Disorder according to the DSM III, but had histories of superior social functioning, including uninterrupted work, no evidence of major life disruptions, medical problems, seizure disorders or severe psychopathology. All pursued successful careers, the identities influenced each other subtly, leaving no recall gaps. The MIR functioned like an internal society or family. In all these cases, these relationships were cooperative and complementary. Conflict was negotiated, or behaviours served different purposes for the different identities.

Kluft (1986) presented three case studies that all reported a common reason for seeking therapy, problems with their relationships with men. In one case a woman had "failed to change masochistic tendencies in her relationships with men" [in other words, she was being continually traumatized in an abusive relationship (Caplan, 1985)], another was going through a traumatic divorce and the third had unspecified "problems". The MIR functioned well for these individuals, and no significant pathology was present. The women appear to have survived and essentially recovered from the trauma of childhood abuse. When the need arose to deal with trauma in adult life, the MIR was reactivated to deal with the situation.

Individuals with Dissociative Identity Disorder can also remove identities using self-hypnosis. Kluft (1988b) describes one client who used autohypnosis to prevent a new identity from emerging. An upsetting incident had triggered the recall of some traumatic memories and an incipient, nameless identity was formed to cope with these events. Using autohypnosis she contacted the identity to assure her that the memories and the new identity were welcome to her, and prevented the split from occurring. In the same article, Kluft describes another case of a man who could not find sufficient help and integrated his identities using autohypnotic techniques. He concludes that the case "illustrates that the applications of autohypnosis in motivated MPD patients may be far wider than generally assumed." (p. 92).

The inner healer

The inner healer, also called the inner self helper (ISH), has been seen by mystics as spirits possessing the body, by clergy as the presence of the divine, by philosophers as a representation of our higher selves and by therapists as a therapist's assistant (Allison, 1974).

Few things are as indicative of the inner power to heal oneself as the presence of the inner healer in the DCS. Allison (1974) describes the Inner Self Helper (ISH) as a source of wisdom, self preservation, perspective and understanding that appeared to be unique to Dissociative Identity Disorder patients and people with other dissociative disorders.

However, the concept of inner guidance is ancient. Some early conceptualizations of the unconscious mind did not perceive as the Freudian repository of animalistic lusts and irrationalities, but as a source of peace, sustaining energy and inborn wisdom (Comstock, 1991). Ross (1989) argues that Breuer's patient Anna O. had a ISH that Breuer did not use sufficiently in his treatment.

Jung viewed the unconscious mind as a source of wisdom, and encouraged listening to this inner voice (Comstock, 1991). Hilgard (1977) named it the "hidden observer", but saw it as less emotional, more analytical and mature. He characterized it as distant from the functioning of the psyche, observing all that happened but not interfering. Allison (1974) viewed the ISH as presenting itself as emotionally subdued, but would eventually express a full range of human emotion.

Other psychologists studying Dissociative Identity Disorder have viewed the ISH as a central, unifying force (Beahrs, 1986; Allison, 1974; Putnam, 1989; Comstock, 1991). Several therapists believe that the ISH is often or always present in individuals who do not have multiple identities as well as in a multiple identity response (Allison, 1974; Beahrs, 1986; Putnam, 1989).

In a study by Adams (1989) of therapists working with Dissociative Identity Disorder clients, over half reported that they believed every Dissociative Identity Disorder patient had a ISH, and 90% of therapists reported contact with at least one ISH in their practice.

Comstock (1991) believes that a person can have more than one ISH, sometimes spiralling upward to higher Higher Selves that superseded the body, and are rarely called on but available if needed. Comstock reports that communicating with the ISH has been reported to occur through a sudden insight or knowing, possibly through some process of projective identification. Also, he comments that the strong spiritual ties of the ISH makes some psychologists uncomfortable. The ISH can communicate directly with the therapist about missing time and forgotten events, interpret somatic symptoms, give advice on the course of therapy, assist with integrating identities, bring the individual into therapy and seek help on behalf of the DCS, crisis management and prevention and other self-preserving functions (Comstock, 1991). After integration has occurred, the ISH remains intact to regulate internal communication, and is accessible only through hypnosis (Watkins, 1982). It stands to reason that the ISH can function outside of the context of therapy, and would be the prime mechanism for self-preservation and healing.

The presence of the ISH displays the adaptivity of the MIR. By encapsulating the influence of the abuser, the individual has managed to sustain a sense of self-love and inner peace that is intact. At some deep level, the abuser failed to extinguish the sense of self-love and self-preservation in the child. This is a strategic victory for the MIR, that despite the ravages of annihilation and psychological colonization, essential parts of the DCS that are necessary for eventual healing were preserved intact.

The role of ongoing traumatization in adulthood

Unfortunately, leaving the family of origin is not always the same as beginning an abuse-free life, especially for women. In a society that was supportive of survivors of abuse, simply leaving the abuser would be enough. However, it is clear that society plays an important role in not only the creation but the maintenance of the MIR. Therapeutic interventions with children with MIR demonstrate that unless the abuse is ended and the child is in a relatively safe environment, the MIR will continue (Dell & Eisenhower, 1990).

The oppression of children

Running away from home is one of the few ways possible to escape the abusive family, unfortunately this act of resistance is not encouraged by society. Economic dependence on the family of origin is one of the cornerstones of the oppression of children. Many abused children run away from home, only to be brought back by the police and into the hands of the abuser again (Webber, 1991).

Others find their way to the streets, unable to find adequate shelter or employment because of their age. Many of these individuals are re-traumatized through repeated abuse (Webber, 1991). Ross, Norton & Wozney (1989) reported that 19% of individuals with Dissociative Identity Disorder had worked as prostitutes. The patriarchal system moves them from the individuals abuse and degradation of their family of origin into the class of general sexual property of men (Brownmiller, 1975).

The oppression of women

The gender ratio of children with Dissociative Identity Disorder is about 3 girls for every 2 boys, by adolescence the proportion of females to males has widened to 4:1 (Dell & Eisenhower, 1990). In adulthood the ratio is approximately 9:1 (Putnam et al., 1986; Ross et al. 1989b). There are a number of theories to account for this.

One is the finding that boy children are not abused as often as girl children (Finkelhor, 1986). Another theory is that males with Dissociative Identity Disorder end up in prison rather than therapy (Allison, 1980; Bliss & Larson, 1985; Kluft, 1988a; Putnam, 1989; Ross & Norton, 1989). This speculation is based largely on the fact that males with multiple personality exhibit more antisocial and aggressive tendencies than females (Loewenstein & Putnam, 1990).

However, as the study of the literature on child abuse demonstrates, there is little correlation between men who rape and assault their girlfriends, wives and children and their tendency to be incarcerated (Finkelhor, 1986). Male individuals with multiple identities are provided with socially acceptable outlets for their behaviours. Ross & Norton (1989) noted that males were more likely to go to jail than females, however, there were very few males in the study. Also, 70% of males had neither been convicted of a crime or gone to jail.

The most likely explanation for this increasing gender difference is the role of ongoing traumatization in adulthood. Over 1 million Canadian women are assaulted each year by their partners (MacLeod, 1987). Approximately 98% of the perpetrators of these assaults are male (Russell, 1986). There is some evidence that survivors of childhood abuse are raped and assaulted in adulthood more often (Kluft, 1985b). While this is sometimes attributed to their "masochistic tendencies" (Kluft, 1986b; Caplan, 1985), little research is done to determine exactly why this happens. Unfortunately, investigating whether these individuals are in precarious economic or social situations that makes them less able to respond to dangerous situations, or that the ongoing violence contributes to the MIR (while non-abused women drop out of the statistics) has not been explored. Loewenstein & Putnam (1990) reported that 57.7% of female patients reported being sexually assaulted in adulthood. While males in this study reported being raped 16.7% of the time, males in the Ross, Norton & Wozney (1989) study reported similar rates of physical and sexual abuse and rape as those for females, 64% to 67% respectively.

It may be that individuals who are otherwise recuperated from their childhood traumas, re-emerge as individuals with multiple identities after being re-traumatized in adulthood. For some, the abuse is simply unending. Such ongoing violence is far more likely to happen to women than men in a patriarchal society (Brownmiller, 1975; Levine, 1989). The ever widening gap between females and males with multiple identities is not simply that women are more likely to seek therapy or that men are more likely to be incarcerated for their abusive behaviour. Men have more opportunities, by virtue of their privileged position in patriarchy, to reintegrate than women.

Although Kluft (1991) recognizes that the "presence of trauma and stress" contribute to manifestations of overtness in adult individuals with multiple identities, he does not consider that this could play a primary role in perpetuating Dissociative Identity Disorder for decades after leaving the abusive situation.

Note the following stages that Kluft (1991) identities as forms of Dissociative Identity Disorder. In each of the stages, the MIR re-emerges after a traumatic incident. "Latent" MIR is described by Kluft (1991) as when the identities are inactive but can emerge when triggered by a stressor, especially re-traumatization or other events that are symbolic of or remind the individual of their childhood traumas. Kluft describes this as latent, however, I would say the initial MIR has been resolved. Sensitization to brutality would trigger the well-developed MIR in the DCS.

Posttraumatic MIR is described as clandestine until the individual is re-traumatized through rape, violence or betrayal, or experiences a head trauma. Ad hoc MIR is when a single helper identity emerges to create a number of short lived identities that cope with a crisis. The identity function briefly and then cease to exist, but the helper identity persists (but rarely emerges). This is probably a response by the MIR to dealing with systems that have been oversensitized by abuse. It may be that some basic damage has resulted and a crisis management team is necessary to maintain mental health. I would regard this as a health preserving stage of MIR. It is possible that after sequential re-traumatization as an adult, the MIR would be maintained as a defense against the future fear of assault, rape and other brutalities.

Therapy as a form of trauma

There are numerous reports that individuals with multiple personality will produce new identities during treatment if the therapist makes technical mistakes or otherwise re-traumatizes the client (Kluft, 1982; Braun, 1984). There are also a number of studies that indicate that therapy which misdiagnoses individuals with Dissociative Identity Disorder will result in little, if any long term gain. The suicide and parasuicide rates for individuals with multiple identities is positively correlated with the length of time they have spent in the psychiatric profession (Ross & Norton, 1989). Longitudinal follow up studies can help determine whether this is due to a higher rate of active suicidal intention in individuals with multiple identities who seek psychiatric care, or if spending 7 years (Rivera, 1991) to 10 years (Ross & Norton, 1989) being misdiagnosed was ultimately a destabilizing influence for these individuals.

Firsten's (1990) study on female psychiatric patients found that women were at high risk for sexual and physical abuse during their hospitalization. The vulnerability of female psychiatric patients, whom no one will believe and who may be heavily drugged, places them in further danger of abuse. Obviously, psychiatric settings are not the safe haven needed to facilitate healing. From a feminist perspective, treatment in psychiatric facilities often serves only to isolate and pathologize the individual (Finkler, 1994). In one study (Rivera, 1991) individuals with Dissociative Identity Disorder received a total of 46 different diagnoses, the most common being depression (46%), borderline personality disorder (37%) and schizophrenia (33%). The treatment for these disorders is often inappropriate for individuals with multiple identities. Parasuicidal individuals reported receiving 4 different types of psychotropic drugs more frequently than other patients, and 12% reported receiving electroshock treatments (Ross & Norton, 1989). Studies on the effects of pharmacology in the treatment of Dissociative Identity Disorder have shown it has limited success, largely as an adjunct to therapy (Loewenstein, 1991), and electroshock is rarely indicated as an appropriate treatment for Dissociative Identity Disorder. Aside from the unpleasant effects of these treatments, the fact that these individuals probably never received in-depth counselling constitutes a form of re-traumatization. The lack of recognition of the impact of abuse in their lives is a form of silencing and discrediting these experiences. By pathologizing the individual, rather than examining the social situations they face, psychiatry often simply reinforces the messages that the "problem" is defined as the person (Levine, 1989).

When therapy does work, it uses the strengths of the MIR and gives support for the inherent process of healing. Hypnosis is an excellent use of the MIR, because it can utilize the developed abilities of dissociation to abreact, control pain, slow-leak overwhelming memories, perform fusion rituals, cognitive restructuring and positive dreamwork (Shapiro, 1991; Salley, 1988).

Play therapy, contracting, age regression, abreaction and other eclectic techniques are used successfully (Rivera, 1988). Kluft (1986) notes that the key to successful therapy is to establish trust, express support for the client and use a variety of techniques.

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