Changes As Abuse Survivors Age

This is written mostly about Alters in DID and PTSD.

Note: In places of this writing, it seems more appropriate to use victim or victims, rather than survivor or survivors.

            On the first page, I said that I've spoken with many women over the age of 45 who have said they believe they can "never" get over their childhood experiences because of the severe trauma and PTSD.   Other women were further abused in therapy (emotionally, mentally, sexually or financially, or a combination of these) which only reinforced the earlier traumas they held inside.  But mostly, it seems that childhood sexual abuse prevents one from developing normal ways of feeling, thinking, and acting to such a degree that women spend most of their adult lives re-learning and re-building shattered parts of themselves.  This relearning is obviously harder for those diagnosed with severe PTSD or for those with Dissociative Identity Disorder.  

Let's look at some changes in the issues one experiences as the person ages, and especially if the person has become ill. 

TEEN AND YOUNG ADULT

A teen and young adult [ages say 12 yrs. to 25 yrs of age] is just either becoming aware of their abuse memories, or maybe are being vocal about it for the first time. [Note: There are people who have "always known" they were abused and maybe talked about it also.  But often feelings have been disconnected from "facts" or memories of the abuse.]  Often in this period, the person seeks therapy for the first time.  They often experience confusion as they try to piece together the memories, or piece together their memories with facts of a time-line.   Most therapists ask about a time-line - probably because it is easier to understand and organize another person's life story by "years" or dates, and names, places, and events.  The "who, what, when, and where" are the focus.  But, this compounds confusion for SA victims, because they've not really kept a running account in their head as to dates, plus kids do not categorize events by dates and years.   So, a great deal of therapy is spent trying to categorize the "who, what, when, and where."  Unfortunately, therapists focus so much on those, but do not seem as efficient in addressing the next natural question in that series, the "whys."  If the therapist gains enough trust, they *may* succeed in conveying to the victim that the events of what an adult abuser did to them are not their fault.  But often, this question remains, along with much shame.

If the person is dissociative or diagnosed with Dissociative Identity Disorder (DID), much time in therapy is usually spent sorting out feelings and "who is who" within the person.  Sometimes, the therapist's excitement and intrigue are clearly evident to the client (and these reactions by a therapist can actually complicate therapy).  Showing interest is one thing; excitement and "awe" in finding a new "alter" or part can actually make a client feel that discoveries are not as "good" unless it sustains the therapist's excitement (which translates to how much is a therapist interested in me, or in "us".)  A good therapist will show an equality in their level of interest, and that new discoveries mean the client is working hard on their own healing.   

DID clients may be asked to "map" their system of alters, and define what each is like.  Again, these are conceptualizations -- ways of categorizing -- that I feel aree often more for the therapist than for the client.  But, "mapping" can help a client to visualize their own internal world and how parts connect or are grouped within the system.  This helps later as a client realizes that groups of alters often are formed around different degrees of similar emotions, reactions, or thoughts.  Realizing this can aide in healing.

Unfortunately, with sessions once a week, the "searching for who, what, when, where" and mapping may end up taking a large chunk of real-life time [in sessions and at home].  If handled improperly by the therapist, a client could spend years and years only in this stage. 

A person may go through a lot of "acting out" by alters and parts, mostly because there are not other coping mechanisms in place.  The earliest goals of therapy should focus on introducing and learning as many coping mechanisms as possible.  Learning self-hypnosis can be a great way to "meet" one's parts - but other coping is needed for real-life, in-the-moment situations that any person may encounter everyday.  So, good therapy will be addressing these coping methods, alongside the discovery of parts, alters, and the current system of coping.

The therapy may focus intensely on "integration" of the client's inner world, especially when it is the therapist's agenda (versus coming from the client's desire to integrate).  Yes, a push might be needed towards this goal, but if the push comes from the therapist's NEEDS or desire to be "finished," the therapist's push will FAIL, PLUS this can lead to 1,001 additional issues.  If handled improperly, the client will experience the "push" as being "pushed away" and will react from fear of rejection.  Therefore -- it is always best that integration intentions come from the client.

25 yrs old to mid 30s

Often, survivors are not just survivors of childhood abuses, but also survivors of either bad therapy or terminated therapy.  The causes of terminated therapy are numerous, from change of therapist's interests, to a therapist moving away or leaving that practice, to insurance or payment issues, or simply that the therapist burned out or refuses to continue therapy with that person.  So very often, termination is handled HORRIBLY, and the client is left -- alone -- to pick up the pieces of themselves and their lives, often struggling to merge the therapy world which elicited their inner world with their real-life world of family, job, and everyday life.  Post therapy can be traumatic after a bad termination!  Even the best termination can leave the person floundering for many, many months.  In my experience, and hearing from countless victims of bad therapy or bad therapy-terminations, few therapists know HOW to do a "good termination."  [It almost seems that whatever gets the client out the door, away from the therapist, and out of the therapist's ethical and legal responsibility, is viewed by the therapist as a "good termination"!!  But for a client...........it is catastrophic...... and ends up so damaging.........

So -- for whatever reason(s) -- the person is now out of therapy.   A few persons may have terminated therapy themselves, feeling ready to do so.  The majority I've known or talked to were not as lucky.  A small percent of the thousands of clients may have actually found enough healing to be able to go on their way.  Again, the majority of ex-therapy clients I have talked to did not achieve this goal, though.  Many of these persons end up struggling to find their own way.... not sure how.... determined (most days) to continue their healing.... struggling often with depression or even suicidal thoughts..... and somehow manage to patch up their emotional world enough to continue everyday life, with varying success.  Or at least what most survivors define as "success."

Some survivors find their alters and parts continuing the only ways of coping they have previously known and used.  Alters may still "act out" in small and large ways.  But, life itself may intervene to stop some actions by alters.  For example, an alter who previously would take off and physically take the car, ending up 3 States away, will be greatly deterred when the car breaks down or there's no money.   

In the best scenerio, a person will try to develop coping methods and negotiations with their alters.  "When I get done writing checks to pay the bills, we will go for a ride in the car."  Or "After I am done working at my job at 5pm, we will go home, eat dinner, and then you can draw pictures on huge paper on the living room floor."  The "adult" may start to give good attention to their parts/alters, to themselves, to thoughts, emotions, and their own goals.   Cooperation within their inner world may take priority, IF the person can gather enough of their own inner strengths AND if they have some good external supports.  These are things to strive for, and hopefully, the person will be able to attain some of this cooperation, self-love, and self-support for themselves.  But, struggles may remain.  And, some will have a harder time than other people in finding a way to balance their inside world with their outside world.

In terms of issues, while old issues remain (sometimes unchanged, or with some improvement, as judged by the person -- not outsiders' judgments), there are new issues developing in middle age --- or old issues that are changing into new issues.  Let me give some examples.   Body image issues may still be problematic, but in a way, worse.  A person who looked for a sense of love and comfort through sex in their teens and 20s may now be experiencing new body image issues: "My body is aging; it doesn't look as sexy as when I was 20; I never felt anyone would want or love me before, and now, no one will love or want me!"   Even if a person has retained a good figure and attractiveness, they may start to feel awkward if they dress or behave in the same ways as they did in their 20s.  Or, they may notice that the cat-calls and whistles from men or the attention they got from women, which used to be directed at them in their20s, is now being directed at some other pretty face or handsome man!  The middle-age question of "where did my youth go?" has a great impact on sexual abuse survivors (or on the sexualized alters in DID).   The person finds they can't get their emotional needs met through sex anymore - or not in the same ways.  The alter, too, may experience emotional upheaval IF they realize they do not look the same as they always believed they looked.  

Also, child alters are more an issue.  It's simply that the felt or apparent difference in body-age to child alters is  or seems LESS when a person is 18 yrs old, 20 yrs old or even 25 yrs old when the child alter is say, 6 yrs old.    But when a 35 yr old realizes their child alter of 6 yrs old still tries to talk to outsiders -- well, it can be more disconcerting -- even disgusting to some.  Mostly, it feels embarrassing to the adult.  At this point even more negotiations may take place, in an attempt to control when a child is "allowed out," or when they are allowed to speak to an outsider.  But, again, some survivors don't have this level of communication with their inner parts, or they don't have the coping methods in place to avoid having alters "come out."

Teen parts may have the hardest time dealing with the body aging, and likewise, the outside person "in charge" may have the most trouble trying to help their teen alters.   Feelings may be so strong from these parts.  And without other coping methods, teens may revert to previous behaviors.  Drinking and drug use may become a problem - or return.  Cutting and self-harm behaviors may become intense!   And it may be very hard to find a place, a spot, to break into the behavior and work out a plan or negotiation with the inside alters.  And, unfortunately, chemical and alcohol dependency or addiction is just as hard to recover from for a DID person as any other person - maybe harder since there are "other parts" invested in using these things to cope.  In cutting and self-abuse, awareness may be increased about the triggers that make them abuse themselves, but still the person has been unable to find other means to cope and to comfort themselves.

A huge event, usually in the 30s, happens if the person has been a parent.   Assuming a person had their first child at 20 years of age, that means at age 38,  their child has turned 18 years old.   While other parents are hit with "empty nest," the person with DID is also faced with other issues.  Adult children go away to college or usually move out of the parental home for a new job, new relationships, a new life.  The parent with DID sees their child going off to a new life, and realizes, painfully, "I'm still stuck."    There may be an urgency felt to catch up on things they feel they missed, or to create a life they feel they have not yet had.  College plans may be formed for the first time, or the person may try to return to college.   The parent may compare their own job status and qualifications with their adult child's, and feel they don't measure up to their offspring.  The person is often flooded with ideas concerning their future, as they form new goals, new plans, or a return to old dreams.  Persons without DID may do the same thing, except they are not also hampered by "old" emotional issues at the same time.  If the person just jumps into numerous plans and activities, they may easily become overwhelmed by the issues they were already dealing with up to this point.  Indeed, Alters may try to sabotage the plans and goals, especially if these collide with the emotional turmoil of issues that the system has already been facing (or, not facing).

Mid to late 30's into 40s

Adult children and/or one's own aging brings forth another normal developmental issue, that of "what contribution have I made to society?" and "what value has my life been?"   For childhood abuse survivors, this butts up against the ongoing and painful questions that have already been asked for years: "What am I alive for?"  It is a natural question from early on, considering that the person has lived through numerous abuses.  And there has never been (nor will there ever be) an answer to "Why was I abused, while other people were never abused?"   Those questions come up repeatedly, from early adulthood and on.  "Why me?"  Then, often the person starts to realize how much they lost -- lost goals, lost dreams, lost ambitions, lost achievements --- losses caused from having to deal with so much emotional baggage left over from the abuses that the person had little emotional reserves to deal with things like goals, dreams, ambitions, or other things of a normal life.   The person may have felt they were "unworthy" of these things before, or had been carrying SO much shame that they could not pursue anything but survival.   But, now.... now they re-visit these needs and wants, and of course, the emotional issues get re-visited too!  

The person needs -- MUST HAVE -- strong emotional support to get through this period of searching for a life that the person feels they never had, and needs now to create.   Even with support, the emotional baggage will come up.  With help, hopefully some or most of these issues will be addressed and resolved.  But many people find they get stuck in a start-stop progression towards their goals.  They find some successes -- some failures.  There needs to be support to cope with real - or perceived - failures in reaching the goals a person is trying to achieve.  A failure can FEEL like such a HUGE setback that the person is greatly at risk of giving up completely!   Most persons do recover partially from a real or perceived failure, and any number of minor setbacks, but still, at best they seem to stumble along as they go through the so-called normal ups and downs in reaching a goal.  These "normal" ups and downs are typically much, much harder for a survivor to cope with emotionally, since they are also dealing with an inner world that they feel (and indeed is so) that they must keep a secret.  

In the best circumstances, and largely through the person's sheer determination and will-power, goals may be achieved.   Graduation or completion of a goal marks a huge success for someone who has struggled constantly with low self esteem, poor body image, perceived inadequacies, perceived and real difficulties in communicating with outsiders, while struggling to keep their inner world in check and to cope with the ongoing effects of childhood abuse (and even dealing with intrusive flashbacks).   During the time of schooling or a job, it is hard for professors or employers to understand things like "family problems" or "financial problems" as interference with performance --- so it is impossible for a survivor to have explained to a professor or employer that "I'm not functioning well today (this week) because flashbacks keep upsetting me and my alters are going crazy."   The fact is, when a survivor reaches a goal they've worked towards, it represents far more coping, determination and will-power than anyone, even the survivor, realizes or gives themselves credit for having and doing!   So, every survivor should celebrate meeting any goal, no matter how small or "normal" it seems to be.  In fact, survivors need to celebrate the many smaller goals that occurred on the way to achieving the larger goal !  If the person's goal was a B.A. (Bachelor of Arts) in Nursing, they should celebrate the completion of every semester of courses, or even every day that they participated in the program to that point!  And, when graduation comes, the person needs to acknowledge and honor themselves for the huge success they have done!!

The 40's, often with unfinished goals, often with physical illnesses, and on into 50's, 60's and beyond....

Every decade carries forth the unresolved issues from previous years.  Any issue can still remain "an issue," or can return as an issue.  Unfinished goals and unfulfilled dreams are more painful.  Often, previous questions take on a theological and spiritual essence, as survivors re-visit questions that have had no answers.  "Why did this abuse happen to ME" becomes "Surely my life was supposed to be different than THIS; surely I wasn't put on this earth just to be abused, and abused again!"   This is especially difficult if a survivor has gone through repeated abuses through the years (as many survivors have).    These statements are not an accusation towards God, but an expression of the deepest kind of pain.  "WHY am I here?"  And at some point, all survivors wonder what a "normal life" might have been like, and how would they have been different had they not been abused?  It is almost unimaginable that there are families in which children are not molested or abused in some way.  But, it is very natural that survivors start to ask these questions, and wonder what their lives would have been without abuse.  

How would it feel to not be hyper-vigilant?  

How would it be to not feel internal chaos?  

How would a peaceful day feel?  

But, these are things which cannot be answered....

Again, the person has the opportunity to find some measure of healing.  But, again, without guidance or support, how can the person take advantage of this opportunity?  In my own experience, the therapists of the 1980s who were gung-ho and so interested in helping survivors heal, have no tangible idea of what the middle-aged survivor needs to resolve these issues and questions!  Possibly is it because that this is really the first time in history that survivors have not been AS HIDDEN as survivors have been in other times of history?  The beginning of the 21st century has more focus on childhood abuses than in the 20th and 19th centuries, when nothing existed for real healing and families and individuals had to largely cope on their own with the after-effects of abuse.  Back then, women might warn female kin "Stay away from Uncle Jack," without explanation of why and without offering much more protection than that -- IF the female child was warned at all !!!   By the 1930s to mid 1960s, society paid a little more attention to accusations of abuse, or at least gave lip-service to this societal problem.  But often in those years, children were yanked from homes, only to be placed in private homes or institutions where a non-relative continued the abuse!  And still, there was no therapy.  

So maybe today, it is that therapists just don't know HOW to help the supposedly "new" group of adults who lived through abuse as kids.   They don't know how to help the many men and women survivors who are struggling still to be comfortable in their own skin as they age from 40, to 50, to 60, and on.   But here's this large group of survivors who, since their teens and 20s, been encouraged to "get counseling," "go to therapy," and "get help," only to be left adrift after they reach their 30s and beyond.   One reason survivors get left adrift is that therapists have been mistakenly trained that if a person needs therapy longer than what THERAPISTS EXPECT, then the person must either "not want help" - or are "incapable of being helped."  Therapists have accused clients of "liking" therapy so much that they do not want to give it up!  Therapists have made judgments about clients, like: "you are dragging your feet," "you don't want to get well," "you keep making up problems, just so you can stay in therapy," or "clients will fall in love with their therapist, and not want to leave therapy."  ALL these statements are rationales, theories, suppositions, and ultimately allegations and judgments that get placed onto the client  -- and they are disgusting, demeaning, derogatory and FALSE.  But therapists use these rationales because THEY simply have NO idea how to help some persons, or help the aging survivor!!  Instead of admitting their own deficiencies in this area, they blame the client, and cause horrendous and long-lasting torment and pain for the once-client.

If therapists could only say, "I don't know the way from here, but I am willing to stand by you and be with you as you continue to grow and change.  Maybe we will find the 'way' together."  If only therapists could say these two sentences -- and mean it sincerely.

As I said, in no time in history have there been so many identified survivors, who have sought therapy, and in that process been vocal (even for a short time) about their experiences.  At no time in history have there been so many survivors speaking out on television, in books, in magazines, newsletters, and on the internet.  At no time in history has society been able to read or know of abuse stories from across their own nation, or from other nations.  Oprah Winfrey is probably the most visible and most vocal representative of childhood sexual abuse survivors in a public forum.   As a woman, and as an aging woman, survivors look to her as a role model.  But, as the most visible (and incidentally very successful and creative) survivor model, other survivors do not see, and do not know, the nitty-gritty inner workings of her own struggles as an aging survivor!   Even if we were to know Oprah's emotional processes as an aging survivor, most survivors may not find enough commonalities between her - and their own - journey; survivors living in poverty or who are facing catastrophic physical illness(es) may not be able to relate to a successful and rich aging survivor.  This remains to be seen -- and will depend on whether Ms. Winfrey allows the public to travel on the journey of her own aging as a sexual abuse survivor.  Until then, her public voice calls on each of us to find our own voices!