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In my view, the spurning of DID is highly connected with knowing and not knowing about child sexual abuse. Side by side with denial of childhood trauma and of severe dissociation, is an unmistakable cognizance of dissociative processes as they are embedded in our language. We regularly say things such as, "pull yourself together", "he is coming unglued", "she was beside herself", "don't fall apart", "he's not all there", "she was shattered", and so on.
Elizabeth Howell
You are no longer human, with all those depths and highs and nuances of emotion that define you as a person.There is no feeling any more, because to feel any emotion would also be to beckon the overwhelming blackness from you. My mind has now locked all this down. And without any control of this self-defence mechanism my subconscious has operated. I do not feel any more.
Jake Wood
Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.
Marlene Steinberg
The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders.The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).
Marlene Steinberg
Dissociative identity disorder is conceptualized as a childhood onset, posttraumatic developmental disorder in which the child is unable to consolidate a unified sense of self. Detachment from emotional and physical pain during trauma can result in alterations in memory encoding and storage. In turn, this leads to fragmentation and compartmentalization of memory and impairments in retrieving memory.2,4,19 Exposure to early, usually repeated trauma results in the creation of discrete behavioral states that can persist and, over later development, become elaborated, ultimately developing into the alternate identities of dissociative identity disorder.
Bethany L. Brand
Prior to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of Dissociative Identity Disorder had been referred to as Multiple Personality Disorder. The renaming of this diagnosis has caused quite a bit of confusion among professionals and those who live with DID. Because dissociation describes the process by which DID begins to develop, rather than the actual outcome of this process (the formation of various personalities), this new term may be a bit un
Karen Marshall
Shortly after I began work with Teresa, I acquired another MPD client, a supposedly schizophrenic young man I will call Tony. He called in to the clinic on a day I was on telephone duty, saying he was having flashbacks of "ritual abuse.” I did not yet know what that was. Tony became my client. He could be quite entertaining. I have a vivid memory of him as a three-year-old, "Tiny Tony,” standing on his head on my office couch, and running down the hall to try unsuccessfully to make it to the bathroom. He had in his head the entire rock band of Guns’n’Roses, and I got to know Axl, the band leader, quite well. I remember the time Tony was in hospital and I went to visit him; Axl popped out and said, "Remember, we’re schizophrenic in here!
Alison Miller
Among DID individuals, the sharing of conscious awareness between alters exists in varying degrees. I have seen cases where there has appeared to be no amnestic barriers between individual alters, where the host and alters appeared to be fully cognizant of each other. On the other hand, I have seen cases where the host was absolutely unaware of any alters despite clear evidence of their presence. In those cases, while the host was not aware of the alters, there were alters with an awareness of the host as well as having some limited awareness of at least a few other alters. So, according to my experience, there is a spectrum of shared consciousness in DID patients. From a therapeutic point of view, while treatment of patients without amnestic barriers differs in some ways from treatment of those with such barriers, the fundamental goal of therapy is the same: to support the healing of the early childhood trauma that gave rise to the dissociation and its attendant alters.Good DID therapy involves promoting co-consciousness. With co-consciousness, it is possible to begin teaching the patient’s system the value of cooperation among the alters. Enjoin them to emulate the spirit of a champion football team, with each member utilizing their full potential and working together to achieve a common goal.Returning to the patients that seemed to lack amnestic barriers, it is important to understand that such co-consciousness did not mean that the host and alters were well-coordinated or living in harmony. If they were all in harmony, there would be no “disease.” There would be little likelihood of a need or even desire for psychiatric intervention. It is when there is conflict between the host and/or among alters that treatment is needed.
David Yeung
Perfectionism is the unparalleled defense for emotionally abandoned children. The existential unattainability of perfection saves the child from giving up, unless or until, scant success forces him to retreat into the depression of a dissociative disorder, or launches him hyperactively into an incipient conduct disorder. Perfectionism also provides a sense of meaning and direction for the powerless and unsupported child. In the guise of self-control, striving to be perfect offers a simulacrum of a sense of control. Self-control is also safer to pursue because abandoning parents typically reserve their severest punishment for children who are vocal about their negligence.
Pete Walker
Dissociative Disorders have a high rate of responsiveness to therapy and that with proper treatment, their prognosis is quite good.
Marlene Steinberg
Did I imagine the castle, the dungeon, the ritual orgies and violations? Did Lucy, Billy, Samuel, Eliza, Shirley and Kato make it all up? I went back to the industrial estate and found the castle. It was an old factory that had burned to the ground, but the charred ruins of the basement remained. I closed my eyes and could see the black candles, the dancing shadows, the inverted pentagram, the people chanting through hooded robes. I could see myself among other children being abused in ways that defy imagination. I have no doubt now that the cult of devil worshippers was nothing more than a ring of paedophiles, the satanic paraphernalia a cover for their true lusts: the innocent bodies of young children.
Alice Jamieson
By the time Cheryl Hersha came to the facility, knowledge of multiple personality was so complete that doctors understood how the mind separated into distinct ego states, each unaware of the other. First, the person traumatized had to be both extremely intelligent and under the age of seven, two conditions not yet understood though remaining consistent as factors. The trauma was almost always of a sexual nature… (p52)
Cheryl Hersha
Treating Abuse Today (Tat), 3(4), pp. 26-33Freyd: I see what you're saying but people in psychology don't have a uniform agreement on this issue of the depth of -- I guess the term that was used at the conference was -- "robust repression."TAT: Well, Pamela, there's a whole lot of evidence that people dissociate traumatic things. What's interesting to me is how the concept of "dissociation" is side-stepped in favor of "repression." I don't think it's as much about repression as it is about traumatic amnesia and dissociation. That has been documented in a variety of trauma survivors. Army psychiatrists in the Second World War, for instance, documented that following battles, many soldiers had amnesia for the battles. Often, the memories wouldn't break through until much later when they were in psychotherapy.Freyd: But I think I mentioned Dr. Loren Pankratz. He is a psychologist who was studying veterans for post-traumatic stress in a Veterans Administration Hospital in Portland. They found some people who were admitted to Veteran's hospitals for postrraumatic stress in Vietnam who didn't serve in Vietnam. They found at least one patient who was being treated who wasn't even a veteran. Without external validation, we just can't know --TAT: -- Well, we have external validation in some of our cases.Freyd: In this field you're going to find people who have all levels of belief, understanding, experience with the area of repression. As I said before it's not an area in which there's any kind of uniform agreement in the field. The full notion of repression has a meaning within a psychoanalytic framework and it's got a meaning to people in everyday use and everyday language. What there is evidence for is that any kind of memory is reconstructed and reinterpreted. It has not been shown to be anything else. Memories are reconstructed and reinterpreted from fragments. Some memories are true and some memories are confabulated and some are downright false.TAT: It is certainly possible for in offender to dissociate a memory. It's possible that some of the people who call you could have done or witnessed some of the things they've been accused of -- maybe in an alcoholic black-out or in a dissociative state -- and truly not remember. I think that's very possible.Freyd: I would say that virtually anything is possible. But when the stories include murdering babies and breeding babies and some of the rather bizarre things that come up, it's mighty puzzling.TAT: I've treated adults with dissociative disorders who were both victimized and victimizers. I've seen previously repressed memories of my clients' earlier sexual offenses coming back to them in therapy. You guys seem to be saying, be skeptical if the person claims to have forgotten previously, especially if it is about something horrible. Should we be equally skeptical if someone says "I'm remembering that I perpetrated and I didn't remember before. It's been repressed for years and now it's surfacing because of therapy." I ask you, should we have the same degree of skepticism for this type of delayed-memory that you have for the other kind?Freyd: Does that happen?TAT: Oh, yes. A lot.
David L. Calof
Dissociation gets you through a brutal experience, letting your basic survival skills operate unimpeded…Your ability to survive is enhanced as the ability to feel is diminished…All feeling are blocked; you ‘go away.’ You are disconnected from the act, the perpetrator & yourself…Viewing the scene from up above or some other out-of-body perspective is common among sexual abuse survivors.
Renee Fredrickson
All I wanted to do was hide away from the world, but I still had a role to play. I had to be 'Girl A' - the key witness in the trial that finally saw my abusers locked up. Girl A - the girl in the newspaper stories who had been through the most hideous experience imaginable. When I read those stories, I felt like I was reading about somebody else, another girl who was subjected to the depths of human depravity. But it wasn't. It was about me. I am Girl A.
Girl A
Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.
Suzette Boon
It is hard to bring paedophile rings to justice. Thankfully it does happen. Perhaps the most horrific recent case came before the High Court in Edinburgh in June 2007. It involved a mother who stood by and watched as her daughter of nine was gang-raped by members of a paedophile ring at her home in Granton, in the north of Edinburgh. The mother, Caroline Dunsmore, had allowed her two daughters to be used in this way from the age of five. Sentencing Dunsmore to twelve years in prison judge, Lord Malcolm, said he would take into account public revulsion at the grievous crimes against the two girls. He told the forty-three-year-old woman: 'It is hard to imagine a more grievous breach of trust on the part of a mother towards her child.' Morris Petch and John O'Flaherty were also jailed for taking part in raping the children. Child abuse nearly always takes place at home and members of the family are usually involved.
Alice Jamieson
Shamed and enraged, I sit by the side of the road and cry.Eclipsed by a sense of disgrace, my emotions feel momentarily stifled and disconnected. Instead of anger, I feel dishonored and exposed. I cannot even formulate my thoughts, much less speak them. My integrity and humility have been violated. I have only my own indignation to spur me on.
Holly A. Smith
Specific parts of you personality may be angry and are usually easily evoked. because these parts are dissociated, anger remains an emotion that is not integrated for you as a whole person. Even though individuals with dissociative disorder are responsible for their behavior, just like everyone else, regardless of which part may be acting, they may feel little control of these raging parts of themselves.Some dissociative parts may avoid or even be phobic of anger. They may influence you as a whole person to avoid conflict with others at any cost or to avoid setting healthy boundaries out of fear of someone else’s anger; or they may urge you to withdraw from others almost completely.
Suzette Boon
Alterations in regulation of affect (emotion) and impulse:Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves.The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.
Suzette Boon
Changes in Meaning:Finally, chronically traumatized people lose faith that good things can happen and people can be kind and trustworthy. They feel hopeless, often believing that the future will be as bad as the past, or that they will not live long enough to experience a good future. People who have a dissociative disorder may have different meanings in various dissociative parts. Some parts may be relatively balanced in their worldview, others may be despairing, believing the world to be a completely negative, dangerous place, while other parts might maintain an unrealistic optimistic outlook on life
Suzette Boon
In this chapter I restrict myself to exploring the nature of the amnesia which is reported between personality states in most people who are diagnosed with DID. Note that this is not an explicit diagnostic criterion, although such amnesia features strongly in the public view of DID, particularly in the form of the fugue-like conditions depicted in films of the condition, such as The Three Faces of Eve (1957). Typically, when one personality state, or ‘alter’, takes over from another, they have no idea what happened just before. They report having lost time, and often will have no idea where they are or how they got there. However, this is not a universal feature of DID. It happens that with certain individuals with DID, one personality state can retrieve what happened when another was in control. In other cases we have what is described as ‘co-consciousness’ where one personality state can apparently monitor what is happening when another personality state is in control and, in certain circumstances, can take over the conversation.
John Morton
It is necessary to make this point in answer to the `iatrogenic' theory that the unveiling of repressed memories in MPD sufferers, paranoids and schizophrenics can be created in analysis; a fabrication of the doctor—patient relationship. According to Dr Ross, this theory, a sort of psychiatric ping-pong 'has never been stated in print in a complete and clearly argued way'. My case endorses Dr Ross's assertions. My memories were coming back to me in fragments and flashbacks long before I began therapy. Indications of that abuse, ritual or otherwise, can be found in my medical records and in notebooks and poems dating back before Adele Armstrong and Jo Lewin entered my life. There have been a number of cases in recent years where the police have charged groups of people with subjecting children to so-called satanic or ritual abuse in paedophile rings. Few cases result in a conviction. But that is not proof that the abuse didn't take place, and the police must have been very certain of the evidence to have brought the cases to court in the first place. The abuse happens. I know it happens. Girls in psychiatric units don't always talk to the shrinks, but they need to talk and they talk to each other. As a child I had been taken to see Dr Bradshaw on countless occasions; it was in his surgery that Billy had first discovered Lego. As I was growing up, I also saw Dr Robinson, the marathon runner. Now that I was living back at home, he was again my GP. When Mother bravely told him I was undergoing treatment for MPD/DID as a result of childhood sexual abuse, he buried his head in hands and wept.(Alice refers to her constant infections as a child, which were never recognised as caused by sexual abuse)
Alice Jamieson
Research on organised abuse emphasises the diversity of organised abuse cases, and the ways in which serious forms of child maltreatment cluster in the lives of children subject to organised victimisation (eg Bibby 1996b, Itziti 1997, Kelly and Regan 2000). Most attempts to examine organised abuse have been undertaken by therapists and social workers who have focused primarily on the role of psychological processes in the organised victimisation of children and adults. Dissociation, amnesia and attachment, in particular, have been identified as important factors that compel victims to obey their abusers whilst inhibiting them from disclosing their abuse or seeking help (see Epstein et al. 2011, Sachs and Galton 2008). Therapists and social workers have surmised that these psychological effects are purposively induced by perpetrators of organised abuse through the use of sadistic and ritualistic abuse. In this literature, perpetrators are characterised either as dissociated automatons mindlessly perpetuating the abuse that they, too, were subjected to as children, or else as cruel and manipulative criminals with expert foreknowledge of the psychological consequences of their abuses. The therapist is positioned in this discourse at the very heart of the solution to organised abuse, wielding their expertise in a struggle against the coercive strategies of the perpetrators. Whilst it cannot be denied that abusive groups undertake calculated strategies designed to terrorise children into silence and obedience, the emphasis of this literature on psychological factors in explaining organised abuse has overlooked the social contexts of such abuse and the significance of abuse and violence as social practices.
Michael Salter
Isolation of catastrophic experiences. Dissociation may function to seal off overwhelming trauma into a compartmentalized area of conscious until the person is better able to integrate it into mainstream consciousness. The function of dissociation is particularly common in survivors of combat, political torture, or natural or transportation disasters.
Marlene Steinberg
Switches among identities occur in response to changes in emotional state or to environmental demands, resulting in another identity emerging to assume control. Because different identities have different roles, experiences, emotions, memories, and beliefs, the therapist is constantly contending with their competing points of view. Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process. It is countertherapeutic for the therapist to treat any alternate identity as if it were more “real” or more important than any other.Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision
James A. Chu
Rikki looked over at me.“Why now?" she asked, looking back at Arly. “Why is this happening now?""Hard to say." Arly [therapist] replied. "DID usually gets diagnosed in adulthood. Something happens that triggers the alters to come out. When Cam's father died and he came in to help his brother run the family business he was in close contact with his mother again. Maybe it was seeing Kyle around the same age when some of the abuse happened. Cam was sick for a long time and finally got better. Maybe he wasn't strong enough until now to handle this. It's probably a combination of things. But it sure looks like some of the abuse Cam experienced involved his mother. And sexual abuse by the mother is considered to he one of the most traumatic forms of abuse. In some ways it's the ultimate betrayal.
Cameron West
Escape from reality. In some instances, dissociation induces people to imagine that they have some kind of mastery over intractable environmental difficulties. Dissociation is often implicated in magical thinking or self-induced trance states. This aspect of dissociation is frequently found in abuse survivors. It is not uncommon for abused children to engage in magical thinking to retain an illusion of control over the situation (e.g., believing that they "cause" the perpetrator to act out).
Marlene Steinberg
The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents... some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the light into the peace and safety of a new Dark Age.
H.P. Lovecraft
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