During this hour in the waking streets I felt at ease, at peace; my body, which I despised, operated like a machine. I was spaced out, the catchphrase my friends at school used to describe their first experiments with marijuana and booze. This buzzword perfectly described a picture in my mind of me, Alice, hovering just below the ceiling like a balloon and looking down at my own small bed where a big man lay heavily on a little girl I couldn’t quite see or recognize. It wasn’t me. I was spaced out on the ceiling. I had that same spacey feeling when I cooked for my father, which I still did, though less often. I made omelettes, of course. I cracked a couple of eggs into a bowl, and as I reached for the butter dish, I always had an odd sensation in my hands and arms. My fingers prickled; it didn’t feel like me but someone else cutting off a great chunk of greasy butter and putting it into the pan. I’d add a large amount of salt — I knew what it did to your blood pressure, and I mumbled curses as I whisked the brew. When I poured the slop into the hot butter and shuffled the frying pan over the burner, it didn’t look like my hand holding the frying-pan handle and I am sure it was someone else’s eyes that watched the eggs bubble and brown. As I dropped two slices of wholemeal bread in the toaster, I would observe myself as if from across the room and, with tingling hands gripping the spatula, folded the omelette so it looked like an apple envelope. My alien hands would flip the omelette on to a plate and I’d spread the remainder of the butter on the toast when the two slices of bread leapt from the toaster. ‘Delicious,’ he’d say, commenting on the food before even trying it.
The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR.While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false.Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.
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.