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Have DID: Getting Worse Not Better

Question:

I was diagnosed with DID, severe PTSD, etc. after a stress breakdown. I’ve heard voices as long as I can remember and have been in tfhe menal health system for over 1/2 my life. I had virtually no memories of childhood or adolescents or really up until about 7 years ago. I have more memories now than I wish. I have been highly suicial, attempted several times, it’s high on my list/ I married a sociopath (narrassistic and highly abusive]. My sister is a sociopath and mother is bizarre. I never stopped splitting and I’m 48. I have a therapist who does not want to talk about my external world nor really my internal world. I don;t know what she wants. She is 70 yrs old and has done therapy with DID clients for many years. I have a psychiatrist I have seen since way before the DID disagnosis. He does med review. I am and have been totally isolated for these 6 past years. My primary family and extended have shunned me, lost my kids to their nutty father, live alone, can’t work and my health is now going. I feel certain people are trying to destroy me and I’m trying to live, sort of. tonite, I took a lighter and almost lit my clothes. Can’t call suicide hotline cuz they call the police and Daddy was an Oregon State trooper. I get triggered to say the least. He is dead now, but doesn’t matter, he destroyed me. Called me "it", not even sub human. Tried to kill me a couple of times. Was enraged the day I was born. I’ll spare you all the horrific and terrifying details. I lost everything. I am not wanteed by anyone. Not even my therapist likes me, but I’m poor. I could be dead in my apartment for weeks before anyone would notice. i’VE prayed for strength and courage, but honestly I am burnt out on everything. I feel blamed for everything by therapist and other mental health "professionsl". I’m hospitalized out. Threre are few resources where I live. I hate the term "survivor"’ as though some of us are heros because we endured torture and being tormented but thats what we do, endure. Not an endurer does it take to make a hero. Hell, as Victor Frankle said of the concentration camps, "The best of us did not survive" meaning the best of humanity. Maybe, I’ve run the course and there is no help for me. Maybe, I can’t be helped. .

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Answer:

A couple things jump out at me as I read your letter. First, your depression is very likely coloring your perceptions. No one likes you. You feel blamed. You’re hospitalized out. You cannot endure and yet you must. This is the language of depression, which is to say, the language of hopelessness and helplessness. It’s not just people who have a life long DID and PTSD problem who talk this way. Anyone who becomes depressed enough for whatever reason will start taking this way. Depression is a fairly treatable condition, and when depression is properly treated, thoughts like this tend to lessen in intensity or go away. The most commonly used treatments for depression involve prescriptions for antidepressant medication (and you may be on an antidepressant for all I know), but there are other effective treatments as well, including cognitive behavioral therapy and interpersonal therapy. And sometimes medications need to be adjusted or mixed and matched (by a doctor of course) becuase they are not working optimally. Since your present baseline is suicidal, there is certainly room for you to decrease your level of depression. It would be worth exploring alternative depression treatments with your doctor, and/or working with a therapist who can treat your depression (and not just your DID).

Second, you may actually have more problems than you know about. DID and PTSD might be your primary problems, but coming from such a screwed up family as you did, and being traumatized as you were, your knowledge of how to get along with other people might be developmentally delayed. This is to say, you might have social and emotion-coping skills deficits. If this is the case, and it is not just the depression talking when you say that you are so unwanted, then there is another layer of issue that you can address. There are therapies designed to help people with pronounced social and emotion-coping skill deficits. Dialectial Behavior Therapy and Transferance-Focused Therapy are two varieties that are research-supported. If you think you could benefit from instruction in self-soothing (e.g., learning how to calm yourself in the face of disturbing memories), seek out DBT. TFT, on the other hand, focuses on helping you become aware of the types of social interaction mistakes you are prone to make so that you can correct them. You might even benefit from EMDR, which is a therapy designed to help people who have been traumatized become less reactive to their trauma memories.

In your helplessness, you seem to be thinking thoughts like "no one can help me", and "maybe I can’t be helped". All of which suggest that you believe that you are not capable of helping yourself. This leads me to my third observation, which is that you seem to betaking a rather passive attitude towards your treatment; waiting around for the doctors to fix you. This is not the attitude that is most conducive to you feeling better. Doctors are guides and coaches, ultimately. They cannot do the work for you. Even physicians who prescribe medications for you cannot make you take them (unless you are hospitalized which you are not right now). It is quite possible that in your passivity, you are thinking that the doctors can read your mind (not literally) and just know what the best way to treat you is. This, of course, is a bad assumption, becuase doctors are terrible mind readers. If you are not benefiting optimally from an antidepressant medication course, it is a good idea to talk to your doctor and ask if it can be adjusted or augmented with other treatments. Psychotherapists benefit from your feedback as well. If you are doing the same thing over and over in your psychotherapy and it isn’t helping, then ask your psychotherapist whether there is another approach you might try. 

Your question is whether your life can improve. I think it can improve, but before that can happen, a few changes may need to occur:

  1. Your depression seems to be coloring your perception and judgement and making you feel more helpless and hopeless than you really are. It would be a good idea for you to accept that your judgements are likely to be more negative than necessary and to therefore take them with a grain of salt. Just because you feel like crap doesn’t mean you are crappy. Just becuase you feel helpless doesn’t mean you are helpless.

  2. It would be a good idea for you to become a more active advocate for your own treatment. Work on overcoming your passive attitudes and think about what are the real pressing issues you need treatment for so that you and your doctors can prioritize them better. To my mind your depression (and suicidality!) and possibly your social and emotion-coping skills are causing more active problems for you (more suicidal urges, more isolation, more difficulty forming relationships, etc.) than your DID or PTSD, per se, alhtough these things are all interrelated to some extent. Many therapists who work with adult DID patients do try to get the various alters to become integrated, but others, concluding that this is a difficult and unnecessary project, settle for just helping the various alters to get along with one another in a coordinated, respectful manner. Since you are actively suicidal, keeping the peace and keeping hoplessness at bay are bigger issues than working towards integration, which is a luxury you can save for after you are feeling better, safer and more supported.

  3. Finally, realize that your problems are large and complex, and that while improvements can and do happen, they occur incrementally, and not all at once. Don’t wait around for large improvment goals to take place before you celebrate. Instead, notice even little improvements and feel good about them. More generally, large self-improvement goals need to be broken down into smaller managable goals that can actually be scheduled and implemented. This is the way that people climb mountains; one single foot-step after another. For more information on this process of breaking down larger goals into smaller more managable ones, please consult our online book Psychological Self-Tools.

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