Saturday, November 14, 2009

Good Help is Hard to Find!

First of all, let me express my gratitude for a few things.  First and foremost, I am very grateful to have the blessing of primary and secondary insurance that will cover the cost of psychiatric services (therapy, meds management) IN FULL, with no deductible or co-pay.  Also, I am unusually blessed to have no limits on the number of sessions I can have per week, per month, per year, or over a lifetime.  The gift of this coverage is humbling, and I am very, very grateful.

So, the good news is that I have coverage to handle the services.  Finding a care-provider who takes my insurance AND who is willing to deal with DID has been a challenge, to say the least.  It's been 12 years since I was last in private therapy.  I made use of public mental health services during the limbo period during which I waited for approval of my disability claim, roughly 2003-2006.

During this period I also trained as Peer Counselor, since it was thought that my experiences and insight would allow me to offer a very deep, real sense of empathy when supporting my peers.  So, I have some training from the other side of the table.  I understand what Transference and Counter-Transference are, and how they need to be managed.  I have a deep appreciation for the work that goes into therapeutic "presence," and the ability to actively listen to a client.

So, with that background, I've approached my search for a new set of care providers with a sense of humor, patience, and a willingness to keep searching for the people who are right for MY situation.  It took awhile to find an appropriate psychiatrist to manage medications.  The first guy, affectionately known in this household as Dr. Asshat, totally chickened out after two sessions.  That wouldn't have been too bad, but he initially offered to do therapy as well as meds management, so the process of telling our story had begun - and then the trust was destroyed.  Thanks, Asshat!

We've since found a new psychiatrist, who seems to understand the intensity of the situation.  Got set up on the anti-depressant that worked especially well previously, Wellbutrin.  Also have a very limited supply of anti-anxiety medication, and some Ambien for horrific insomnia and night terrors.  Okay, check.  Those of you who've read my other blog postings understand that the meds need to be in place first, so that there is a safety structure built around the process of exploring therapeutic work.

After getting the new psychiatrist on-board, we moved on to calls regarding therapy with psychologists and therapists.  We worked from the insurance list of providers, and got some feedback from the psychiatrist as to who might be especially helpful.  Placed countless phone calls, many of which were just never returned.  Rude, in my opinion, but at least I know they're not the provider for me.

One psychologist, who of course has a PhD, called back to say that I probably just needed to change my diet - without asking, of course, what my current diet was.  She also said that my issues are likely caused by the fact that I'm approaching Menopause.  Oh, thanks, doc.  So, I just need to eat nuts and berries, and accept the fact that I'm ancient.  Nice bedside manner there.  I think we found Asshat version 2.0!  I chose to thank the doctor, hang up, and then laugh hysterically...

Fortunately, I'm at a place in life where I trust my own inner knowingness MUCH more than I did when I was 30, or even 40.  I'll be 48 next March, which while not YOUNG, exactly, is certainly not certified geezerhood.

I have since found a psychologist who seems like an excellent fit.  A strong woman with substantive clinical experience and (it seems) a familiarity with what DID looks like, and how to deal with the many facets of treating someone with it.  (Yes, pun intended.)

I know from all my previous therapy that it is I who do all the work.  A good therapist can assist me, rather like a Sherpa guiding an explorer as they climb Mt. Everest.  But ultimately, even with all the assistance and guidance, the climber herself must do the work to get to the summit.  That's how I look at this process.  It won't be brief; I'm in it for the long haul.

The work begins, and I know I am strong enough to see it through.

Monday, November 9, 2009

The Little Ones Speak

This post was authored via the little ones dictating content to Elizabeth, the sometimes-Gatekeeper.  All efforts have been made to strike a balance between the authentic voice of the children, and the standardized grammar and spelling requirements that adults observe.  Apologies are offered if this seems difficult to read, either because of how it's written, or - more likely - the content herein.


It's scary when big people are yelling.  When we was still little on the outside, the big people around us would yell a lot.  Them big people aren't here anymore, but we gots big peoples inside with us.  Sometimes they get mad and yell, and is scares us.  They not be yelling at us, but just yelling cuz they're mad at somebody else in the Tribe, or cuz Jo ain't listening.

We don't like the yelling... makes us sad and afraid that something bad gonna happen.  Don't know when or even what it gonna be, but yelling always means somebody gonna do something bad.  We don't like the "badness."  Don't like big people getting mad, even if it's not at us.  We hide when they yell.

Elizabeth says that it's okay, we don't have to hide all the time.  She never lies to us, but hard to trust that it's okay to talk.  We gonna see what happens.  Big people in the Tribe are talking on the outside sometimes, and not always hiding no more. So we gonna see if they're safe before we gonna come out from the hiding place.

Want to get some time to play and not get in trouble for wasting time and being in the way cuz the big people got stuff to do.  Don't wanna be crying all the time; it makes the head hurt really really bad.


Within the Tribe, there is a wide spectrum of voices and experiences.  Over time, we'll reveal more about the structure, most especially within the narrative of the book, but suffice it to say that it's a diverse group.  A broad variety of perspectives can be both valuable and frustrating.  Ultimately, each "part" has value either for its knowledge, abilities, access to memories, or because it is a core part of the original self.

Thursday, November 5, 2009

A (not so) Lone Voice in the Wilderness

Dissociative Identity Disorder (DID) is something that is portrayed as scary, bizarre, or something to simply be laughed at.  Worse, and most horrifying of all, people with DID are portrayed as inevitably destined to re-enact the horrors of their past by abusing children or harming others in some way.  Words cannot possibly express the sheer agony and grief that this widely held misperception causes.

I have known well over a dozen people who are dissociative, and have emailed and talked online with dozens more.  None of them - not ONE - would ever consider doing anything to harm another human being, especially a child.  In fact, you'd be surprised to learn how many people in the child welfare and care systems are dissociative or full-blown DID themselves. 

However, for those of us living with it, it's a very real challenge - but also a very powerful blessing in many ways.  These very extreme coping mechanisms are only developed in children who are the most intelligent and creative, at least according to a former therapist trained by a pioneer in dissociative treatment.

Pronouns are a big pain in the ASS when you live with DID.  Using "I" when you really mean "we," or slipping and using "we," and then having people look at you funny - it gets old.  No doubt, the narrative on this blog will switch (ahem, bad pun) from "we" to "I" and back again, somewhat randomly.  Such is life with DID.

While it can be chaotic when things are fragmented and rather random, it's also kinda cool to know that within me are such knowledge or skills as advanced Trigonometry, four years of French, strong tech skills, including the time on Amazon's Site Development team, quilting, painting, apparel design and photography skills, powerful public speaking abilities, and other wonders.

Additionally, the very suffering that caused the DID allows me to have a deep empathy for others in pain.  (Add to that the "psychic gene" that came down to me through my mom's side of the family, and you can understand why I try to avoid large unruly crowds...)

A diagnosis of Multiple Personality Disorder (MPD) - what they used to call the same thing as DID -  was made in 1991.  The strong suggestion to quit working and go on disability came shortly thereafter, and kept coming.  As a mother with two children and a worthless husband, it didn't seem to be an option to simply not work anymore.  Somehow, we carried on...  for over another decade.  Even managed to ditch the useless husband, and give up men altogether, and life was much happier for it.

The tech world was growing rapidly, and then imploding.  I worked for several high-tech start-ups, and even Cisco Systems.  I had at least two certifiably psychopathic bosses, including one who forced me to ~literally~ schedule a restroom sobbing time into every afternoon's schedule, just to cope with his unreasonable demands and a 16-hour workday.  I was in a car wreck on the way to a second-round job interview, stopped at the end of a freeway off-ramp, yielding to traffic as required.  A car coming off the same freeway rear-ended my vehicle HARD, at 40+ MPH, as estimated by the insurance company.  (Even worse, someone else was hired for the job!)

These events culminated in a crescendo of chaos in early- to mid-2002, and at that point it was no longer an option to keep working.  The Tribe had become fractured, further fragmented, and deeply wounded.   Life was a surreal, dark carnival ride, and every face or situation seemed potentially threatening.

The Universe craves balance, and out of this darkness came a gift - the opportunity to shift focus completely, and facilitate healing within ourselves, and potentially for others as well.  The subject of this spiritual journey will be in an upcoming blog post...

Fast forward to Fall, 2008. After ending an unhealthy relationship that Summer, I was resigned to perhaps living alone the rest of my life.  It would be better than living with an emotionally abusive pathological liar!  However, to my wonder and surprise, I learned that a friend I'd known for nearly two years (and whom I very much liked) had deep feelings for me.  When I looked within my heart, I could see the truth; I'd had similar feelings since we'd met.  However, when we'd met, we'd each been with another person, so those initial feelings had gotten shelved.

I'd ended my previous relationship, and now my friend had also ended hers.  Thus, a moment of opportunity...  She took me in her arms, and we never looked back.  We traveled to California late that October, and got married in the Old Orange County Courthouse on October 24, 2008, not long before the accursed Proposition 8 passed.  Ours was one of approximately 18,000 marriages upheld by the California Supreme Court in the aftermath of Prop 8's passage.

In the last year, much has happened.  Life is inevitably a mixture of good news and bad, pleasant and very UNpleasant surprises.  We manage to laugh at most of it, pretty consistently.  Still, some dark alchemy had occurred, a silent milestone reached, because I found myself increasingly anxious and uneasy as the Spring of 2009 bloomed.  (I recently learned that the horrifically abusive step-father came into my life 40 years ago, almost to the day, as of this writing.  No coincidence, I'm sure.)

Over the course of the Summer, I began once again to experience the initial edges of flashbacks - though, in most cases, I was able to block them.  I simply did not want to know, refused to "go there."  I'd done hard work on the subject of the childhood sexual abuse (CSA) and more that I'd endured as a child.  It didn't feel fair to have to open up that can of worms once again - frankly, it still doesn't.

This time, though, I have an understanding that my refusing to deal with these memories and experiences leaves my inner wounded child alters holding the bag.  They've been holding on to these experiences, these memories - the worst of the worst - for several decades.  It's time to ease their burden.  Children shouldn't have to carry the horrors while the adults turn a blind eye.  It wasn't okay for my mother to do it, and it's not okay for me to do it within myself.  Time to buck up, and step forward, "Once more, into the breech..."

I've never been someone who drinks much, and although I did some reefer in high school, I've never been a druggie of any kind.  Especially after my training as a shaman, I believe in the power of laughter, Reiki, meditation, drumming, exercise, herbs, yoga, and attitudinal shifts - not necessarily in that order.   However, in this case, I realize that asking for short-term pharmacological assistance in this area is an example of good self-care.

The few times that the flashbacks have broken through, we've ended up curled up, screaming and crying, unable to speak, the body temperature and blood pressure rising dangerously.  It's been a wonder we haven't stroked out, to be brutally honest.  Thus, it was reluctantly agreed that having even just a minimal supply of anti-anxiety medication for the flashbacks and associated panic attacks would be a good idea, as well as Ambien for the industrial-strength night terrors.

Our regular GP doc is well aware of the DID diagnosis.  He also knows what we've been currently facing - there have been, ahem, "multiple" visits.  For over a year, a headache has been persistently present, ever-worsening.  A trip to the ER in September yielded a clean CT scan, so the good news is that it's likely not a brain tumor.  What this almost certainly represents is the pressure in the mind to "hold back" the repressed memories that are under enormous pressure, trying to escape.  We went through this in the mid-1990s, but not nearly as severely.

Finally found a psychiatrist who would take us on.  Seems like a good guy, and he's certainly better than Dr. Asshat - a psychiatrist who dared to give us hope, only to send it crashing to the ground after two sessions.  Seems Dr. Asshat couldn't figure out HOW to bill our insurance, and so gave up.  Informed us we'd need to find another provider.  (Animal, our inner protector, says "He's just a chickenshit!"  Animal's probably right.)

The new psychiatrist actually (gasp!) LISTENED to us when we were in for the initial visit.   Jo brought a lot of information in printed form, and provided extensive information verbally as well.  The doc took copious notes, and didn't visibly flinch, not even once.  Gold stars for managing his counter-transference!

Now we're in the process of finding a psychologist or therapist.  The reason this comes LAST in the process is that the repressed memories which are trying to surface are under enormous pressure.  Before we open the spigot and risk an explosive outflow that swamps everything and potentially puts us in the hospital, it's smart to have a full team of care providers already in place.  The psychiatrist is affiliated with a large, well-respected hospital in the area.  We hope never to learn about their psych ward first-hand, but it's nice to know it's there.

The process of filtering through the various psychologists and therapists available has begun.  Countless phone calls have been placed, and in one case an email has been sent.  One promising practioner gave her email address on her voice mail greeting, saying that's the best way to reach her.  Well, as one might imagine, it's a challenge to convey our situation in a 90-second sound bite, and thus email is wonderful resource for sharing our situation for her to ponder.  Whether she's brave enough to take us on, only time will tell.

(NOTE: There will be a darkly funny future blog posting about a psychologist who called back and had rather, um, simplistic suggestions for our situation.)

Jo has had years of therapy.  And a couple of those years were in the public mental health system.  In fact, Jo's trained as Peer Counselor through a local mental health agency, and also through META.  But receiving services through the mental health agency meant getting a new intern every year, and then only for about 9 months.  One of the interns we dealt with, Amy, was well-intentioned, but ultimately quite frustrating.  She refused to deal with anybody except Jo, no exceptions.

Now, if one of the other Tribe members shows up for a therapy session, there's a damned good reason - there's usually important information to be shared.  But Amy was adamant on this issue.  The choice of taking this condition or getting no services at all wasn't really a tough call.  It hurt, and was ultimately damaging, especially to the wounded little ones, but we lived with it.  However, we now know enough to broach this subject up-front, and insist on the care-provider's willingness to deal with the alter structure.  If they're not willing, we're not staying - it's that simple.

So, here I am; here we are.  On the cusp of what promises to be gut-wrenching work, but ultimately worthwhile.  Inevitably, the unending dread of something is worse than the thing itself.  No matter how bad it is - and this is a soul-crushing level of horrifying - ultimately, shining a light upon it, and seeing its true dimensions and shape takes much of its power away.

I've heard that many 12-Step programs say something to the effect of, "You're only as sick as your deepest secret."  That thought has been echoing for months.  I had the experience of coming "out" as a lesbian a decade ago, and that was actually anti-climactic - because virtually everybody but me already knew.  I've also had the experience of coming out as someone who follows a non-Judeo-Christian faith, and that's sometime been a challenge - mostly for other people.  I have respect for every faith and spiritual practice, so long as it harms none. 

This situation, me "coming out" as a WE...  This is the big, scary risk.  But on some very deep level, I know that it will also free me.  And, I hold some small hope that perhaps a few people will take some courage from my story.  Ultimately, though I am deeply challenged by these circumstances, I know I will transcend them.

Life is a journey, filled with discovery.  Onward!