HEALING
The Long Journey to Integration
Is it possible to heal from multiple personality disorder?
Lillian's path to wellness spanned five years. During that time she endured multiple suicide attempts and frequent hospitalizations.
Healing differs from recovery in that recovery implies that the MPD patient once had a unified identity. Healing for the MPD patient involves the integration of multiple fragmented parts to form a unified identity.
How does one heal from trauma so horrific that one's identity becomes shattered? Unlike other forms of dissociative disorder, the original trauma leading to multiple personality disorder occurs in the period during which identity itself is being formed - usually around age three.
In this psychologist's experience, healing takes place through a series of stages.
STAGE 1: UNAWARENESS
At the time of Lillian's first suicide attempt she was not aware of having other personalities.
Unlike a person hospitalized with suicidal depression, Lillian mysteriously became well within one week of her hospital admission. In “Lillian, A True Story of Multiple Personality Disorder,” the reader learns that at discharge Lillian was unexplainably talkative, humorous, and outgoing. She showed no signs of depression. Later the reader finds out that Lucy, Lillian's outgoing personality in her late teens, had taken over, leaving her psychiatrist no choice but to discharge her.
Individuals at this stage of healing show an indifference to what cannot be explained — disappearances, clothing that mysteriously shows up in the patient's closet, canceled bus tickets and more. Some MPD patients actually report not recognizing their own reflection in the mirror.
During this stage the MPD patient begins to develop an awareness of the presence of "others" as is reflected in Lucy's poem SIX OF ONE in which the personalities of Amy, Lucy, Lee, Julie, Lillian and Esther were revealed (Chapter 1, Pp 31-32).
STAGE II: COMMUNICATION
During this stage, communication develops between the personalities and a trusted adult.
By appealing to each personality's interests and needs for a safe relationship, Lillian's aunt Jean succeeded in creating a pathway for communication.
It was Lillian’s Aunt Jean's warm-hearted recognition of each personality's need for acceptance that opened the doors for communication.
Relying on her intuition, Aunt Jean created a structure for each personality to communicate through letters, artwork and journal entries.
Aunt Jean's journal included, ”...I'm trying to find a way to keep all of you separate and not mix you up. I bought five notebooks . . . I would like each of you to put your name on a label and choose a notebook to put your letters in ... Lucy picked up the red notebook. Julie selected the blue notebook. Lee had a green notebook... Amy printed her name backwards on the orange notebook..." (Chapter 2, Pg 42)
STAGE III: CO-CONSCIOUSNESS
Using this simple method for establishing communication, Aunt Jean was eventually able to encourage the personalities to communicate directly with one another.
With each personality’s trauma recognized, the personalities learned to cooperate with one another for their common good. While not always of the same mind, even the most resistive personality came to recognize that each personality had a role to play in protecting Lillian.
STAGE IV: COOPERATION
Chapter 19 captures co-consciousness, a milestone in healing. In Chapter 19 Jean invites the personalities to participate in a public information presentation on the relationship between child abuse and multiple personality disorder.
Each personality's unique differences in style, speech, posture, sociability and interests were revealed as each one cooperated with the others to bring their message to the audience (Pg 181).
In volunteering to participate, each personality supported the other personalities in speaking on the effects of traumatic child abuse. At another point in Lillian's healing, thirteen personalities cosigned an agreement in which each co-signee's agreed to prevent the others from committing suicide.
STAGE V: WORKING THROUGH TRAUMA
Successful healing requires the patient to re-experience the trauma that gave rise to each personality. Known as exposure therapy, the patient is called upon to remember and to re-experience each trauma as it was originally experienced. During this stage many patients literally speak, cry and posture as if they were the age when the trauma occurred.
The events, feelings and body memories experienced during the original trauma are re-experienced in real time. For virtually all patients this is the most painful period in the healing process.
The experience is emotionally excruciating. Many patients during this stage become actively suicidal.
At the time of Lillian's treatment, this stage of therapy was usually conducted within the safety of a hospital.
Relying on the patient's natural defense of dissociation many psychiatrists at the time conducted these therapy sessions while the patient was in a hypnotic state.
Today, other methods such as EMDR also rely on dissociation to ease the patient's terror.
Regardless of the method employed, this stage is one of deep emotional turmoil for the patient. It is not unusual at such times for the patient to take flight from therapy.
In some cases the Stage V process brings never before seen personalities to the surface for the first time.
This process is well described in the introduction to Chapter 21 on Integration (Pg 202).
STAGE VI: INTEGRATION
Integration is the period during which the patient has worked through the most painful of their trauma experiences. During this stage the patient's personalities are no longer needed to protect the patient from re-experiencing their trauma.
It is during this stage that many patients report fearing the loss of their personalities.
As the name implies, integration is not a period of loss but rather it is a period during which Lillian learns to function as a person with a unified identity.
Having relied on "the others" to handle emotional stress Lillian feared that she would not be strong enough to manage the responsibilities of daily life. This was particularly true with respect to Esther's determination and strength of character.
Lillian wrote, "I feel scared. Esther has always been ... there. This is scary. What if I lose Esther? What if something comes up? What if I need her...? Esther is so strong. Can I be like that?" (Chapter 21, Pg 204).
Patients during this stage may also create pseudo personalities. These personalities do not represent true splits in identity. Rather, these pseudo personalities serve the function that was once performed by one or more of the personalities.
During integration Lillian created Christine, whose function it was to protect her son James.
In a letter, Dr. Milton Robinson wrote to James' case worker (9/10/82), "Lillian out of her own desire to protect James has created a new personality. This personality has only been a protective alter who has no need of her own.”
Such personalities often fade quickly once the patient becomes more self confident.
While integration represents the ultimate goal of therapy, it is not without its trials as the patient must learn to manage life on their own.
During this period Lillian found herself feeling lonely and overwhelmed. “I'm losing everything. I'm losing all the parts of me. I thought I would be accepted as just Lil but it was the 'Others' that made friends, that could do everything, that kept our house working, that cooked the meals. I even failed as Jim’s wife. I just want to run. Jim must have felt it was others that could be affectionate with him, not me.” (Journal entry 01/03/83)
Lillian felt undeserving.
"I'm not good enough... the house is a mess. The dishes need done. Clothes need washed ...I'm not good at being me. The only way to please Jim is to bring the "others" back. It was the "others" that could do everything - that kept our house working, the meals cooked and things running smooth." (Journal entries 01/03/83, 02/08/83, 02/15/83, 02/18/83)
Over time the loneliness faded. Lillian came to have a more realistic sense of self-worth. Finally Lillian was able to see the goodness in herself.
STAGE VII: FUNCTIONING AS ONE
After Lillian's final hospitalization and with her treatment complete, Lillian set course for a more normal life.
No longer separated by hospitalizations, Lillian rejoined Jimmy; at first living out of his truck, then staying in motels and finally moving into an apartment near Jim's parents in Ohio.
Although Lillian remained depressed she considered herself a happy person - "Who am I now? All my time is mine. Not lost. There are tears by the bucket for the lost years I now will remember, along with the feelings. I don't automatically know how to cope with everything at once but I'm staying one person. There are frustrations, glaring mistakes, faltering steps, and once in a while success. I am relearning. My husband and children continue to stand by me. I know how much they love me." (Pg 302)
Lillian was living proof that one can heal from multiple personality disorder.
