Called to Flourish Podcast: Dissociative Identity Disorder

0:10Welcome to the Call to Flourish podcast. I'm Thomas Cronquist of Divine Mercy University, and I'm your guest host with father Charles Sikorsky, the president of the university. And, father, we have a very interesting topic today. We're we're speaking with doctor Ben Keyes again, our program director for the Center of of Trauma and Resiliency Studies, and, he's gonna be talking to us about dissociative identity disorder. So very much looking forward to that. Father, how are you doing today? Well, yes. Looking very forward to this conversation. I know I I think this is one of doctor Keyes' favorite topics and something he spent a lot of time studying and researching. Doctor Keyes, welcome. This is our, I think, fourth podcast with you.

0:52They're always very interesting. And and can you tell us what exactly dissociative identity disorder is and how you're involved with that? Dissociative identity disorder used to be called multiple personality disorder. We used to believe that as the person, fragmented in their thinking, in their psyche, that they were separate parts that grew up alongside of each other. Due to research, we realized that it was a single personality that had literally fragmented into parts because of the trauma that they experienced, predominantly around childhood sexual abuse prior to the age of eight. Now when I came up through the system, I was told that if I saw a DID client, it would be once maybe in my entire career.

1:54Well, I've had a career of working with this, and seeing several 100, DID clients, over the years. And it really wasn't until 1989 that the first two books came out on how to treat and diagnose dissociative disorders, particularly DID. Now, if you had been trained prior to 1989, you would see it, and you were told that it was this rare sort of thing. It turns out it's not that rare at all. We just didn't know how to find it or how to look for it. And it's approximately one percent of the entire population, at least in The United States, and it's about ten percent overall of clinical populations in hospitals and treatment centers. That's fairly high percentage, and what's interesting is that those numbers have stayed very steady over research in I I think the total is now 62 countries.

3:13I was involved in, the research that was done in the People's Republic Of China, where this is a a culture that was pristine. The cultural model of of, dissociation says, well, of course you find it. You know, it's in your literature. It's in your books. It's in your movies. Well, this was a pristine culture that didn't have it in its books or movies or anywhere. They also didn't treat it, so nobody really knew about it unless they had been trained in the West or in Europe. And we basically, over a number of years, research, we basically found the same thing as we did in every other country, about one percent of the overall population and about ten percent of the clinical population in hospitals and treatment centers, and very consistent with the rest of the world.

4:13And so what it did was it dispelled the cultural model, basically. As a result, the research team, myself and doctor Colin Ross in Texas and our Chinese, partners all received an award from the Journal of Trauma and Dissociation, for the work that we did. This is something you spent so much time on. This is this is this is something very, you've lectured on it. You've you've done research. So I'm gonna be the, you know, I know a little bit like Sybil, the movie, the book. What misconceptions do I have on how this works, and and how does this, maybe you could just give me an overview of what this, disorder is. The the word myriad comes to mind. A myriad. Okay. Well, first of all, the work of Cornelia Wilbur, who was Sybil's therapist, really came to be known, and for a long time, this was, this was all most of the world knew about multiple personality disorder.

5:32Then along came Eve Carlson, the three faces of Eve, and we didn't quite know where to put it or what to do with it. But in the literature, more and more stories about these type of clients started coming to to the fore. Over time, we began to know that this was a disorder that happened in early childhood. It was tied predominantly to early childhood sexual trauma. There were a few cases that were outside of that, but it was minimal. For instance, I had a client that at age seven went through a operation for appendicitis in the twilight state. She went through the entire you know that twilight state where you can't talk, but you can hear everything and you can, you can feel what's going on?

6:36She went through the entire operation that way, and literally fragmented. The sexual trauma happened later, but the fragmentation happened at the time of the surgery. So it's overwhelming trauma that causes this and it it causes a fracture. And we do what's called compartmentalization. The pain goes over here, the hurt goes over here, the betrayal goes over here, and now instead of being in one whole place, they're now in separate places. And as the child grows and into an adult, those parts literally solidify into sometimes what we call altars. In other words, parts of self that can take independent control of of the body and sometimes have, either full or partial amnesia between the parts.

7:41In other words, the parts don't necessarily know each other. So a doesn't know b, b doesn't know c, they come out, they do what they do, and the person ends up losing time and they experience it as lost time. Oh, the last thing I remember I was making breakfast and it's 04:00 in the afternoon. And these are sort of common symptoms that show up that really lead to the diagnosis. But the two things that you need is you need the amnesia and you need that the part takes executive control of the body, at least one of those parts. And so the person doesn't necessarily know that they don't know that they have this problem? How do they realize they have a problem? Like, what Or how do they get diagnosed?

8:33Often, they know that they have a problem when they start hearing stories from other people and their that the the their experiences don't match up. You know, they very often the child assumes that, you know, everybody loses time, because that's their experience of it. But as they hear that it's not there, they realize that some something's wrong and something's missing. Often, they come to therapy for depression or a marital issue, and that's when it's really discovered that there was this trauma that occurred in early childhood that set up the fragmentation. And usually, a client is in the system, I think the average is close to seven years, seven point two years, before they are accurately diagnosed.

9:32They're diagnosed as schizophrenic. They're diagnosed as bipolar. They're diagnosed as pretty much anything in the, personality disorder category, and yet, and I'm almost sorry that it's classified as a disorder because it comes about as a defense mechanism. It's a way of a person coping with overwhelming trauma that doesn't make sense to them at their age and doesn't make any sense of what what can I do with it and how can I cope with it and how can I deal with it and the fragmentation occurs? Today, there are so many cases. We hear about so many cases of sexual abuse, sexual abuse of of minors. But I'm wondering, with the prevalence of pornography, is that a strong enough can that be a strong enough, trigger exposure to pornography as a as a child to to lead to DID, or does it have to be something more physical if you if as it were?

10:32It's usually more pronounced than just being exposed to pornography. For instance, had a client that, and she actually wrote a wrote her story in a book, where her father used her for for pornography. She was the the main act, if you will, and he passed her sexually around to his friends and filmed it and then put it out as pornography sold it, made a fortune. But she was filmed at a very young age and clearly fragmented in her personality. And the traumas that she experienced, well into her adulthood, she would have flashbacks and, you know, memory loss from the different parts talking to her. She eventually fully integrated, fully recovered, became a, a licensed clinical, psychologist and spoke around the world about, recovery, from early childhood sexual trauma.

11:46How would we determine if someone has this? Like, what would what would be signs of it, or what are some of the symptoms that that you would see if you're if you're suspecting maybe you're seeing things that might fit this pattern. Actually, the symptoms are very similar to, symptoms of schizophrenia, because they share the same, what are called first rank symptoms, the positive symptoms. Positive is where something is added to. So hearing voices, seeing things that aren't really there. So you would you would pick this up from someone who's talking about hearing voices inside them, commenting on on their life. Whenever I hear anything like that, I usually will ask about early childhood trauma.

12:43Sometimes they're not aware of the trauma. Other times and most of the time they are, but they're not sure what it was or what happened. They were too young to have full memory of it. Often, the memory get of the event gets put into a place in our brain called the implicit memory, and the only way to reach that is for it to be triggered. It's stored there because it was so overwhelming as it was being processed in the brain that the hippocampus had to put it somewhere, and so they put it in this place called the implicit memory. And later on in adulthood, something triggers it, a smell, a picture, somebody, a phrase somebody says, and all of a sudden, boom, it floods back in, often referred to as recovered memory.

13:45But it's it's very real because that's what the the brain did in order to cope with it. It was so overwhelming, it had to put the information somewhere. Doctor Keyes, could you in your experience, could you, could you give us, obviously, preserving confidentiality as, an experience you had maybe in treating somebody and and success and and helping them to to reintegrate? Can you can you share something like that for us? Give us a little glimmer of hope. This sounds very dire. It's long term. The the normal trajectory for recovery is between two and ten years, and I say that's the average. So, there are clients that have been in treatment fifteen, twenty years, but there are also folks that, that move through the issues and work work through the dissociation, in three, four years.

14:45It it is a long term issue. And that's actually been one of my areas of study is trying to find ways of of hastening that process. Currently, I'm looking at virtual reality techniques that the government our government has been working with for some time with returning, veterans, and that looks very promising. Also, EMDR, is a technique that rapidly processes information and material, and it sort of moves the the treatment process forward. That has been the research on that has been very promising. But you you wanted an example of someone that's worked all the way through the process. My client Sandy is actually a great, great one. It's in the public domain, so I can talk about Sandy, pretty well straight out.

15:55Her book, she's written a number of books, but, the one that we, worked on together was called e pluribus unum, one out of many. And she tells her story upfront, life background and so forth. And then through her artwork, she's an amazing artist, through her artwork tells the story of moving through therapy to full integration. She had seen several therapists prior to me and, actually, one of my supervisors was one of her first therapists and the one that diagnosed her accurately. When I saw her, she had seen about three or four therapists that had just totally opened her up to all of, a lot of the traumas that she experienced, but didn't take the time to close her back up. So, I mean, it was literally like watching a person being an open wound, just hurting all the time.

17:06I worked with her for, about two years, and if you add the other work that she had, it would be a total of about seven years of therapy that, slowly, we work through the issues, we work through the problems, there are a lot of integration of the parts. In other words, the parts come together as a as a single whole instead of being separate. And at the end of this, she had been working as, as a hypnotherapist, doing, you know, smoking cessation and things like that. And she wanted to do heavier work, and so she started doing work with trauma clients, and I highly pressed on her the need for her to do more training. To her credit, she went back to school. She got a master's in counseling, and then she got a doctorate in psychology, licensed as a clinical psychologist out in Colorado, and, wrote books and spoke around the world for years.

18:19Unfortunately, she passed away about a year ago, but absolutely brilliant and sharp. Her dissertation added to the heuristic model of psychology, looking at yourself as a single subject, and what she added to that model was spirituality. And, it was, she was immediately picked up by four universities upon graduation and the work that she did in her dissertation. So, yeah, people do and, do get well, and I tell my clients, if you stay with me, you will, eventually, integrate and be a single personality. So doctor Keyes, I've, you know, I've heard stories. One story I heard was of a woman, I'm pretty sure it wasn't Sandy, who, who held a pretty high level job at a big corporation, but but had this this is dissociative disorder.

19:27And I guess the question is, like, how is it possible for someone, who's shifting back and forth in different personalities and they have this amnesia? Like, how do they function, and how could you possibly hold a big job and still, you know, not lose it or, you know, and and and survive and not not have this called out on them? I had a client, many years ago. Actually, she she worked for IBM, and she had a they had her on a route. She was a a supervisor. And so she lived in Saint Pete, Florida. And her route was that she would travel to Houston, where she had a boyfriend that that she dated, somewhat. She lived fairly well, near where she was working. And then a month later, she would travel to Los Angeles where, she had a live in boyfriend that, they lived pretty much the beach life.

20:39They were on the sand and, she would surf and, you know, it was kind of interesting. And then she would fly to New York where she also had a live in boyfriend who, was very involved in the arts. They would go to opera and art openings and so forth. And finally, her route would lead her back to, St. Petersburg, where she was married with two children. And what was happening was that, these were three major parts and they would shift when she was on the airplane. And so she had absolutely no knowledge of being in Houston, of being in LA, or New York. She just knew that on the on the flight back, in her briefcase was everything she needed to return to the office. Everything was filled out and done.

21:40She wasn't completely sure how it was done, but knew it was. Number of years into this, and this is how I met her, IBM changed her out. And in other words, she was flying instead to Chicago, Chicago first, then, San Francisco and Atlanta. And her internal parts started warring. Basically, you know, Hey, I want my boyfriend back. I want my clothes back. I want my lifestyle back. What are you doing? And the internal battle was so severe that she she went into counseling, she was referred to me, and and and sure enough, there was there was the amnestic barriers that we talked about earlier, between the parts. They didn't know each other, but with this happening, all the the parts inside started talking to each other.

22:57She, she, the one that was living in Saint Pete that was married with two children, had no idea of the other three parts. And as it turned out, she had a total of 10 parts, And that's considered low, but 10 very separate parts. And, you know, working through the the clashes and the differences, working through what the issues were, getting them to work together were all part of the therapy process. I saw her for another four years. She eventually had to leave IBM because she just couldn't handle the, the switching and the not knowing and and, parts would take over and and she would have no control over it. It was just it was dangerous. So, she stopped. She desperately tried to keep the other parts from coming out, and, of course, she couldn't do that.

24:08But, eventually, they worked things out. Eventually, she, integrated, but it, it took her a total of, six years from the time that I saw her. Wow. And so was she still like I said, when she went to Houston on her route or initial route, like, she would still be doing her IBM work, but having enough, like, this relationship with this other guy and not remembering Not remembering being married with two children back in Florida. Yep. So she could still manage her work, but just, like, in a different home life thing or a different personal life? Correct. And different different clothing, different furniture, different everything between the parts. And and that's that's fairly that's fairly common.

24:58I mean, part parts can be anything. They can be any age. They can be any gender, or transgender. They can be, I've worked with parts that were infants, that were children, that were elderly, that were animals. I worked with two people that had a part that was, one was a cat and the other was a dog. It can be anything. Can you talk just briefly about the difference between schizophrenia, borderline personality, bipolar disorder, the difference between those and DID? You hear you hear, you know, the the different diagnoses used in conversation, but I there must be very, without going too deep, very specific differences between them. This is not a 100%, but, one one of my ways of looking at this is, are the voices talking to the person on the inside and commenting on what's going on, or are the voices on the outside coming to me?

26:21Like, that fluorescent light above me, which just went out, that fluorescent light above me is telling me to, to to say nasty things to you. So if the voices are coming from the outside to me, that's schizophrenia. The voices commenting on the inside can lightly be or could possibly be trauma or dissociation. Now that's not a be all and an end all, and, I I'm enough of a researcher to, to use a certain amount of assessments to be able to look at what their experience is and do they fit in this category or this category. And all of the diagnosis that you gave fit a couple of very specific, assessments that give me a pretty good idea of what's really going on in this in in the person's system.

27:31So you mentioned before. So sometimes these these can get mixed up, and some of the you traditionally have been confusion with that. Are there other disorders today that maybe could be dissociative or are being called something else? Sure. You know, the the ones that were mentioned, borderline personality, bipolar disorder, schizophrenia, All of that gets sort of mashed in depending on when you were trained as a clinician and what you were exposed to as a clinician. So if you were told that you would never see this, you're not looking for it, so it's very easy to not catch it. So if you get symptoms, you call it schizophrenia because, oh, I got voices, oh, I got visualizations of a thing of people.

28:26Well, that's the experience of someone who's dissociative as well. And the in the newer trainings, most schools have started really teaching a lot about dissociative disorder. And the research has borne it out. I mean, the research has been pretty clear, and decisively clear that dissociative disorders are very real, and particularly DID is a very real phenomenon. I know you mentioned this, a little bit when you're telling the stories, about the two different cases you you worked on. So there is it normally a trigger or something that might make a person shift from one to the other? And to what degree can they control that themselves? It really depends on the client. There are clients that have no control over it whatsoever that the parts move in whenever they decide to move in or or out.

29:24There are some systems that are very benevolent. They work try to work together with a person, to, to get well. There's usually one, one alter that is pushing them to get well, to make this work, to, repair the damage that was done. Excuse me. There's often a part of self that is very connected spiritually, and that's often the part that is behind them getting into therapy. It's it's been an interesting journey. And there's, in psychology, there's a whole area of thought that's developed around parts work, parts of self, parts of being. And how do I identify the parts within me and bring those parts into confluence, into agreement with each other, and repair the dissonance, repair the parts that are at war with each other or struggling with each other.

30:42And that really is the therapy process is I I sometimes call it doing, doing, family therapy with one person, because it's really the the the relationship. You have to connect to each part, join with each part, get them to work together with each other, and then, as they're working, the need for the separation starts to be less and less. And that's what happens with integration. One question here then. This might sound overly simplistic here. So you mentioned you mentioned, doctor Kiza, a, predominant personality, maybe it's a spiritual one. Like, how do I know this is really me? Like, when I go through therapy and and is there generally one that's more predominant? And then, like, that's the quote, unquote real one.

31:34How do you sort that out? They go, this is who I am. And Actually, all of the parts are them. What you're referring to is what we sometimes refer to as the core personality or the part that is typically out handling whatever's going on in the world. But they often do that with a lot of help from some other parts. And more and more as they go through treatment, more and more that consolidates. That's that's that's a healthy thing. That's a healing thing. Nothing ever gets lost in the system. Nothing ever, it's it's all there. But, if it's if it's fragmented out, you don't have access to it. I had I had one client that, one part that went to school, so they had all the information from college.

32:32The other parts didn't. So if they were out, they couldn't function at work because they didn't have the mathematical equations and the science that the other part had. So for them to be able to work, that part needed to be out to work. So they had to come to some sort of agreement. Doctor Keyes, are there different, parts that are associated with different types of trauma? I I mean, can you see patterns where a particular trauma would cause this, the separation of of parts? Are there commonalities, patterns that you've seen? Not really. I mean, the commonality is the trauma itself, and and the the the way that we are wonderfully built by god to deal with it. I mean, it's it's it's almost like a safety valve.

33:33If, I so much trauma and overwhelm react in me to a certain point, I need to have some way of letting the steam out. Because if I don't, which often happens, I I I fragment. And that fragmentation can keep going. I mean, I've worked with people with 400 parts. Now you work with them in groups and sometimes large groups on the inside. When I talked about Sandy earlier, I talked about her having 10 parts. That was 10 main parts. When I saw her the first time, the first map showed 250 splits. And one of the things that I often do with with clients is I have them, what's called mapping. What are the relationships inside? Are they close? Are they far away? What parts talk to each other? What points what parts isolate?

34:39And so you can create this map with x's and o's. You can, have them draw a house and they're in certain rooms. I've seen all kinds of different maps. You really allow the client to to do this. Sandy was very, skilled with in art, so she drew the scenario that she was seeing and where the parts were and how they were connected to to, the childhood pornography and the things that happened to her in early life. There there was one area that that was a compound, and these were parts of self from from the sexual abuse that was being filmed over the years. Different clients do it different ways. So it seems like it's generally almost always related to sexual trauma. Is that correct? Or is it always sexual trauma?

35:4497% related to sexual trauma. And then you mentioned this map. So is there a test? Like, a how how do you come up with a map? Like, is that is there a a particular testing mechanism or No. The map the map is really drawn by the client. Basically, I say to them, it could be a collage. I've had many clients do collages. This part is this over here and this part is this over here. And, I've had, three or four of them draw a house with different rooms. I've seen mandalas. You know, this part is this, this part is this, this part is this. Some have names, some didn't have names, but they were all related in some way or another to the whole system. And it's it's amazing when the core part of self that I I mentioned earlier comes to the awareness that they're they are a part of that system.

36:53It's not that they are the part of the system. Different parts normally have different names and different identity descriptions, and abilities. And very often, you know, we we were talking spiritually. Very often, you get a teenager, for instance, who wants to gain control in the system. So, they call themselves Satan. And, of course, everybody goes, Oh, you must be possessed. It's not a possession. It's a teenage alter who's trying to get control in the system and trying to scare everybody. And I I you know, when I lecture, I say I've met I've met Satan at least about 10 times, and I think every demon I can think of, at least four or five times, because these are these are teenage alters that are trying to gain some sort of foothold in the system.

37:55Doctor Keyes, if somebody thinks they might be suffering from this, where can they go for help? It seems like you need a very, specialized training to deal with this. Where can someone look for help? Where do they start? Well, first of all, they can get in touch with me at the center, and I can tell them who's available in their area. I'm connected to two or three organizations that, that work with this. But the in the, International Society for the Study of Trauma and Dissociation, is a group of clinicians. We're about 1,500 strong throughout the world, that work with DID specifically. And, depending on where people are, I can definitely connect them to therapists that can help them. And we teach on how to work with this through the Center of Trauma and Resiliency Studies.

38:59We teach it through our training on sexual trauma and also our training on complex trauma called the HEART model, which is a model a faith based model that I've developed, to work with complex trauma and dissociation. Doctor Keyes, can you give us your, email address again? I know you have in past, episodes, but give us your email address so people can send you questions. And, I think that would be helpful. Sure. It's bkeyes,bkeyes,alllowercase,@divinemercy.edu. So I I just have one final question. You heard Divine Mercy, University. Our mission is to blend science and faith, and we take spirituality very seriously in faith and especially our Catholic view of the person. You mentioned, the spiritual part maybe of the predominant personality or core personality, so to speak.

40:06So to what, what degree could that take control? So someone could be very pious and at the same time have these other personalities taking them into different in different directions? Yeah. Very often. The the part that I referenced is often called the internal self helper or ish. The ish is a part of self that is connected spiritually, often often from exposure from childhood, to Christianity or to, a living God. And they often are sort of pushing the client along to to get well and to heal and to find their way back to God. They often can be very helpful in, navigating difficult areas and working with this. I'm always very happy when I find an internal self helper, because they really are companions, both for the client and for the therapist in navigating the the the world.

41:22It's a magical world. Anything can happen on the inside and often does. So you're only limited by your own creativity and understanding what's possible on the inside. And, some of the techniques that have been developed in working with this are very creative and very useful. We also use dialectical behavioral skills, to help the client manage, their feelings and manage being able to think appropriately in difficult situations as they're working through treatment. Doctor Keyes, I have one last question. Unfortunately, we're running out of time here. I think we could talk for hours about this. It's very, very interesting. And, is there is there, any kind of connection between human trafficking and DID?

42:19Do you see a lot of DID with people who've suffered the trauma of human trafficking? Actually, we used, survivors of human trafficking to test the HEART model. It was a seven year longitudinal study on and and found that it works very well. But to answer your question, yes. And the reason that we used the trafficking population for for this is because almost two zero one, they are either PTSD, DID, or borderline personality. And that's all from their, whenever whatever age or timing that they were exposed to being sexually traumatized and then the continuing of that in trafficking. I mean, you think about somebody that's there against their will to begin with, they're being raped sometimes eight times, eight to 10 times a night, to be able to make the money for the trafficker.

43:31That's a lot of trauma over time, and, you know, it's very common that survivors are using drugs, are using alcohol just to survive the trauma. Doctor Keith, thank you so much for a very interesting talk. I would encourage people to go to, divinemercy.edu for more information about the, your center for trauma and resiliency studies and to learn more there and to and to also, maybe communicate with you through that. I look forward to, more very interesting, conversations with you. This is, I think, number four, but I'm sure there are gonna be more in the future. And, again, thank you for your time. Thank you, Tom. And father Charles, thank you so much. Thank you, doctor Keyes. It was a fascinating conversation.