Dissociative And Unsure Of What To Do

You mean, what are you supposed to do when you get home besides making a life for yourself as best as you can (e.g., find work, a place to live, and maybe make some friends)? Well, I’d have to agree with “those who are aware of your situation” that besides finding a place to live and to work, that you should also see someone to help you cope with your conditions. Not just anyone, however. I think you would benefit from seeing a psychologist or other counselor senior and experienced enough to have experience working with dissociative patients. I recognize that you are tired of seeing therapists and doctors and that you want a break from it. I also hear you saying that you are self-harming, are suicidal, and have attempted suicide on more than one occassion. You are experiencing a sense of being influenced by additional “personalities” that appear to live inside you. Judging by your remarks, one or more of these “personalities” doesn’t like “you” very much. Maybe that is what you mean when you say that “Satan” is playing with you (e.g., that one of these personalities is messing with you), and maybe you are just speaking metaphorically, but either way, things seem difficult for you, and you are having a great deal of difficulty managing to hold yourself together. Having a regular place to go where you can get some support from an understanding expert professional who can offer you good advice sounds like a good idea to me.

A few thoughts about your diagnoses, for those people who maybe aren’t familiar with them. Schizotypal Personality Disorder is a sort of not-quite-psychotic version of Schizophrenia. It is used to describe people who display eccentric and odd behaviors; who dress funny or have odd mannerisms, or hear voices but who are still essentially grounded in reality. Now, normally, when someone complains of hearing voices in their head (or “personalities”; not all that much difference there sometimes), the first thought that comes into a clinician’s head is generally going to be “Schizophrenia” becuase that is the most common reason why someone might be experiencing auditory hallucinations. However, there are several alternatives to Schizophrenia that can explain auditory hallucinations that must be considered, including substance induced psychosis (like the type that occurs when you do too much cocaine or crystal meth), and dissociation. Drug induced and schizophrenia induced hallucinations share a common brain-based mechanism – a naturally occuring chemical in the brain called Dopamine has become unbalanced from how it should be (amoung other problems). Hallucinations that occur due to dissociation have an entirely other cause. With dissociation, the brain “hardware” is essentially intact (or so we think), but the mental “software” that runs in the brain has gotten a little segmented. A normal brain supports a single identity; a single unified sense of self. However, in the case of severe dissociation occuring at a young age (often due to abuse), you can get a situation going where the mind gets all partitioned into discrete little units that don’t know how to talk to each other very well. Kind of like, if your 100GB hard disk got divided up into 10 little 10GB logical sections. This happens becuase some of the memories that need to be stored on the disk (in the brain) are horrific enough that the child’s young mind doesn’t want any other part of him or herself to know that those things occured. Once this happens, normal identity development sort of stops, and what the child is left with is a sort of set of partial selves that duke it out amoungst “themselves” for who will drive the body around. This is the situation described by the diagnosis of Dissociative Identity Disorder, or DID (formerly Multiple Personality Disorder). In the context of DID, voices that are heard, are generally voices of one “sub-self” talking to another “sub-self”.

If you have DID, the importance of a diagnosis like Schizotypal Personality Disorder kinda becomes besides the point. The Depression and Anxiety diagnoses are important, particularly becuase of your suicidality, but their otherwise straightforward treatment is complicated by the DID.

That you are self-harming isn’t all that unusual, given the other issues you are describing. Again for people who don’t know, self-harming (generally performed by cuting one’s self with a blade, or burning one’s self) is generally not a suicide attempt in of itself, but rather a self-punishment, a means of letting off steam or tension that has no other good outlet, or alternatively, a way to bring one’s self back to “reality” when they are dissociated (spaced out).

Given the substantial chaos in your mind, the suicide attempts, the self-harming episodes, the blackouts, and the like, it really will be best that you form a relationship with one or more mental health clinicians (therapists) who can try to help you manage. There would be a few goals to such contact, the first being to monitor your suicidality and try to prevent it from reoccuring. Other immediate goals would include to help teach you better, less dangerous and troubling means of coping with stress, and to help you learn how to have better control over your moods through practical means (e.g., by exercizing, by learning to dispute irrational thoughts, by learning self-soothing skills, etc.). Anti-depressant and anti-anxiety medication may be appropriate for you as well. If this were determined to be the case, you’d need to see a physician as well (a psychiatrist would be best, but a regular doctor would do too).

It is possible to address DID with psychotherapy, and that might become an ultimate goal of your therapy over the longer term. However, the process of addressing DID in therapy can take a long while to accomplish and can have mixed results. Sometimes things get stirred up in an unhelpful way and the situation is made worse. Really, you would need to partner with an experienced therapist and the both of you would need to decide that working on the DID was the thing to do (rather than just trying to keep you emotionally together and practicing coping techniques) before it would make sense to go foward with that goal.

Ex-soldiers are sometimes eligible for health care benefits through the VA Medical Centers. If that is the case for you, you’ll want to look into whatever services they may be able to provide you. Treatment for your depression is more likely to occur than for your DID (for the former can be handled medically, while the later requires longer term psychotherapy), but you can ask, and you should ask for such help.

It would be good for you to find a therapist with whom you can maintain a relationship for a long while, if possible. This may not be available through the VA, or through any other health insurance you may be eligible for. You may need to pay out of pocket. I don’t know where or how you might find the money to support this activity, but if you can find it, I’m saying that it would be a good investment in your health to spend on therapy for yourself if the alternative is decompensation and suicide. Ask if your therapist will work with you on a sliding scale if necessary; as many will for documented cases in need.

Apart from seeking out medical and psychotherapy care once you get back home, there are a few other things you can look into that might be helpful: Check out various internet communities for on-line support. Mental Earth (www.mentalearth.com) is one I can recommend, but there are others out there too. You’ll even find that other people with DID are on-line, and can help you to understand how they have learned to cope with their condition, and what has worked for them therapy-wise. Finally, read about self-help methods online and through your local library (both sources of free information). Our self-help book, “Psychological Self-Tools” is a reasonable place to start. The sections concerning self-soothing and relaxation techniques may be of use to you, for instance.

Good luck.