Dissociation from person is called depersonalization … a curious feeling that one is not one’s self.  Like the symptom to be described next, it’s not uncommon for that form of dissociation to be accompanied by a panic attack though that’s not always the case.  Survivors often experience a fascinating, low-level form of depersonalization which involves difficulty recognizing them selves.  They may look at an old photograph and have a curious inability to connect with the photo; they do not experience it as a picture of them.  The symptom has to do with what might alternatively be thought of as a sort of compartmentalization of their histories.

 Dissociation from place is called derealization.  In whatever situation they find themselves, there is a sense that it is not real.  Perhaps the best characterization of the experience is that it is like looking at a picture or video of what is in front of them rather than the reality of the moment.

 Dissociation from time is manifested as déjà vu … a feeling that one has been there before.  It is an emotional reaction to the present as if it reflects a past experience though that past experience eludes actual memory.

 Keeping bits and pieces of themselves stored in different rooms of their minds, so to speak, helps to cope with their histories and keep memories from breaking through.  Should the monsters of the past be able to break through, there is the risk of ego-fragmenting rage and grief accompanying those memories.  The power of that rage and grief is such that it can blast the sense of self into nothingness.  Because survivors have, instead of a solid block of a self, a somewhat loosely cemented self composed of bricks with fragile mortar holding it together, it can be exploded, disassembling the self into a sense of nothingness.  The defenses of survivors are largely concocted to avoid the emergence of the overwhelming and potentially fragmenting rage and grief that are associated with their memories.  In a sense, it is not the memories that are defended against, but, rather, those incredibly powerful emotions.

 The foregoing is all background to be being able to talk briefly about how discontinuous their own histories are experienced.  For most people, their lives are a continuous stream of historical events … a smooth, coherent movie of sorts which chronicles those lives.

 Survivors, on the other hand, tend to relate to their lives as discrete vignettes with little or no connection to each other, rather like a book of novellas which have little to do with each other.  While they can relate to, recover and remember those novellas it is as if the next novella has no relation to those which came before and those which came after.  I’m not sure what one would call this manifestation of dissociation or, if you will, compartmentalization.  Certainly it has to do with time but so too does it have to do with person since it is as if some different person, or persons, had lived those vignettes.

 There is far more that could be said about the dissociation symptoms of survivors … far, far more to be sure; but the near universality of their experience of their lives as a series of unrelated vignettes is particularly fascinating from a clinical perspective, not to mention particularly disconcerting in the experience of the survivor.

with greasy arseholes they don’t know from a jukebox slot

and barely know from a jukebox slut

and I wonder what Cassidy would be doing now

     God give rest to his soul

     and Jack’s, for chrissakes

          Jack marked Neal’s passing

               who marks Jacks?

They vomit their violence on every corner

into every slanted gutter, lucky not to slip in it and lose a leg

up on the universe

lucky if they could understand that a leg up is the way to piss

away their lives so, at least, those might have some meaning

and the harmony still eludes us all

the attempt to catch a bit of the universal riff

the beat, man

beat beat beat

The handle of Goldman to flush the toilet can only be reached with

the tongues of the fools to come on the hill

in the mouths of the beetles

and god but didn’t they try to get it all together

but one runs marathons with Cassidy across the years and works

and for all their running they never caught the brass ring

which probably doesn’t exist

I don’t think they knew Jack or Neal

but the brass ring has to be believed in to go on

I don’t think the feral monsters even know about that

They seek only to destroy and not a fucking one of them knows why.

and move aside when you wish to stand alone.

I would encircle you in tender safety when you would be held

and content myself with the rapture of your presence when you would not.

I would cradle your rage as gently as the tears which lie beyond

and make a necklace of your laughter to wear when we are apart.

I would champion your will as if it were heaven’s own,

and soothe you in defeat.

Yet if you would leave I would not hinder but wish you Godspeed.

Though I might pray each evening for your return,

I would comfort myself each morn with the gentle sunrise of your memory.

Without regret would I give equal thanks

for the time I was allowed in the starburst of your beauty.

misapprehension of our dissonant perceptions is at hand

and due to faulty dialectic synergistics more or less.

Exactly how things got this way is anybody’s guess.

There seems to be a lack of consonance, a double bind

communication, meta-message, transaction’ly disqualified,

not to mention derivations of unconscious fantasies –

both systemic ego conflict and some id perversities.

The consequence of eloquence is never to be heard

since attention’s drawn to syntax and semantics of the words.

In addition connotations are abetted by projections

which replace entropic losses with our tangential reflections.

To make the situation worse, undifferentiation

from respective family ego masses blocks our few assertion

possibilities since fusion of respective pseudoselves

allows triangulation in of MORE with bats instead of bells!

How we’ll manage ever in attempts to verbalize

some semblance of a crystal message not distorted or disguised

I can’t imagine and suspect its really all just an illusion

and that those who say we can all have an obvious delusion.

to soar midst aspiration’s fantasy!

Such wond’rous longing, such dizzy spirals of affection given

that dash and flutter through valleys where, but for this,

only dispair lay, and blackness.

What consuming delight

for which to say enraptured would be shameful heresy.

And what an odd, confusing twist –

what a crumbling and melting

to have the brilliance of such light

wax to searing flame of star’s most violent center.

What sad loss, what redoubled ache

is occasioned by delight ascended into agony.

Turned from, how with wistful memory,

it recedes to dusty past

and fades to languid glow

to bathed in only in the soft darkness of dreams.

The disorder appears to strike almost exclusively females in their late sixties to mid-seventies, the mode being early seventies.  The onset is rather sudden (over less than three months).  The clinical manifestations are the development of persecutory delusions and, usually, auditory, visual and even olfactory hallucinations.

Professionals I’ve tried to talk to about this odd disorder are prone to pass it off as dementia or medication effects, but neither has proven to be the case.

While psychosis can develop in persons with dementia, it is clear that these women do not have that disorder.  Dementia is defined as having (1) memory impairment and at least one among the following symptoms: Apraxia, the inability to carry out normal motor tasks like buttoning a blouse; agnosia, the inability to name common objects; aphasia, difficulty with either or both verbal expression or receptive aphasia in which the words of others sound like nonsense; or, finally, disturbance in executive functioning (calculation, judgment, reasoning, etc.).

NONE of the women observed as having this disorder exhibit any significant signs or symptoms of dementia.  It is common for them to be fully competent in self care, to manage their finances just fine.  Their grooming and homes may be immaculate and, outside of the effects of the psychosis, they function just fine in every way.  Neither have medications problems been associated with what I’ve observed.  Many who have come to my attention take no medications whatsoever.

These women often come to the attention of law enforcement, either through their proclivity to call 911 about some imagined intrusion or persecution or through calls from neighbors or family.  The come to the attention as well of Adult Protective Services agencies because of their behavior.  The nature of my work is such that I haven’t been able to delve deeper into the problem.  I have, however, been aware of enough cases involving this psychosis to know that it can persist for at least 3 years without the development of any significant signs or symptoms of dementia.  It appears for all the world to be a stand-alone psychosis.  I might add that no mood disturbances have been observed, ruling out psychotic depression, and there have not been any prior histories of psychotic disorders.

It’s intriguing to ponder what the heck this is all about.  How long has this been going on?  Has it forever been glossed over as simply dementia or is it a relatively new problem?  If it is relatively new, why is it showing up now?  Is it simply a matter of longevity (as has been the case with the increase in the incidence of dementia); is it environmental; is the psychosis even treatable (I have my doubts)?

I doubt anyone of note or influence is likely to read this, but I’m hoping somebody, somewhere will think “whoa … there’s something going on here” just as they did eventually with the association of migraine headaches with PTSD.  I’ve been all over the internet hoping to find some other description of this anomalous psychosis without even a hint that it’s been noticed.

Have you seen this?  Share your story.

I listen to a lot of podcasts and one phrase that rubs me wrong is “growing a business” (or some variant thereof).  It’s the seemingly way out-of-place and unnecessary agricultural reference that’s irksome.  Why not just say “expand … business?”  The image of someone planting business seeds, watering them, and standing back to wait for them to grow just doesn’t work.

It occurs to me as I write that the phrase might be redeemed if the allusion was taken all the way as a metaphor:   Toss in fertilizer in the form of new ideas, increase the number of field hands to take care of the crops, plow under old practices to enrich the soil for new growth without losing the old nutrients, obtain new acreage on which to grow things and other metaphorical references might help.  However, the single, out-of-place allusion just doesn’t work … and anyone subject to such a sheep factor is unlikely to score big through innovation.

Since there is such a powerful sheep factor, I doubt the phrase is going to go away, so I get to keep grumbling.  Life is good.

 SERENDIPITY?

 When I was in graduate school, I had one opportunity in two years to take an elective course.  Schools of social work are sanctioned by the National Counsel on Social Work Education which requires any university offering degrees in social work to ensure certain core curriculum is largely consistent no matter where one attends school.  It’s more than a bit unique to have a nationally standardized curriculum and it was a surprising opportunity that I could squeeze in an elective.

 The course catalog offered one entitled The Biological Bases of Behavior.  While my interest was largely in intrapsychic phenomena, I thought I probably should learn something about what the course suggested would be the content.  It turned out to be quite different from what I was expecting.  For one solid semester, we studied the process and uses of mental status examinations, differential diagnosis, and just a twitch about the use of medications in treatment (the sole ‘biological’ element in the course).

 I was enthralled, fascinated and generally jazzed by mental status examinations and their capacity to get at deep, intrapsychic processes and symptoms.  I went on study further on my own, doing such obsessive things as reading a psychiatric dictionary cover to cover to help me know what to look for and what to call what I might find.  Over time, I developed some tactics and techniques of my own for performing such examinations.  Serendipity had primed me to notice things no one who had researched and written about sexual abuse survivors had ever touched on other than a few, nonspecific generalities … such as the fact that survivors have nightmares.  What had been missed was a collection of shared symptoms which were astonishingly similar and consistent across class and culture.

 ROOKIE

 My first job after graduate school (I had been in public social services up to then) was in a mental health clinic.  Not terribly long after I started there, I saw a woman who had been mandated to seek treatment by Child Protective Services in connection with the abuse of her children by her male partner.  I was, of course, doing fairly thorough mental status examinations as a part of my intake evaluations of new clients and noted some symptoms which, at the time, appeared to have some logical connection to her situation and reason for being referred to the clinic.  From her I learned just a very few things.  I thought I might be onto something that had to do with risk factors for abusing children or associating with abusers.  I was barely even warm.

 I should interject that a colleague had talked excitedly about an upcoming conference at which Susan Forward, whose book Betrayal of Innocence had come out about the time I graduated, was going to speak.  My colleague said it was all about the sexual abuse of children … would I be interested.  Naw; I couldn’t see that particular issue as being something in which I’d be interested.

What I did do was request that any new clients seeking treatment at the clinic who had been referred due to any child abuse issues be assigned to me for their initial evaluations so that I could see if I was on to something.  Boy howdy, was I ever, even though I was at best lukewarm.

 In those interviews I probed deeper and developed techniques to get at things I had no way of knowing might exist in addition to what I did know might exist.  Along the way, the collection of symptoms was getting fleshed out so clearly and consistently that I could (for myself, at least) comfortably call the patterns a syndrome.

 EPIPHANY

 I began to incorporate those techniques into my usual mental status examinations with other females.  What I found was that many other women, who had no child abuse-associated problems or complaints, had the same syndrome.  Out the window went the vague hypothesis about child abuse proclivities in behavior or partner choices.  Sneaking in the back door was their common history of childhood sexual abuse.  I now knew what it was all about and gobbled up mental status information like turkey and dressing at Thanksgiving.

 Even though I had blown off the Susan Forward thing, I knew enough about the sequelae of childhood abuse to know I had made a unique discovery; so unique, in fact, that I knew I would eventually publish what I had found.

 I had reason, not terribly later on, to consider that blowing-off as very likely a defense mechanism.  (In one session of my own personal therapy, talking about something that had nothing to do with my topic here, my therapist suggested something to me that might be a factor in what I was talking about at the moment.  I protested that the suggestion had absolutely nothing to do with anything, period … and promptly dissociated into a depersonalized state.)  Being cursed with a fairly good and active capacity for introspection I began to challenge myself.  Sure … this stuff was absolutely fascinating from a clinical perspective; sure … it was a somewhat momentous discovery; but exactly why was I so obsessed with it?

 COMPLETION OF THE CIRCLE

 One of the symptoms I had noted, discussed in a post here though it may not quite properly be classified as an intrapsychic symptom, was migraine headaches.  My mother suffered terribly from them.  Other symptoms, which I call associated symptoms, existed around the family.  Those ‘associated’ symptoms were what Susan Forward and many others spoke of:  Depression, anxiety, relationship problems, poor self-esteem, etc.  Because lots of people suffer those problems that have no history of abuse, it was correctly thought that such problems were not flashing red lights when it came to sexual abuse.

 A matter of months before the publishing of my first paper on the syndrome, my father committed suicide.  In the wake of that, my mother (I finally feel comfortable with this revelation since she passed away some years ago) invited me to take her on a drive into the mountains to a park.  Once there, we sat on a picnic bench and she told me of her rape by a cousin at age 6.  She spoke of how, had she sought some kind of treatment, her relationship with my father (from whom she had been divorced since I was 14), and our very lives, may have been very different.  Though I had harbored my suspicions, I did not solicit the information but it was as if converging lines of my life, my career, my understanding of my family and a host of other things finally came to a single point and exploded into a circle that encompassed it all.

 She spoke as well of family suspicions that my father had been sexually molested by a Scout leader he had, and her suspicion that his mother (my grandmother) herself may have been at the very least inappropriate with him.

I have probed deeply enough into myself both affectively and intellectually to be reasonably certain that I was not victimized as a child.  However, the victimized were a part of me and that colored my life in countless ways, not the least of which was being led down a trail of discovery that ran from a community mental health clinic, out into the larger world in a meandering circle and right back to the heart of my own family.

 Out of respect, I cannot speak of other family members other than to say I’ve had multiple suspicions and not a little corroboration of those suspicions.

 So here is the blog, the syndrome, my concern for my figurative sisters, my anger at the psychiatric establishment for name-calling, and, if I may please be forgiven, my tiny bit of pride and satisfaction about having been able to help things along at least a little.

 As Forrest Gump would say, that’s all I have to say about that.

SURVIVOR

I still see the evil shadow in the darkness of the night

from the bed where warmth and safety should have been my given right.

I hear the voice which calls my name or cries out in distress

I’m terrified of being left alone in helplessness.

For in the blackness, in the night when I am all alone

is when I hear the footsteps, bumps and breathing in my home.

Even when I sleep I cannot find escape or peace.

Nightmare earthquakes, floods and fires, vicious frightening beasts

threaten me or family and chase me out of breath.

and perhaps the worst of all of these are the dreams I dream of death.

Daylight drives the dreams away but not my haunting fear

of furtive shadows in the halls, of unseen eyes that leer,

of sudden movements captured in the corners of my eyes,

of the evil presence, the unseen touch that chills my soul to ice.

I live in silence with all of these because I fear that maybe

if I told you of these awful things, you would think I’m crazy.

SOLITUDE

 An overarching phobia common to sexual abuse survivors is solitude.  If you have read through the previous posts, the reason will be clear:  Hallucinations, especially, are far more likely to occur when the survivor is alone.  The need to avoid solitude is one factor in survivors sticking with lousy partners; the reality of dealing with a dork beats the terror of dealing with hallucinations; better the known than the unknown.

 NORMAN BATES SYNDROME

 Survivors dislike (to put it mildly) showering when alone in the home.  In addition to the factor of solitude, there’s the ultimate in vulnerability.  The survivor is alone, naked, cornered in a shower, has her vision obscured by a shower curtain or door and the ability to hear a potential assailant is masked by the white noise of the spraying water.

 When the task must be accomplished alone, many survivors take special care never to have their vision further obscured by the act of washing their faces or shampooing.  They often carefully wash their faces in a way that allows at least one eye to be open.  It doesn’t take much imagination to understand why I refer to this as the Norman Bates syndrome.

 GUNFIGHTER SYNDROME

 The classic old position of the wild west gunfighter in a bar, sitting in a corner facing the rest of the room (and the door) had its utility.  The possibility of missing a potential threat was greatly reduced, albeit at the expense of being cornered.

 Survivors are particular about the placement of their beds.  They would never face the bed in such a way that there is not an easy, clear field of vision to the bedroom door.  They will in addition, with the foregoing being the number one rule, avoid having the head of the bed under a window.  The preferred position, if possible, is having the bed located such that they can clearly see the bedroom door, any window(s) and any closet door.  Yes … there are boogie men in there.  The closet door, of course, would absolutely never be left open or even cracked.  The bedroom door, however, has to be kept open in order to be able to see any approaching threat before it got to the actual doorway.

 I’m hoping that as survivors happen upon this blog, they will share some of their particular experiences with hallucinations, phobias and the like.  For one thing, I am always interested in learning more about the variations in those symptoms.  In addition, other survivors to follow would be afforded some corroboration of their own experiences and not feel so alone and so … well … crazy.