Gaps in the Service (NHS)

In the last depressing post, I told you about how things went pear shaped last year. So what happened after it all went wrong? November was pretty awful. December was really bad but less 'risky' and January to March have just been dark; not risky, but dark.

In November (I think), there was one miserable day that started with dissociated cutting (it happened out of the blue while I was loading the dishwasher); then a child part calling T on the phone to tell her that she was scared which then resulted in me going down to see her at her office and her having to try to make arrangements for my safety. Because T was concerned about the risk of me ending my life she tried to refer me to the 'Home Treatment Team'. I was having suicidal thoughts and couldn't promise her I would be safe, you see. The Home Treatment Team assess people to see if they need to go into hospital or if they can be supported to stay at home with daily visits etc. I agreed to the referral, partly because I knew I didn't have a choice and partly because I was also scared for myself and felt if I could just be locked in a room I couldn't do too much until this passed. She rang them to refer and they basically told her they wouldn't accept the referral because I didn't have 'a serious mental illness'.

In these parts there is this thing about mental illness being different from conditions like personality disorders. The Home Treatment Team don't accept people with personality disorders because they don't see that as mental illness. I'm not really sure of the details of this so correct me if I'm wrong, but it might be something to do with absence of psychosis that they reject you for.  I don't have a personality disorder, to my knowledge (and I have checked with T a few timesabout this). I have a dissociative disorder. Because this is seen as something that is caused by experiences, it's not seen as an illness ie it's an adaptive coping mechanism or a neurosis. I agree, my problems aren't going to be all sorted out by medication; my problems are more likely to be sorted out by someone helping me to work through the trauma. BUT, if I am suicidal I am still in need of protection and probably medication to see me through that time and prevent me from ending my life. Also, who's to say that the two are mutually exclusive? It may be that I have Dissociative Identity Disorder but also have a depressive episode that is serious. And surely if one of my alters is trying to end my life, my thoughts are in some way disordered at that time? It just seems like a bunch of words and definititions that have been made up, probably for a good reason, but a side effect is an issue where real people who need help don't get it.

The problem is, if someone who doesn't have a serious mental illness diagnosis is suicidal then what is to be done for them; because to my knowledge, hospital admissions have to go through the Home Treatment Team? (I would personally question how someone can be suicidal and not mentally ill: again, it's all just words isn't it?) What are these people to do? Well, T was advised to refer me to psychiatry and the Self Harm Team. These would have been wonderful ideas, perhaps for me on any day over the previous few months where I was going downhill but in my crisis at that moment, waiting three months for an appointment with a psychiatrist wasn't really very helpful. Or as T put it: "there is a gap in the service".

So because I fell under the category of not mentally ill, in the Home Treatment Team's opionion I was refused the only route of access to safety and protection the local Health Trust had to offer. It seems like, if you don't have this magical diagnosis then you can f**k off and die somewhere else. Having a diagnosis of DID is just a slap in the face from all angles. My doctor won't acknowledge it: ask my GP what my record says and she will say I have chronic depression, not DID, not even a dissociative disorder, because her computer doesn't have a code for that. And so she will not talk of, or acknowledge anything but depression with me. Yet ask the Home Treatment Team to help and they won't acknowledge me because I have a dissociative disorder. More words and definitions that forget about human lives. What about individual human beings who are real people? If the people in that team were dealing with a member of their own family who was suicidal, would they be refusing them an assessment? I very much doubt it. They'd be doing everything they possibly could to make sure that person was safe.

If my understanding of any of this is wrong, I DO NOT apologise. Because, I am not stupid. If I can't understand how the services work then there is something wrong with how the services are communicating with service users. All I know is, I needed help and it was refused. I wonder how many people have been in the same situation as I was in and did not live to complain about it in a blog post? Who speaks up for those people? A gap in a service where it involves people who are in danger of death is not going to be highlighted by those who die by suicide. They can't speak up and tell the world that they were refused help.

For me, at that moment, on that day, I wasn't surprised. I knew enough of how that team works. In fact, if I'd been more my usual self I would have thought to tell T not to bother calling them as I would have known how it would go. I was actually relieved not to be taken on for assessment because the last thing I wanted was interference that wasn't simply just locking me up so I couldn't hurt myself if I switched to the part that wanted to die. I would have accepted going into hospital for my safety but I did not need someone coming round my house daily to check I was still alive. My issue at that moment was not that I was planning to end my life, but that another dissociated part was planning to do it and I was afraid I could not control that part. I felt I just needed a place of safety.

So what happened? Adam came to T's office where I was waiting, wishing the ground would swallow me up. I love my T and sympathise that she also could not find support that I needed and probably felt a bit alone at that time too but I could see how the process needed to go. She had a professional responsibility to ensure I had a safety plan; I'd already said I couldn't promise I wasn't going to end my life so she had to act on this. She was denied help as much as I was. So what was she to do? She needed to have it recorded that I had a safety plan; I suppose that's something they have to do. In the end I just had to lie. I had to say I wasn't going to hurt myself, even though I didn't know if I would or not. I'm sure she understood that it wasn't in my gift to make that guarantee but she needed it documented that I had a safety plan. I still feel bad about the fact that I just had to help her tick that box by being dishonest. She'd only recently told me that she admired my honesty (as a quality that I have in general) and there I was clearly just agreeing to something I didn't honestly believe I could stick to if I dissociated into the other part.

We also agreed Adam would look after my medication because I admitted I had been Googling how to take an effective overdose. I felt angry about this; like a child being punished. You know... "If you can't act responsibly 'insert something you own here' will be confiscated until you can". I know my feeling angry is my own issue and that they were just trying to help me. I know it's to do with feeling like people were trying to control me and take away my choices. I'd already discovered from my research that an overdose really isn't the most reliable way to go about ending your life and I knew that if I wanted to hang myself I could always find the means, but the latter was agreed by T, that we couldn't eliminate everything but we wanted to minimise risks. I did not agree to giving Adam my blades and I think T could see that it would make things worse to do so. They are a safety net for me. I'm a bit like Maggie Gyllenhaal in 'The Secretary' when it comes to my precious blade set. Getting rid of them completely has never been possible.

I felt SO ashamed that Adam was there having to be a part of my mess. So, so, so ashamed. I felt defensive inside and exposed and I felt like I was being punished for self harming just as I did when I was a child (more of my own issues when others are trying to help). I just wanted to die. I just sat there, between T and Adam, being asked to make promises I couldn't know I could keep and wishing I could just disappear and not exist anymore.

Well, I'm writing this post so clearly I was not at risk and the Home Treatment Team were right about me anyway weren't they? Or am I just one of the fortunate ones who managed to stay alive despite them? I would like to know if someone is keeping a record of the number of times people seek out help when they feel they are in danger and are refused and what happens to those people. Not one person should end their life after calling out for help or having someone seek help for them and it being refused. If that has ever happened (and I know it has), it is too many times to have happened.

What did I learn from this situation? Unfortunately, it further confirmed to me that if I am in a desperate situation, I can't expect help from my health service. I believe T did everything she could have done for me. She always treats me with respect. I think I have been lucky to be treated by her and I go about expecting the same of everyone else I encounter in the health service and am then constantly horrified when I am treated like an inferior being or a time waster. T always takes me seriously. I can see that she treats everyone as equal, including herself. Not everyone has the same life experience and this affects people in different ways but that doesn't mean they are better or worse. Also her understanding of my predicament in relation to it not being 'me' but another dissociated part was clear. I take that for granted actually. She 'gets it' so well that I forget how weird it probably sounds to other people because it's so normal for me and talking about parts with her feels as normal as talking about anything else. It's not something many people in everyday life would understand when they think of suicide: the idea of dissociation coming into play. They think of someone in a desperate place, full stop. They don't think of someone who feels like they are posessed by another entity who could take over and kill them at any moment, even though they themselves don't wish to end their life in that way. And believe me, I don't wish to.

I have considered suicide in the past; long and hard. That is my nature: I think things through. And I am logical. Although I struggle with feeling like I don't want to be alive at times, I also have the capacity to see that suicide would devastate people who love me and have very negative effects on other people who know me. I also have the capacity to realise that if I can tolerate being alive, there is always a chance that things will get better. And life is tolerable for the most part. Sometimes it feels awful and I feel hopeless and wish I didn't exist but I don't want to hurt other people and if I keep breathing in and out and time goes by, maybe things will change. And sometimes I do laugh or feel the sun's warmth on my neck or listen to a bird chattering in a tree and in those moments, I am alive.

Sexual arousal when remembering and talking about sexual abuse

You have probably guessed what I'm about to talk about from the title but just to be explicit: this could be triggering and please read with caution. Speaking of 'explicit', I have tried not to be too so but I am about to tell you about something that is so in its very nature. This post has been written by myself (Candy: observer), as well as Little C and Candy (the part that generally goes to therapy and might be considered one of the 'main persons'). Should really get different names for your benefit to save confusion. Everyone thinks they are 'Candy'. Little C starts; I have typed for her and mostly corrected things from how she would say them except where it felt wrong to. Didn't want to take her style away from it, but have hopefully made it more understandable than it otherwise might have been.

"Today I wented to the psychology session with Candy and talked to the psychologist who is called T on here and I not allowed to tell you her real name but it's a better name than T. I talked to her about Easter and things and she asked me some questions about bad things that happened before when I was a baby and when I was in house number one and house number two and I tolded her about getting squished and having to do things I don't like to do and the big faces in the cage and willies and about stuff like that and it maked me feel yucky while I was telling her it and I got sore back and arms and face and head and feeled sick and I got weird feelings in my fanny and maked me think about willies and then I needed to go to the toilet. All of them things makeded me feel sad and yucky and I wanted T to give me a hug because I was scared and sad. T gave me the headphones and put the nice song on for me and I listened to it going in my ears and tried to think about being on the moon and tried to take big breaths and feel better.
From Little C"

After switching back from Little C in the session Candy felt all of those pains and that 'weird' feeling which was sexual arousal. It is a really awful thing to experience this arousal when remembering or talking about sexual abuse. It is confusing. Candy arrived home wondering that in fact her problem is not so much trauma related but actually some kind of sexual perversion: that she would feel turned on by that kind of situation. In stating this to herself Candy felt ashamed and disgusted with herself however, reassured herself that at least therapy was the right place for her, so she would just need to explain to T that she should be treating her for some kind of sexual perversion disorder rather than DID. We decided not to spend too long wondering what would have caused 'me' to become this way.

I am not unaware that people who have experienced sexual abuse can become aroused when remembering or talking about their experiences or during flashbacks and dissociation. I'm also not unaware of studies that show that females may have a natural arousal response to sexual material which can help protect them physically from damage during rape. I have been told that the pleasure points in the human body are wired to work from birth but that they aren't usually activated until later in life and that sexual abuse can activate these prematurely making an arousal response in a child even though they in no way wish the experience to be happening. I know all of this. I don't think I remembered any of it at that point though, or if I did, I didn't feel like it applied to me... Candy.

"I felt sure I must simply have a disorder that makes me turned on by horrible things and that maybe I'm just not getting enough sex or perhaps my low sex drive over the past six or seven years was just my way of trying to manage the huge sex drive that I really have and had previously and this is it bursting out again. I felt ashamed when I came home, knowing that my body was feeling this way with the images of abuse still in my mind.

To put it frankly, having a physical reaction when I am having flashbacks is not a new experience for me. I often feel pain in my body and usually notice afterwards that I am wet between my legs when I go to the toilet, so I know then that my body must have had a sexual arousal response, even though I wasn't aware of it happening. I am usually only aware of pain and feeling sick. I find the wetness difficult enough to mentally deal with and feel bad that my body has responded this way. Sometimes the reaction seems to be a lot stronger though, like this time. I am consciously aware of it and the feeling of arousal, although I don't want it, is strong... really, really strong. How horrible to be talking about awful experiences and to feel that way physically and how horrible to see too that my physical reaction is much stronger than I nearly ever have during 'healthy' sex with Adam. Sometimes when I am cuddling Adam and I know he wants to have sex, I feel like my body is dead. There is no wetness, no tingling, no feeling of change or becoming ready. Just anxiety and numbness... and sometimes an overwhelming need to fall asleep. He may try to stimulate my clitoris and vagina using his fingers or his mouth but it doesn't have any effect on me at all. I often just can't feel it or if I can, it's just irritating or uncomfortable. Yet looking in my head at the image of someone who should never ever have been touching me this way doing similar things, although it repulses me, immediately makes me feel like I am burning inside and out with a need for more.

I didn't know what to do after a while of still feeling this way and still having the images coming through my head and the feelings coming through my body. I wanted to feel normal again, but I also felt like I needed to make it real somehow, like somehow that would make it better... if not mentally, physically. Sometimes after having this experience I have felt like I had to masturbate. It seems wrong because I am unhappy and upset and thinking about terrible things. It's not that I think masturbation is wrong. I don't, I think it's a healthy thing in itself, in the right circumstances despite that I don't really do it very much. I just couldn't tolerate having the feelings any longer and I knew a way to get it over with. So, I used our Rabbit Vibrator to masturbate, but not in a healthy, gentle or pleasant way. More to recreate the feelings of pain inside but to have the sexual response that being abused brought with it; the ones my body was remembering. There wasn't enough pain. I remembered that there should be pain at the back; a lot of pain. I felt a need to recreate that pain too, but I stopped myself from trying to do that this time. But it wasn't just done in order to get a climax to be able to stop feeling it. It was done as a need as well to feel what I felt. That's the hardest thing to acknowledge. How could I want that to happen again?"

A Rampant Rabbit is not for the faint hearted in my opinion, despite it's reputation as a wonder toy. Our version has a very hard ridge at the corona which can be painful even though it is not bigger than an average penis. It hasn't had much use for that reason; even Shan prefers other more modest toys or 'a real man' as she says. But today it was fit for purpose: pain and pleasure and to relive and release. How can that be a good thing? Why did she feel it had to be done? Why did she want to relive it? Was it to be able to move on in that moment? Or is it just a learnt reaction from years of it happening... like the study... just have the sex with me and get it done.

"How can it be OK to have these feelings about such horrible experiences? I hate it and the thought of it is unbearable but in those moments it's almost like it's wanted. Did I want it? I feel so ashamed even though I know that other people go through the same thing. I am not sure that it's not me being devious even though I understand it and sympathise for others who go through it. I want to be able to talk about it with T. I don't know if she could say anything to help but it's such a confusing way to feel and I need to be sure it's not that there's something wrong in my reaction. I feel sorry for her though. It's not a fun topic and I don't know if she would be embarrassed to talk to us about it. I know it happens to people, I know why a person might feel arousal, but why the need to relive it? What is the benefit and should I stop it from happening? I guess T would say I should. But then what? How do we sit with those feelings?"

Are there different degrees of switching in dissociative identity disorder?

In response to a very heartening comment on an old post asking if I had given up on blogging, I had said that I would answer that question with a post. I have felt bad about that as it was quite some time ago and I never did post again, but I feel now is the time to admit that it has not been for lack of trying. I did try to write a post to get me back into it but it somehow became a monumentally long autobiography and by the time I reached the age of sixteen in the post I was feeling utterly exhausted and overwhelmed and also realised that no one in their right mind would want to reach something so long, so I never posted it. So instead of trying to write a 'getting back into blogging' post, I have just written a post. A plain old standard post with no mention of my lack of blogging, no introductions for new readers and no apologies for not blogging etc (aside from what I have just said). So here you go... (oh and PS, I'm doing a lot better lately than I was a year ago and maybe I'll tell you about that some other day)

In therapy this week my clinical psychologist and I discussed the previous session and some 'switching' (changing from one part/alter/personality being in control, to another) which had occurred during the session. My memory of this is vague... I remember being anxious, not being able to breathe, then feeling like... bad feelings in my throat... then I don't remember what happened next... then I was watching someone talking to T (I was watching from inside my body, in the background, far away) and asking her what she wanted them to do for her. I could see out. I could see the room and I could see T and hear her saying I wasn't anywhere but her office but it somehow didn't make sense and I wasn't the one talking to her. I remember everything being blurry and later my eyes feeling strange and not being able to see properly.

This week, on meandering through our reflections of the process from each perspective together we talked about degrees of switching. Or perhaps we came to conclude that there are degrees of switching. The switching that happened last week was clearly obvious. It was clear to T that I wasn't the one talking to her. I don't have much to say about that really. That's an obvious aspect of DID. But for me there is a different kind of switching, which seems to be more of a grey area.

I can't remember exactly how this came about but at one point I commented that sometimes I don't know 'who' (or which part) I am. I feel like I am actually a different person (not just observing a different person) but I can't say who and I feel that other people probably wouldn't even notice but to me, I am someone else. I happened to be feeling this on this particular day also, I don't know if that's part of why I was talking about it or not as it happens at other times and I don't mention it. I had noticed the change about an hour before I went to my session but I didn't mention it to T because I didn't feel it was necessary; it seemed like more of an internal difference than an out and out switch. I was taken aback therefore when T responded by asking if I felt that way at the moment because she didn't think she was talking to Candy. This surprised me a lot as I hadn't actually realised how obvious my 'internal changes' are.

I couldn't help but smile a little at that moment. I think it was relief actually because I want to be 'seen' and understood and T had just proved that she does see me and notices these subtle changes... or I am more obviously different than I thought. But either way I just felt glad that she seemed to notice and understand. Even Adam doesn't get it sometimes. He knows how to identify some of the parts and responds to them accordingly but there are times where I think he just assumes I am in a mood or something. Don't misunderstand, one alter can have moods. I can be in a bad mood and it not be that I have changed to a different part. I may be a part but I have more than one aspect to me nonetheless.

So T had realised she wasn't talking to 'Candy' and wondered what part she was talking to. I explained that I still feel like I am Candy but that I'm also someone else. It's hard even for me to understand that; let me try to explain... When I completely switch, I often feel like I am observing someone else from the background. I am Candy, but I'm not out at that moment so I am not the person you will be talking to; someone else is in control of me and I am just seeing out from the background. However, during these less obvious switches I still feel I am the person in control and I am talking to you but I am actually someone else, rather that just observing someone else. Does that make sense? Yeah, I'm not sure either. If you have DID you are probably kinda getting it and might have better words or knowledge of dissociation to explain it.

We discussed a little bit and T proposed that it is like I am in between the two; the two being 'myself' and 'another part'. She said: "You're neither here nor there" which I found kind of funny but true in a way. On this day I seemed to be in between being myself and being Ebony, a darker part. T said that I seemed like a less happy person, more subdued. (I wondered then if she ever does sees a 'happy' side of me? I often feel she only sees the downer sides of my personality and then I worry that she must find me a terrible sad sack and a bore) So could it be that it's half a switch? Or is it that I have switched to another part but that me and that particular part are not entirely separate personalities?

In general we like to think of Dissociative Identity Disorder as involving very distinct, separate personalities who have no shared knowledge or memory with the other personalities. I suppose that is what is even 'required' by those who make a diagnosis of DID. In reality, for me anyway, it is not all clear cut. I can't deny that there are those levels of separation (I try to deny it plenty but that's another blog post) but there are other levels of separation which are not so distinct and separate. Is this what it's like for people with Borderline Personality Disorder and Complex PTSD? This reminds me of when I used to try to figure out what was wrong with me when I knew I had dissociation but wasn't sure what diagnosis I would have. It's hard to really worry about categories or symptoms and diagnoses anymore. I used to worry about what my official diagnosis would be if I was 'tested' etc, like it made a difference to how I should feel. I guess I thought if I got diagnosed with DID it was more serious than if I got diagnosed with something else and on one hand I didn't want that because I wanted to be able to deny anything bad could have caused it, but on the other hand I felt if I was told I didn't have DID then I shouldn't be feeling the way I was and that, somehow would make me feel bad.

Nowadays I don't worry about it so much. I have learnt somewhat to accept the periods of denial I go through and not get tangled up in analysing myself but try to sit with the feelings and remember that sometimes I feel differently. Then during the other times, when it is apparent that I very much do have a dissociative disorder and I am more aware of intrusive images and symptoms etc and starting to feel overwhelmed by the need to either accept or deny that I was abused in this way and that way and the other way by him and her and him and them etc... then I try to keep it simple by forgetting about the past and focus on looking at how my life is affected at this moment in time and remembering that this is what I am working to change in therapy, no matter what has caused it. Phew. Hard to write parts of that last sentence and now I am having to do the very thing I just wrote about. It's upsetting and it's an ongoing thing that affects me. I don't need to analyse it more than that at the moment. Breathe...

I digressed a bit there, sorry. To get back on point... maybe the levels of segregation/separation in a system (all the parts/alters/personalities that make up one human with DID) can vary as well from one time to the next. On one day I might be able to be more aware and involved in being a different part where on another day I might be more oblivious to them. I think the experience of feeling like I am another person is a good thing though. It allows me to be able to be more connected to my  DID 'system' and even if only for a short time, realise that therapy is the place for me and that I am not a total time waster who's lying to myself as well as my therapist.

Dissociative struggles during a therapy session and coping strategies

While stirring the teabag in my cup today in the kitchen, I thought back to my clinical psychology session last Friday morning and wondered to myself what in the world I have been doing going to therapy for the last three years and nine months. Three years and nine months of my life attending sessions first every other week and then in recent times weekly and there is nothing wrong with me in the slightest. I thought through the phone call I planned to make to New Psychologist and what I would say: "I won't be coming to therapy this Friday, or any other, because I have been making up that there is anything wrong with me. I was never abused. I don't have alters or depression or anxiety or anything else wrong with me. I was just acting. I'm sorry for wasting time."

I realised that my psychologist would more than likely ask me if this was the 'non believing' part of my system and that she would suggest that my view may be temporary and that I keep the appointment. Then I imagined her suggesting that it's a lot of energy for someone to put into a lie for what benefit? Then I thought to myself that someone who would go to so much trouble to lie about having dissociative identity disorder should surely be in therapy anyway because clearly that is not healthy behaviour, so I dismissed the notion of making that phone call and with the intention of 'coming clean' at the next session and settled on the sofa with my tea to catch up on Big Brother.

This kind of thinking happens to me from time to time and New Psychologist has pointed out to me that it occurs clearly in relation to certain triggers. She feels that spending time with my mother is highly likely to trigger a switch to this non believing part, mainly because my mother puts a lot of energy into trying to convince me that any problems anyone in our family has are genetic and not because of anything that could have happened to us.

I believe that I am more likely to switch to this part when I am working, mainly because it's much easier for me to function if I am in denial about any of my issues. Today though, I feel the disbelief was a reaction to what happened last Friday in my therapy session. I felt strange right from the start of the session. I didn't want to talk and struggled to engage in the conversation. I don't know if something NP said eventually triggered what happened but about half way through the session I began to have strong physical sensations of something in my throat that was making me gag or cough or something. My heart was racing and my breathing went weird and I was scared, really scared. It's hard to describe. I knew where I was still but I couldn't focus on what NP was saying and I couldn't bring myself out of what was happening. I didn't understand what was happening either.

New Psychologist was helpful. I could hear her calling my name and reminding me that I was safe and that I might be having a memory of something but that it wasn't happening now. She also asked if I could look at her so that I could connect with her and know that I wasn't alone with it. I wasn't able to look at her though. She moved nearer to me and clapped her hands and called my name. I normally get really anxious when either her or T move near me but I was so involved in what was happening and scared about the feeling that it didn't matter to me that she was close. In fact it might even have helped a bit because I did feel less alone. She got me something from my bag: some smelling salts that she gave me a few weeks ago (MacKenzies Smelling Salts: they're for sinus relief actually and contain ammonia and some kind of menthol and sniffing it is like someone squirting a mixture of old style hair dye and toothpaste directly into the inside of your head. It really gives a shock. She thought they could help me if I was having flashbacks and I've been using them to help ground myself) and held them under my nose. I could smell them but even though they're strong it seemed faint and far away. I think they did help a bit though and after a while I felt my body calming and the sensations becoming less frequent. New Psychologist asked me to look around the room. She pointed out things on the walls, colours etc and then when I was more with it, asked me the date and where I was etc. Sometimes things like that really haven't helped but this time they did.

It helped that she continued to talk to me while it was happening. T (my usual psychologist) tended not to say much during times when I was having these awful episodes of dissociation and often I was screaming to her inside my head for her to help me, but not able to speak to ask. I think I'll tell New Psychologist that actually. Maybe she can pass on her wisdom of how to help to T for when she comes back.

Later in the session Little C came out to speak to New Psychologist. This is the second time she has spoken to her now. I don't know what age she is but I am guessing between three and five. She's very cute and I am lucky enough to be able to observe a lot of the time when Little C is out. She wanted to show NP a picture she had drawn and her special box of things that she had brought (it has things like stickers, postcards and pens in it). I guess Little C could feel the sensations in her throat as well because she got quite upset and told NP something about a 'thing' being 'put in there'. NP asked Little C a bit about it but LC didn't want to say too much, except that it wasn't nice. NP asked if Little C knew who it was that put it in and LC got upset and couldn't answer. She told NP she shouldn't ask that. She said that Adam does it sometimes. NP told LC that she was glad to hear her say she shouldn't ask and that it was good that she said that because... something to do with her not knowing NP well enough yet or something, and that it was OK. Then LC changed the subject and started talking about more fun things.

It's hard to write about this guys. On one hand I feel detached from it and thinking over it just makes me feel more confused about why I would have 'acted' this way. On the other hand part of me knows how real it all is and was and that is an extremely difficult thing to acknowledge. It doesn't take a genius to figure out what the sensations in my throat were a memory of when combined with the information that Little C shared about it. It's too hard to accept that something like that could have happened to me and it raises painful questions like the ones NP asked... and that's why I end up in the 'non believing' state that I was in today.

After my session on Friday I was in a lot of pain, all day. My neck, back, hips, legs and head were aching and sore. The headache lasted all weekend. Today was the first day it was mostly better and maybe that was because of the switch to not believing it anymore. Maybe it's just a way of coping sometimes. I guess there is progress in that sometimes now, when I'm in that state, I can acknowledge to myself that there are other times when I definitely know I haven't made this up and I am more content to 'sit with' the feelings and not get too dramatic about anything.

Dissociative Identity Disorder: what are alters and what is switching?

I decided to split this post in two as it made more sense and let's face it; was a bit long...

A person with dissociative identity disorder has inside them, separate parts of their inner self which to them may be experienced as separate people (alters). I like to think of the condition in terms of a bus with lots of passengers. The bus is the body; the driver is the particular alter who is in control at that time. Someone with DID may have a 'main driver' who they might identify themselves as being for the most part and then other parts/alters who may be like them in many ways; or very different from them. 

When the person in the driver's seat swaps with someone else, this is called 'switching'. For some with DID, the driver might be very separate from the others on the bus: you could imagine there is a curtain behind the driver so they don't know what the others are doing at the back of the bus. When someone with DID switches and another alter (or driver) takes over, the original person may not know anything about what is going on during the time that someone else is driving. This is why some people with DID experience time losses, where they don't know where the time has gone or what they have been doing.

Not everyone with DID experiences switching between alters in this way. For some it can be less separate, where the drivers seat may not be screened off so others are still able to communicate with the one driving. For someone else, it could be that the bus has dual controls where more than one person can be in charge and influence actions at one time. My experience of switching between alters can vary. The most separate kind of switching, where I wouldn't know who has been out or what has happened, doesn't happen to me a lot (I think). Up until recently, I didn't think it happened to me at all. I liked to think I always knew what was going on at any one time. My therapist has helped me to realise that this thinking is naïve, as she gently reminds me that I do lose time and find evidence of having done things I don't remember doing: all sure signs that I might not be as omnipresent as I think I am.

For the most part though, my experience of alters is more of a shared awareness. Switching takes place frequently, sometimes an alter will 'come out' for just a few seconds and then go back in and this might happen many times in a few hours, sometimes a part will come out for an hour or two. Sometimes one part might be dominant for several weeks at a time. Most of the time though, no matter if switches are short or long in duration, I know what's going on. It's like I step into the background but am still there and able to influence or control things if need be. It also means, I know what is going on, so I won't experience time losses the way I might if it were more separate. 

Sometimes, I stay in control but others influence me. So I might express views of others because I can hear them in the background. This is how I manage to function relatively normally in the world: because I have the ability to edit and make sure what I say is appropriate. It means I can manage what's going on inside in order to be able to still maintain a job. So, if one part wants to spend the day colouring in and doing crafts, I know about this and can express to that part why it is important that they don't do that until we get home from work in the evening. I guess it makes life easier than it might otherwise be. Sometimes though, I'm not that tuned in to the parts that are at the back of the bus, and this has been more so the case lately. I don't know if it's me that puts the screen up or them, but I can sense them there without being able to communicate with them.

It's like there are three levels at which alters can be: one is right at the front, with me or instead of me. The second level is not out front, but near me (in the passenger section of the bus but near the front): where I can sense their presence and sometimes hear them or communicate internally with them. The third level is more far away and separate (right at the back of the bus, or maybe even upstairs on a double decker) and I may not be aware of the parts at all when they are here. Sometimes I can sense them stirring even back there though.