For us as a couple, the last six years have been a journey, gradually and inconsistently, of coming out of denial. Carolyn’s breakdown during April 2005 brought a sudden change to our lives. Over the next year or so we flailed about, trying just to survive: daily dissociative intrusions, traumatic memories in the form of flashbacks and triggers, night-terrors and body memories, episodes of self-harm and suicidality. A story emerged from different parts of her personality of horrendous abuse – crimes committed against her and other children, the nature of which left me traumatised too. And all the time there was a powerful voice inside both our heads which said to us: It didn’t really happen. You’re just mad. You’ve made it all up. Carolyn had a happy childhood – a standard middle class upbringing.  Both for Carolyn and for me as a husband there was this overwhelming desire to just deny it all. The implications of the memories and the feelings that went with them were simply too much, and more than we thought we could handle.

Slowly we accumulated multi-modal ‘evidence’ – the dissociation, the recollections from her parts, the crippling somatic symptoms she experienced, the many triggers – and I came to the conclusion that a lot of very bad things had happened to Carolyn for a very long time. For over five years now, through her therapy, she has been building an historical narrative of chronic sadistic abuse, rape and torture that continued for many years as a child. The voice of denial has continually whispered to us, fuelled by our desire to believe that these things can’t really have happened, can they? It’s just too awful to imagine.

SOCIETAL DENIAL OF DISSOCIATION AND TRAUMA

Why is denial so strong? Denial, like dissociation at the time of overwhelming trauma, is a defence. In trauma you feel helpless, and dissociation as a child avoids that sense of complete overwhelm, the annihilation of your will. The only way to survive and keep some semblance of normality is to separate off parts of yourself that did not experience this helplessness. And for me as for the rest of society, denial defends us against the feelings of helplessness in the face of such evil being committed. Because the perpetrators are not just ‘monsters’ as the tabloids would describe them – they are not just stereotypically ‘evil’ people – but they are often respectable, middle-class people, the pillars of the community. Denial defends us against the thought that this can all be happening, on our estate, next door, maybe within our own family. Because that reality does not make sense, we defend ourselves against such uncomfortable, even unbearable, feelings with denial.

Carolyn’s denial has taken a lot time to overcome and even now, at times, she can slip back into thinking it can’t have happened despite what I see as overwhelming evidence. And so can I. But this is hardly surprising given that society as a whole has struggled to accept the reality of child abuse. So dissociative survivors, who often have “symptoms rather than memories” (Fisher, 2009), often struggle most of all with denial.  And historically we can see that survivors have rarely been believed. It wasn’t until 1984 that the Department of Health added the category of ‘sexual abuse’ to its definition of ways in which children could be hurt, alongside the existing categories of physical abuse, emotional abuse and neglect. But Carolyn was being sexually abused well before 1984, as were countless other children.

FREUD AND DISSOCIATION

And yet over 110 years ago Sigmund Freud, the father of psychoanalysis, stated in his paper The Aetiology of Hysteria, “I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood” (Freud, 1896, p.203). He was one of the first neurologists to listen to and believe the stories of so-called ‘hysterics’, the name given to women who suffered with what would be now labelled complex post-traumatic symptoms, dissociative disorders, and conversion disorder. He was perhaps the first person to publicly hypothesise the link between the psychological trauma of childhood sexual abuse and later mental illness.

Freud and some of his peers believed that unbearable emotional reactions to traumatic events produced an altered state of consciousness, which some then called ‘dissociation’. Freud saw that his patient’s unexplained ‘hysterical’ symptoms related to very distressing events that had been removed from their memories and said that “hysterics suffer mainly from reminiscences”. The word ‘hysteria’ comes from the Greek word for ‘womb’, as these symptoms were found predominantly in women and so at first it was thought that they must have an organic cause in women’s bodies. Freud found that when the traumatic memories and feelings were recovered and talked about, then the hysterical symptoms were significantly reduced. This developed into what Freud named ‘psycho-analysis’, or in lay terms ‘the talking cure’.

Through his work with ‘hysterics’ Freud began to hear repeated stories of child sexual abuse and incest. From this he formulated his so-called ‘Seduction Theory’.  So, if Freud had made this big breakthrough, why then did the sexual abuse of children remain taboo for the next three generations? Unfortunately Freud’s discovery was met with a wall of denial and hostility from all of his professional peers, and within a year he had retracted his theory. Why? Because if Freud was correct in his theory that sexual abuse was the origin of ‘hysteria’, then given its high prevalence, the sexual abuse of children in Viennese society must be endemic.

So Freud stopped believing his patient’s stories of childhood sexual abuse. He concluded that the patient’s stories were untrue and instead revealed their ‘unconscious childhood sexual desires’ towards their parents and older siblings.  Freud and the rest of society pulled the veil of denial over the scale of child sexual abuse. And instead he devised a form of psychoanalysis based on a denial of reality, a set of theories based on ‘unconscious fantasy’. His theories included the ‘Oedipus Complex’, a phase around the age of five where due to supposed ‘infantile sexuality’, a child unconsciously desires sexual union with their opposite-gender parent.

Although this theory is not generally accepted in a literal sense by analysts nowadays, it was highly influential at the time. And of course it meant that for the first three quarters of the twentieth century the reality of childhood sexual abuse largely remained a taboo. If a woman came to see a classic Freudian psychoanalyst, he would explain away her traumatic memories and give her his interpretation, as fact, that she was just recovering unconscious childhood desires of what she wanted to have happened to her, not what actually happened. So the blame for the origin of all later mental health problems was placed upon the patient, rather than her early relationships and abusive environment.

When I read the history of Freud and others I am amazed at how much was known about complex trauma and dissociation over one hundred years ago, but that it was covered up and explained away by a denial of what had caused it. Thankfully, classic Freudian psychoanalysis did not remain the dominant force in the development of counselling and psychotherapy over the rest of the twentieth century. And therapists are nowadays largely willing to accept that a client might actually be telling the truth!

Things have changed a lot since 1984. Thanks to the pioneering work of Childline and the NSPCC, the many changes in social care, and the growth of counselling and psychotherapy, the reality of the scale of child sexual abuse is slowly seeping into the nation’s consciousness. We read news stories almost daily about the arrest of perpetrators, child abuse images on the internet, paedophile rings and human trafficking. But there still persists a widespread belief that child sexual abuse is rare. Stereotypes of abusers as strangers, the ‘dirty old man in a mac’ still prevail to a large extent, and that only extremely evil people – the tabloid ‘monsters’ – abuse children. Statistics vary depending on the study and its parameters, including how closely it defines sexual abuse, but many organisations and researchers repeatedly affirm that between 1 in 4 and 1 in 6 girls are abused, and between 1 in 6 and 1 in 10 boys. That is certainly not rare!

And many dissociative identity disorder (DID) survivors still think too that they are rare. However, in studies of the general population a prevalence rate of DID in 1% to 3% of the population has been described (ISSTD, 2011). Nijenhuis & van der Hart (2009) argue this means that dissociative identity disorder is at least as common as schizophrenia, and yet point out that in 2009 there were 25,421 papers on PubMed relating to schizophrenia but only 73 relating to DID.

CHANGE IN AWARENESS OF TRAUMA AND DISSOCIATIVE DISORDERS

Gradually however a significant change in awareness of trauma and dissociative disorders is taking place. Credit must be granted to the tremendous work carried out by the forerunners in this field in this country: the work of Valerie Sinason and the Clinic for Dissociative Studies, Remy Aquarone and the Pottergate Centre, First Person Plural, TAG (the Trauma and Abuse Group), RAINS (Ritual Abuse Information Network and Support) and numerous others. However, as things move forward there has been the inevitable backlash of denial. In recent weeks there has been a very cynical article in a national newspaper about the work of Valerie Sinason and it even went as far as completely denying the existence of ritual abuse. This is despite the recent national press coverage of the convictions in Kidwelly in South Wales (The Guardian, 2011).

Denial can be seen and understood as a necessary defence against helplessness. And that is why hope is so important. If we don’t have a message of hope of recovery, then it is no wonder that society at large and individuals in particular need to guard against helplessness by denying that there is a problem in the first place. Bethany Brand’s study on therapeutic outcomes for dissociative disorder patients treated in the community gives significant hope for recovery: “Clinical case studies and case series suggest that many dissociative identity disorder patients improve with treatment, with up to two thirds of them eventually integrating personality states and becoming less symptomatic after years of treatment” (Brand et al, 2009, p.154). Furthermore the Sidran Traumatic Stress Institute state that “compared to other severe psychiatric disorders, Dissociative Disorders may carry the best prognosis, if proper treatment is undertaken and completed” (2009, p.4). It’s getting access to this ‘proper treatment’ that is the key issue and sadly there just isn’t enough of it available, especially through the NHS.

Another source of hope, however, is a kind of existential question about the nature of dissociative identity disorder and whether someone has multiple personalities, or whether the multiple parts of the personality constitute one single and whole person. Why does this matter? Well, for us personally, we believe that Carolyn’s parts constitute the whole of her as one person. She does not have a body which plays host to multiple people. This is in line with the ISSTD Guidelines (2011), but others may view this differently, and are free to do so. But for us it is linked to hope. There seems to be a lot more hope for recovery and healing if it is a case of playing ‘dot to dot’, making links between personality states that all constitute one whole but which have been dissociated from one another. If it is a case of all the parts being separate people, then how can you expect there ever to be communication, co-operation, collaboration and eventually co-existence? The sharing of a body is going to be, it would seem, an eternal source of conflict, with each ‘person’ needing to guarantee their own survival at the expense of the other ‘people’ inside: there just isn’t enough body to go around. That conflict seems to be the source of many dissociative survivors’ difficulties in managing day-to-day life, and our hope for recovery lies in the fact that this is not some ‘survival of the fittest’ race amongst alters to take control of the body and ‘win’. Instead there is a very natural collaboration to work towards, which does not mean that any of the ‘parts’ are exterminated or killed off, but they are ‘integrated’, joined together, sewn together like a patchwork to become the whole.

As there has been increasing connectedness between Carolyn’s parts – increased ‘integration’ as some would define it – she has been able to move increasingly out of denial. Society’s attitudes do not help, but our own battle with denial is the one which really counts. We have to believe ourselves first and foremost, not give away the right to judge our reality and truth to others.

Denial is a very powerful force and a significant factor in dissociative identity disorder. I will close with a quotation from Judith Lewis Herman (2001, p.8) which points out the dichotomy that we are faced in choosing which side of the battle-lines we stand upon:

In order to escape accountability for his crimes, the perpetrator does everything in his power to promote forgetting. Secrecy and silence are the perpetrator’s first line of defense. If secrecy fails, the perpetrator attacks the credibility of his victim. If he cannot silence her absolutely, he tries to make sure that no one listens. To this end, he marshals an impressive array of arguments, from the most blatant denial to the most sophisticated and elegant rationalization. After every atrocity one can expect to hear the same predictable apologies: it never happened; the victim lies; the victim exaggerates; the victim brought it upon herself; and in any case it is time to forget the past and move on. The more powerful the perpetrator, the greater is his prerogative to name and define reality, and the more completely his arguments prevail.