Critical issues in the dissociative disorders field: six perspectives from religiously sensitive practitioners.
Rosik, Christopher H.
This article is a compilation of responses to six questions
concerning critical issues in the contemporary psychological and
spiritual treatment of dissociative identity disorder (DID--formerly
multiple personality disorder). The panel of respondents, most of whom
are well known in the dissociative disorders field, is comprised of
Elizabeth Bowman, M.D., Harry Carlson, M.Div., Christine Comstock,
Ph.D., James G. Friesen, Ph.D., Jerry Mungadze, Ph.D., Christopher H.
Rosik, Ph.D., and Carl Wilfrid, M.Div. An overview of the responses
indicated that the panelists varied sharply in their willingness to
consider exorcism as a therapeutic option. Even those who were willing
to consider exorcism differed in their understanding of the clinical
threshold that needs to be met before initiating such a spiritual
intervention. Clinical neutrality and caution regarding the veracity of
specific traumatic memory content was commonly urged. The church
community was seen as an important potential resource for healing,
despite its historically mixed record in ministering to DID sufferers.
Perspectives on the future of the dissociative disorders field ranged
from guarded optimism to overt pessimism. These responses highlight the
divergence of opinion that can exist over controversial issues and
suggests the need for continued dialogue between and among clergy and
religiously oriented therapists.
**********
The phenomenon of dissociation and its clinical manifestations,
especially Dissociative Identity Disorder (DID), have gained increased
scientific attention and scrutiny in the past two decades. Many
contentious professional debates can be found in the literature that
involve some aspects of DID theory or treatment. However, there have
been few forums for professionals with religious sensitivities to share
and contrast their views on issues within the field of particular
interest to the faith community. (1)
The intent of this article is to create such a forum by soliciting
responses to several questions from seven professionals who each have
extensive experience in treating dissociative disorders (DD). The panel
consists of one psychiatrist (Elizabeth Bowman), four psychologists
(Christine Comstock, James Friesen, Jerry Mungadze, and Christopher
Rosik), and two clergy (Harry Carlson and Carl Wilfrid). These panelists
respond to questions concerning exorcism, false memories, the role of
the church, the positive and negative effects of religious faith,
changes in the treatment of DID during the past two decades, and
predictions about the future of the dissociative disorders field. As the
reader will observe below, although there is a general consensus of
opinion in some areas, meaningful differences in perspective also exist
and shape the specific therapeutic approach these practitioners take to
the religious and spiritual aspects of DID treatment.
What is the role of exorcism in the treatment of DID?
Bowman: DID is not a spiritual disorder, but a mental disorder that
calls for psychological treatment. Exorcism is a spiritual treatment
that does not belong in the treatment of psychiatric disorders, DID
included. Persons who advocate exorcism for DID patients view them as
ill with both a psychological and a spiritual illness (i.e., DID and
possession); thus, they believe they are making accurate differential
diagnoses and applying appropriate treatments for both conditions.
Exorcisms in DID treatment are performed by well meaning practitioners,
but I believe they are the result of misunderstanding the psychodynamics of DID, mis-diagnosing dissociative phenomena as spiritual possession,
and failure to recognize transference and counrertransference pressures.
The majority of outcome reports on exorcisms in DID patients show
negative or short-lived clinical consequences (Bowman, 1993; Bull,
Ellason, & Ross, 1998; Fraser, 1993; Pfeifer, 1994). In the United
States, exorcisms are also extremely risky legally, so I advise secular
and religious therapists avoid them.
Exorcisms usually involve DID patients who are treated by
conservative Protestants. This clustering of demon possession with
dissociated identity and with therapists who believe in demon possession
should raise thoughtful questions. Are DID patients really more
susceptible to demon possession than other human beings, or are
dissociative ego states being perceived as demons? Why do so many of the
DID patients of some theologically conservative therapists but none of
the patients of theologically different therapists seem to need
exorcism? Enthusiasm for exorcism seems to be associated with
considerable interest in reports of satanic ritual abuse (SRA) (Friesen,
1992), raising the question of the therapist's role in the
production of these reports. The historical reality of SRA reports have
been called into sharp question (Fraser, 1997); therefore, reports of
possession during satanic rituals need to be re-visited or given other
explanations (e.g., fantasy prone personality; Wilson & Barber,
1983).
Addressing exorcism in the treatment of DID is difficult because
exorcism and possession in DID straddle two clashing world views-the
scientific and the spiritual. Still, Christianity asks us to think
critically about spiritual matters (1 John 4:1). It is impossible to
scientifically test for the presence of demons in DID patients, so I am
skeptical that practitioners can reliably distinguish demons and alters
in DID patients. Claims to distinguish demons from alter egos are based
on the subjective conclusions of secular and religious observers, each
rooted in different worldviews. Few studies exist of actual outcomes
after exorcisms (Bowman, 1993; Bull, Ellason, & Ross, 1998; Fraser,
1993; Pfeifer, 1994). Lists of purported characteristics of demon
possession are entirely composed of phenomena that colleagues and I have
seen in quite human DID alter egos (Friesen, 1991). Angry alter
personalities often exhibit behaviors that appear identical to
traditional descriptions of possession: evil-appearing glares, a ngry
voices, self-hatred, self-harm, aversion to God and religion, and other
symptoms.
The apparent disappearance of supposed demonic phenomena after
exorcism is not retrospective proof of possession. In highly
hypnotizable people (e.g., some DID patients), hypnotists can induce and
relieve paralysis, anesthesia, and other physical conversion symptoms
with hypnotic suggestion. Alter personalities, who were seemingly
exorcised, have reported that they have hidden for years afterwards.
This could explain symptom disappearance. The exorcism ritual may
function as behavioral therapy, which temporarily extinguishes the
behaviors of malevolent alters (Bowman, 1993; Fraser, 1993).
These rituals may also function as religiously acceptable metaphors
that allow patients to relinquish childhood identifications with the
evil in their abusers. Non-religious hypnotic interventions can
accomplish the same thing without the spiritual risks of labeling the
patient as evil. One of my colleagues helped DID patients bundle up ego-alien identifications with abusers and hypnotically mailed them off
to eternity with no return address. These techniques give patients power
to relinquish ego-alien introjects without calling them demonic.
Possession is recognized as a culturally sanctioned dissociative
trance state in many cultures. When nor culturally sanctioned,
possession is part of the diagnosis of Dissociative Trance Disorder in
the DSM-IV section of criteria sets for further study (APA, 1994, pp.
727-729). Given the long association of possession with dissociative
trance states, I suspect that lists of the characteristics of demon
possession have been drafted from unrecognized Grade V hypnotizable
persons and undiagnosed DID patients seen over millennia. Thus, it is
understandable that modern DID patients appear to fill the criteria for
demon possession.
Practitioners considering exorcism should first read Wilson and
Barber's (1983) treatise on highly hypnotizable persons (i.e.,
Grade 5 hypnotizability) and their ability to abreact fantasy that they
cannot distinguish from reality. These "fantasy-prone
personalities" can evoke physiologic stigmata based on fantasy
alone, just like those described in demon possession. Since Christianity
asks people to handle truth carefully, Christian therapists need to
educate themselves about the abilities of highly hypnotizable people
before concluding they are demon possessed.
Recommendations for Practitioners. If you are thinking about
considering an exorcism, do not act until you have obtained consultation
and three to six months of close supervision from an experienced,
well-trained psychodynamically oriented psychotherapist. Also, consult
your malpractice carrier, your employer, and your lawyer. Protestants:
you do not have a monopoly on spiritual wisdom; listen to the advice of
a Catholic priest or bishop with experience in discerning demon
possession and the need for exorcism. Finally, ask your patient to be
seen by an experienced dynamically trained consultant for a second
opinion about diagnosis and treatment.
In supervision, carefully consider the psychodynamic formulation of
your patient and her object relations, and transference and
countertransference pressures. Consider whether projective
identification (i.e., you feeling the patient's unconscious
disavowed feelings), identification (yours and the patient's) with
aggressors, or your own frustration with therapeutic impasse are
motivating you to label part of this patient as demonic. Is exorcism a
fantasy to rescue both you and the patient? Consider if you are
"acting in" (e.g., enacting the patient's disavowed view
of herself as evil and in need of banishment, or enacting her desire to
have a powerful parent rescue her)? Consider the narcissistic trap of
unconscious temptation to feel like a powerful hero (i.e., a spiritual
warrior)? Would you feel as gratified if someone other than you did the
exorcism? Feelings of powerlessness and attendant rescue fantasies are a
common countertransference when dealing with trauma patients. Read
literature on countertransfe rence in treating trauma and borderline
personality disorder (Herman, 1992; Wilson, Lindy, & Raphael, 1994),
and on managing treatment boundaries (Hundert & Appelbaum, 1995),
avoiding dual roles (pastor/exorcist and therapist), or misusing power
and position (Peterson, 1992).
Consider if there are hypnotic alternatives to exorcism that would
allow the patient to dispose of her ego-alien identification with the
evil done to her without labeling herself demonic. How might your
patient feel if the exorcism does not "work"? Many negative
spiritual and psychological outcomes from exorcisms of DID patients are
rooted in shunning of patients by churches or in the patient's view
of herself as evil and untreatable after symptoms return. What will be
the consequences for the patient who now understands herself as demon
possessed?
Therapists in the United States, including pastors and pastoral
counselors, who perform exorcisms on DID patients should be prepared to
defend themselves against malpractice lawsuits, professional ethics charges, or loss of licensure. Abusive exorcisms that injured or killed
patients have resulted in criminal charges. Theology aside, performing
exorcisms on therapy patients is forensic suicide. Acquaint yourself
with literature on recovered memory and risk management before
proceeding (Gutheil & Simon, 1998).
In short, my advice to therapists considering exorcism with any
patient (especially a DID patient) is to slow down, educate yourself,
get supervision and consultation, and think very carefully about your
motivations and unconscious pressures in the treatment relationship. If
you have even the tiniest doubt about an exorcism, do not become
involved with recommending or executing one.
Carlson/Wilfrid: This is an incisive and perhaps key question. It
can be very tempting for those treating individuals suffering with
MPD/DID to "get it over with in a hurry." In addition, many
patients also are eager to "do something magic or quick." This
can be damaging to the patient who may either feign integration to
please the therapist or become more anxious because "nothing
happened."
Is the entity a demon or an alter personality? It is crucial to
know what we are dealing with. A Biblical admonition: "Do not
believe every spirit, but test the spirits" (I John 4:1). Even
Jesus, when he meets a demon, confronts him by asking, "'What
is your name?' ... 'My name is Legion'" (Mark
5:1-17). Who are you? What is your purpose? Clergy, above all, need to
be very cautious before assuming an entity is a "demon." The
New Testament refers to both "demon-possession" and
"demon-oppression" (Acts 10:38).
Some years ago, a woman came seeking an exorcism. Two previous
exorcisms "did not take." While speaking with her it became
clear that she did not have a demon, but she was oppressed by a very
angry alter personality. Exorcism is for demons, not alter
personalities!
A word of caution for clergy and others who tend to look for
demons: Test every spirit! Really ask questions! Be empathetic, but
listen to the personality coming out. Ask questions with sensitivity.
Remember, persons with MPD/DID know when you are not being honest, and
they are always testing your integrity.
Test every spirit means every entity, including the Inner Self
Helper (ISH). On one occasion, a patient related that an evil (therefore
fake) ISH was providing me wrong information. We developed a
"cue" (Jesus is Lord) to assure proof. Shortly after this, the
person stated the fake ISH was still there, so we changed the cue to
"Jesus is my Lord," which the fake ISH could not say (cf.
James 2:19).
Do not get involved in this kind of counseling if you cannot devote
the time to continue. It is tempting for all of us to try shortcuts, and
sometimes exorcism can be a potentially false and dangerous attempt at a
shortcut. In Mark 9:14-29, Jesus cast out a demon that had been
troubling a man "since childhood." Quite interesting! The
disciples were unable to cast it out, and Jesus says, "This kind
can be cast out only by prayer." This suggests a more lengthy kind
of process. The passage also states that the disciples were unable to do
the exorcism in the usual way. Jesus does but it hints at a different
kind of approach in dealing with certain demons.
Comstock: Exorcism casts out something that does not belong.
Dissociation is the separation of a personality into parts that do
belong. Therefore, exorcism is not an appropriate treatment for
dissociation. Clinical findings do not demonstrate any long term
benefits from exorcism, whereas even a spirit could benefit from
therapy. I focus on interpreting the person's feelings about the
part or pattern that they want exorcised in the clinical manner, asking
about past experiences, other people's reactions, meanings,
feelings, and the issue resolves in the usual way.
Friesen: When it comes to the word "exorcism," some
strange images of dark, unfathomable struggles come to mind. Hollywood
has had a field day with this word. This is not how God works, at least
not in my office. He simply expels evil spirits when called on to do so.
If there is a struggle, it is a human struggle, due to unhealed wounds
and unresolved conflicts within people. When healing and resolution are
in place, the devil is easily defeated. As people get closer to God,
their spiritual battles become more effective. "Submit yourselves,
then, to God. Resist the devil, and he will flee from you. Come near to
God and he will come near to you. Wash your hands, you sinners, and
purify your hearts, you double-minded. Grieve, mourn and wail. Change
your laughter to mourning and your joy to gloom. Humble yourselves
before the Lord, and he will lift you up" (James 4:7-9). James is
calling all of us to a deeper walk with God, and dealing with difficult
feelings, including grief, mourning, and gloom, will be part o f it. As
we get more into alignment with God, it becomes easier for us to resist
the devil.
In I Peter 5:8-9 we are all told to be on the alert because of the
devil's destructiveness. "Be self-controlled and alert. Your
enemy the devil prowls around like a roaring lion looking for someone to
devour. Resist him, standing firm in the faith ..." Many people
with DID have experienced religious abuse (i.e., the misuse of power by
authority figures in a religious context) and spiritual abuse (e.g.,
curses, hexes, family sins, exposure to the worship of Satan, and other
attacks in the spirit world). The devil prowls, looking for weakness in
each of us. Those who have suffered religious and spiritual abuse are
particularly vulnerable to the devil's attacks-reminding them of
their abuse, falsely blaming them for the abuse, and falsely concluding
for them that God will not help them. We all need to be spiritually
clean so that these kinds of lies from the evil one will not take root
in us. It is particularly important for people with DID to get
spiritually refreshed and cleaned as part of their healing, so th at the
evil one will nor be able to attack them at the point of their
woundedness.
Religious strength and protection are vital for those whose wounds
are deep. In the apostle Paul's call for Christians to use
God's armor (Ephesians 6: 10-18), he stresses that people are not
our enemies, but that our struggle is against the rulers, the
authorities, the powers of this dark world, and the spiritual forces of
evil in the heavenly realms. It is incumbent upon us all to maintain
strength as we fight against the devil.
Here are a few practical points for exorcism in particular, and for
spiritual warfare in general:
1. Do not treat people as though they are demons. Despite
people's good intentions, spiritual warfare often turns into
religious abuse. The person carrying out spiritual warfare sees the
dissociative person go from one personality to another, and falsely
believes that a demon has just taken over. Then the abuse
starts--talking to that part of the person as though it were a demon,
and commanding it to go in the name of Jesus! What a horrible mistake.
Not only does the personality just put in charge get treated very badly,
but it also loses a chance to get some help. I have lost count of the
number of people who told me that this happened to them. It is a
terrible affront to God, it is a serious wound inflicted on the person
who is supposed to be getting spiritual help, and it becomes very hard
for the person to trust other Christians after that.
2. Do not carry out any spiritual intervention unless there is
agreement with the client. To start casting out without the agreement of
the one being prayed for is to ignite a storm in that person. If the
person being prayed for does not indicate agreement, there can be no
expelling. There will only be conflict.
3. Teach people how to exercise their power in the spiritual arena,
including teaching dissociated parts to pray and to expel unwanted
spirits.
4. When an attempted expulsion is not successful, it is not the
client's fault. There may be a lie, a vow, a family spirit, or a
religious spirit still attached to a wounded personality, and sometimes
these need to be dealt with before the evil spirit can be expelled.
Another development can go this way: The expulsion may be successful,
but an evil spirit gets reattached sometime later. In order to prevent
this, the lie, vow, family spirit, or religious spirit needs to be dealt
with when the evil spirit is expelled.
5. Expelling spirits and bringing in God must go together. Remember
what Jesus said about expelling spirits and unoccupied houses (Matthew
12:43-45). Expelling spirits is not what this teaching is about--it is
about leaving a house unoccupied! Unless God is there, any person is
wide open to being demonized. The crucial tasks are finding the wounds
and conflicts that are blocking the person from turning to God, and then
getting His light into the whole house (Luke 11:34-36).
Mungadze: There has been research proving that exorcism is harmful
to DID clients. There has been research also proving that some exorcism
has been beneficial to DID clients. In my own experience treating many
DID clients who had been through exorcism, the majority of them had very
bad experiences with exorcism, whereas a few had good experiences. The
differences seems to be based on who led the exorcism. Those who had
exorcisms done by people without clinical training in DID treatment had
bad experiences and those who had exorcism performed by clinical
professionals trained in the treatment of DID had good experiences. This
leads me to conclude that exorcism has a role in the treatment of some
DID clients, whose clinical picture shows the need for it. Exorcism
should never be the initial step in DID treatment. It should not be a
primary form of therapy for the DID client. It should be remembered that
DID is a psychological disorder and not a spiritual condition. Spiritual
issues that arise in treatment, such as demonization, should be seen in
light of the total clinical picture
Rosik: Conclusions regarding the role of exorcism or deliverance prayer in DID treatment are, at present, likely to be greatly influenced
by the therapist's worldview (Rosik, 2000a). In my judgment, it is
premature to rule out at least a potential role for such intervention on
the basis of the existing literature. The relevant scholarship on this
topic is sparse and difficult to generalize due to such factors as
variant definitions of exorcism and biases inherent in convenience
samples (Begelman, 1993; Bowman, 1993; Bull, Ellason, & Ross, 1998;
Fraser, 1993; Rosik, 1993, 1997). This also implies that exorcism as a
therapeutic intervention should be approached very cautiously (Rosik, in
press). It should only be considered with patients whose belief system
recognizes exorcism as a valid ritual. As a prerequisite, the therapist
should have (a) extensive knowledge of and rapport with the
patient's alter personality system, (b) attempted standard
psychological interventions that were unsuccessful, (c) inquired as to
the phenomenological experience of the alters, and (d) obtained informed
consent from most, if not all, of the alters. When attempted, the
exorcism should be noncoercive and, wherever possible, patient led.
Involving a supportive member of the clergy known to the patient can
also be helpful. Finally, it needs to be mentioned that the employment
of exorcism in the therapy of DID has a dangerous potential to evoke
countertransference grandiosity on the part of Christian counselors.
Ultimately, we cannot be certain whether successful exorcism expels evil
spirits, therapeutically rearranges ego states, or both. Hence, I would
not recommend therapists utilize exorcism unless they can approach it
with a relatively matter-of-fact demeanor that conveys the intervention
is simply another tool in the clinical armamentarium.
How do you address the issue of false memories in the therapy of
DID?
Bowman: I use two approaches: educating my patients and maintaining
therapeutic neutrality. Soon after trauma memories (recovered or
continuous) are reported in therapy, I begin to teach patients about
memory and the need for both of us to be cautious about its accuracy. I
continue to educate about scientific findings on memory throughout
treatment (Bowman, 1996a, 1996b). The primary educational messages are:
1. The memories of all people contain mixtures of accurate and
inaccurate details.
2. External corroboration is the only certain way to know a
memory's accuracy.
3. Spontaneously recovered abuse memories have been corroborated as
often as continuous memories of abuse, but may contain mixtures of
accurate and inaccurate details.
4. Do not mistake dreams or flashbacks for memories. Dreams are
symbolic material. Flashbacks of documented events can contain
inaccuracies.
5. Memories recovered during hypnosis may be accurate but may be
more easily distorted by expectations or subtle suggestions.
6. Memories of ordinary childhood abuse have been highly
corroborated (75%-90%), but memories of ritual abuse are rarely
corroborated (0%-20%) and are likely not literal historical events.
In responding to continuous and recovered abuse memories, I give
patients the responsibility to decide about their own memory accuracy. I
decline to make statements of belief about uncorroborated memories,
stating that "I wasn't there and I can't know for sure
exactly what happened." I distinguish believing in them as people
from believing in the accuracy of their memory processes. I avoid
intentionally using hypnosis for memory recovery. I ask patients to
consider literal and symbolic explanations for memories. I do not
suggest that dissociative patients who lack abuse memories have been
abused. I never suggest the identity of an abuser. And, I maintain
neutrality as patients struggle with ambivalence about their memory
accuracy.
Comstock: I know that memory is not perfectly reliable and I know
that my patient knows that also. Two people can remember (or experience)
the very same incident differently and a person's memory or
understanding of an event will change over time. Therapist and patient
will probably share an experience during treatment that will demonstrate
this very point. I think of memories as a mix of some totally accurate
portions and some distorted portions. The important clinical meaning of
a memory is to communicate a similarity between the patient's
feelings from the past and the present. Memories can point out which
part of the present day life feels like the past and therefore, which
part needs to be unblocked, reprocessed, relearned, changed, or grown
beyond.
Friesen: First, I validate to the person about how hard it is to
trust those images, and the bits and pieces of information that are
trying to take shape in their minds. Next I educate them that intrusions
into their conscious awareness are parts of them seeking healing, and I
encourage them to help the dissociated parts. Then I make a very strong
point-the memory cannot be evaluated until all of it is available to
look at. We need to look at the primary material--the memory
itself--before we can make sense of it, so I tell them to do what they
can to look at the whole episode. Finally, I ask them to read my book,
The Truth About False Memory Syndrome (Friesen, 1996), which emphasizes
that a memory always comes from somewhere, and always has a factual
basis. As we examine the memory we will be able to tell how much of it
is real.
After a person has had a re-living experience in my presence, I
explain to them how a "flashback" is different from other
memories. Initially, it was too painful to process so it was dissociated
by the amygdala, and it was recorded in bits and pieces in the right
hemisphere of the brain, which does not have the ability to use words
nor keep a story line. It is stored in bits and pieces because that is
the way the right hemisphere works. At some point, often when something
reminds them about one of the bits and pieces of the memory, it starts
being processed for the first time ever! The episode that was too
painful to process is now being processed, and whatever is over in the
right hemisphere is now transferred, through the hippocampus, to the
left hemisphere, where it finally gets words and a story line. The thing
that is distinctive about a dissociated memory is that when the bits and
pieces are getting lined up and put into a story form, the re-living
goes into motion. While the event is emerging, each new piece of the
episode becomes a surprise, in that the person had no idea what was
going to come up next, and there is a pace established to the re-living
that is often about the pace of the original event. This seems like a
"making something up process" to some people-they conclude
that the re-living is the mind making stuff up, but it is really the
mind finding out what actually happened! Only after the bits and pieces
are finished processing is it possible to make sense of the event. Until
that time it will certainly seem unlike other memories, which did not
get dissociated, and may therefore feel false. After the memory is
processed, we will he able to see how it fits into the person's
life.
Mungadze: In my opinion, based on all the research on memory, the
brain and DID therapy, the best way to address the issue of false
memories is to do good therapy that focuses on helping clients heal from
whatever type of trauma they may have experienced. The therapy should
not be reinforcing or discounting the client's account of the
events recalled, but rather facilitate the client's objective
evaluation of their memories.
Rosik: It is important, both clinically and legally, to address the
current scientific knowledge regarding memory with patients. When the
topic presents itself in therapy, I will usually discuss with the
patient how research has shown that memory is reconstructive (as opposed
to reproductive) in nature and that memories may be accurate,
inaccurate, or some combination thereof. I do not believe it is the
therapist's role to decide for patients if their memories are false
or true. If they push the matter, I generally offer a statement such as,
"I believe you have been through something traumatic. My intention
is to assist you as you determine what this might have been." This
usually deflates the resistance and builds alliance while keeping
patients responsible for developing their own narrative truth.
3. What should be the role of the church in caring for individual
suffering from dissociative disorders?
Bowman: The Bible provides no special commission for care of the
mentally ill. Thus, the church's role with DID sufferers should be
no different than with any other person, with or without a mental
illness: to love and accept those persons, connect them to God, and
provide spiritual support and teaching. The church should be guided by
scripture in responding to DID sufferers: Do not be critical or
judgmental by labeling mentally ill persons as sinful (Matthew 7:1;
James 2:13). Treat the Dissociative Disorder (DD) sufferer as neither
more special nor more sinful than any other Christian (James 2:1-9).
Encourage them to stay in therapy with a competent therapist,
whether religious or secular. Do not instill distrust (paranoia) of all
non-religious therapists because they may be the only competent
community resources for treating DID.
The church should help DD sufferers and other abuse survivors
directly and indirectly. Directly, the church should provide supportive
congregational and pastoral relationships that convey acceptance of DID
or PTSD as simply another type of human suffering (Bowman & Amos,
1993; Whitaker, 1994). Provide the usual social supports given to
hospitalized persons (e.g., prayers, cards, visits, phone calls). The
church should avoid sinning against DID or other mentally ill persons by
quickly labeling frightening or mysterious symptoms as demon possession.
The church should provide experiences where DID sufferers can serve
congregants and be affirmed for their gifts.
Indirectly, the church should diminish stigma by mentioning mental
illness in public prayers for ill persons and by teaching congregants
about the difference between mental illness and spiritual malaise.
Preach hope, healing, and God's love, but minimize messages that
induce guilt for feeling depressed, angry, or for being less than
perfect. Publicly name the abuse of children or abuse of parental power
as sin. DID patients have often been abused by males, so provide female
as well as male metaphors and images of God (Matthew 23:37; Mollenkott,
1983). The church should avoid contributing to a climate that
dis-empowers women and children and separates them from direct
communication with God. For example, avoid idolatrous chain-of-command
theologies or theologies that render mothers less able to object to
abuse by fathers. Also, use female and male examples in sermons to
illustrate spiritual and personal strength and virtue.
The church's role is not: (a) to be a therapist or provide
therapy; (b) to gratify incessant demands for attention or tolerate
child-like behavior in public; (c) to treat the DD sufferer as
special/different from other Christians; (d) to take a position on the
DID person's memories; (e) to censure the person's anger or
depression, or label them as evil or demon possessed. Erroneous
judgments on those matters are very damaging. Such judgments may
represent hubris and are God's job, not yours.
Carlson/Wilfrid: Faith Lutheran Church in Chico, California, has
for three years held an annual workshop for sufferers and their
significant others, families, and therapists, too. This came about
because some members in the church have close family members who have
been in therapy for DID. These workshops help families make connections
and get some information out. Therapists, multiples, significant others,
and helpers talk to the group about what this is like.
Out of this has grown an ongoing support group which has now
spawned a second support group in a nearby city. There are probably not
many churches that are doing this kind of thing. This happened because
the pastor was working with DID and some key lay people had personal
involvement. Support for people on their journey is so important. Having
someone who is available as a wise and patient supporter can be of great
help to patients and families alike.
Another role for the church is as a source of information. The
church can host a workshop where pastors and therapists would be helpful
in providing insights on counseling and other important matters. Many
pastors have had dissociative people come to them, and while their
counsel may not have been harmful, some knowledge could have been
helpful.
As for the specific role of the pastor in caring for dissociative
parishioners, a couple of important aspects of such a role come to mind.
First, the pastor must be a developer of trust. Trust is the key
ingredient in the establishment of a fruitful therapy. This can take
some time, and this trust will be tested! Promises are covenant
language. This is the way God works. God came to Abraham and said,
"I will bless you, and you will become a blessing." This is a
big theological theme: God is a God of covenant! Pastors should
understand the need for making promises in terms of building
relationships and building trust in these people if they are going to
work with them at all. Most DID sufferers have a difficult time with
relationships in general, and many have experienced rejection or abuse
in church. A church needs to be a safe place from rejection and safe
from additional psychological or sexual abuse.
Second, the pastor should be a person of love
([alpha][gamma][alpha][pi][eta]: agape). Love therapy is unconditional
love. He or she must respect even the darker, nasty, angry, SOB kind of
alter personalities that are in the person. This is the most important
gift a pastor can offer. Most of the dark, nasty, suicidal,
self-destructive alter personalities really have a soft inside; they
want to be loved. They do respond to love and respect. No one has ever
listened to these alter personalities or taken them seriously in their
fear and brokenness. Unconditional love is certainly a Christian
therapeutic approach. But it takes a long time for these alter
personalities to trust, and it takes a long time to come to understand
them. (Another reason that exorcism is at least premature: just trying
to get rid of the alter personalities. That is the way everybody treats
bad kids--trying to get rid of them.) How do we give them the benefit of
some respect, and come to understand how they were formed, why they were
forme d, what they have done, and what their concerns were?
And, let us not forget the positive alter personalities. These are
often so weak, and fearful, intimidated, and polite. They are the
rescuers; they are the alter personalities that bring balance, and they
need to be included, strengthened, and encouraged for the healing and
integration process.
Comstock: The church can provide the patient with real community in
an atmosphere of love as well as spiritual support and guidance. The
church can allow the patient to learn to participate in social and
individual activities focused on the positive, unconditional, unceasing
love of God even though there are tragedies and human betrayals. The
church can teach the patient how to pray, how to see the miracles and
graces in human relationships, and, also importantly, can help to fill
the days. The church can allow the person to lose some of his or her
sense of isolation and self-absorption as he or she develops additional
social skills, relationships, and confidence.
Friesen: When the Bible says, "Religion that God our Father
accepts as pure and faultless is this: to look after orphans and widows
in their distress" (James 1:27), the principle being underlined is
this: Orphans and widows are examples of people who have no family. We
are to be the family of God to them, and to treat them as though they
were in our family. It looks to me like this principle is not understood
very well in churches today, and therefore, the DID people who need a
family often do not find one. In many cases, it comes down to this harsh
reality: Therapy is of no value to them unless they get established in a
family first. Therapy is a waste of time and effort unless their family
needs are taken care of first. For a fuller examination of this problem
please read The Life Model: Living From the Heart Jesus Gave You
(Friesen, Wilder, Bierling, Koepcke, & Poole, 1999).
Mungadze: People suffering from dissociative disorders usually have
acute needs, including needs that are best met by the church. These
needs include: needing to be treated as every one else, having
fellowship with others, being understood, and given spiritual support. I
think that the church can meet these needs without care taking and
without making them feel they are a project. It is important that the
church give these DID clients privacy concerning their disorder. In
order to do this, the church should not have information about their
counseling.
Rosik: I have long contended that the church has an important role
to play in the care of persons suffering with dissociative identity
disorders (Rosik, 1992a, 1992b). For Christian DID clients, whose
biological families are often extremely dysfunctional, their spiritual
family often assumes a preeminent role in their lives. In addition, with
the rise of managed care and the accompanying financial barriers to
longer-term psychotherapeutic treatment, I believe in many cases the
church will function as the primary agent of healing (Rosik, 2000b).
This is because psychotherapy, while necessary, is not sufficient as it
does not provide the supportive community so beneficial to the healing
process. Quasi-communities such as those previously developed in
long-term day treatment programs or inpatient units are no longer
financially viable. In my experience, DID patients do not generally
appear to benefit from homogeneous group therapy or support groups run
by paraprofessionals, nor does such participation tend to br ing
patients into contact with emotionally healthy individuals. As noted
above, many of these individuals cannot turn to their own family of
origin for the experience of safe human connectedness. Thus, the church
is perhaps the last community in our increasingly individualistic
society that has the human and financial resources to assist the DID
sufferer over the long haul.
In specific terms, churches can care for these patients by
fulfilling the biblical mandates to listen to and pray for them (James
5:16), encourage and involve them in the life of the church (Heb. 10:24,
25), and emphasize the theological teaching that has typically been
missing in their lives regarding their value to God and God's love
for them (Is. 43:4; Luke 12:7, 22:4; John 3:16). One caveat for pastors:
There is a difference between supporting and enabling DID sufferers. Do
not do things for these individuals that you would not do for any other
parishioner. Too often I have witnessed well meaning clergy become
gradually overwhelmed and burned out by DID patients whose inner turmoil
led to an increasing violation of reasonable interpersonal boundaries.
Remember, it is always easier to loosen a boundary with these patients
than to tighten it later. So do not make boundary exceptions or unduly
gratify demands without serious reflection, prayer, and consultation.
4. In what ways do religious faith and spiritual experience promote
healing in DID? How might they undermine it?
Bowman: While spiritual experience is generally an unqualified
asset for DID patients, religious faith can either promote or undermine
healing. Religious faith, whether Christian or other, has been
demonstrated in research to be associated with better mental and
physical health (e.g., lower rates of depression, suicide, cancer
hypertension, anxiety, substance abuse, antisocial behavior, etc.;
Larson & Larson, 1991). In DID patients, religious faith can provide
a clear structure for right and wrong that strengthens the conscience to
help them resist the strong destructive impulses (e.g., suicide,
self-mutilation, homicidal urges) that are often contained in angry
alter personalities. Religious faith provides a sense of meaning in
seemingly endless suffering during treatment.
Religion provides better parental images than those available to
DID patients who were abused by parents. For Christian patients, faith
provides a positive male image (Jesus) with which to identify. For
Catholic patients, benevolent female images (St. Mary and other saints)
are also available. Most important, spirituality and religion offer
cathexis (connection) to a powerful helper (God) who, unlike real-life
parents and friends, does not hurt or abandon these patients. The
constant experience of God (although rare for most DID patients) is a
powerful asset for enduring psychological pain during treatment.
Religious faith opens access to a potentially supportive faith
community (e.g., church, mosque, synagogue) and to the wealth of social
support that accompanies it. Religious faith provides DID patients with
people who pray with them and for them, and who may provide the DID
patient with their first glimpse of normal loving relationships. Healthy
religious communities function as surrogate families to ease the
loneliness of DID patients whose biological families are unsafe.
Unhealthy systems of religious faith can undermine healing. These
systems are oriented toward inducing guilt, emphasizing strict
behavioral rules and human sinfulness, and tacitly censuring lack of
perfection or human expressions of anger. In these systems, the DID
patient's difficulties with low self-esteem can worsen. The most
destructive religious systems are those that label mental illness as sin
or demon possession, causing the already suffering DID patient to feel
intrinsically evil and guilty for having his or her symptoms. Religious
systems can also undermine healing by promoting an atmosphere in which
the power or actions of parents (especially fathers) cannot be
questioned without great guilt. Further, some religious systems prolong
the passive disempowered stance of many DID patients by excluding women
from leadership and censuring them for assertive behaviors.
Carlson/Wilnfrid: It probably begins with the trust level between
the pastor/therapist and the individual. It is hard to impose religious
faith and positive spiritual experience in the midst of fear and guilt.
The individual usually feels a great sense of betrayal by everyone. This
includes God, because of unanswered prayers, as well as family and
friends who were either abusive or indifferent.
Healing is a long process. The patient's pastor/therapist
needs to have patience, patience, patience; time, time, time; love,
love, love. The individual has a deep desire inside to be hopeful, wants
to be part of life, wants to be included, and wants to trust! Being with
others in worship and Bible study can be beneficial, but the healing can
be a slow process. Trust in others can be slow and difficult. And it can
be tested often.
Sometimes there is a tendency for religious communities to think
too much in terms of black and white. You are either good or bad. That
is what these patients are stuck in--too much black and white thinking.
"I'm either good or I'm bad. This person is either
trustworthy or not." Religious people tend to be that way, and this
could undermine healing.
Also, "You have to love all your enemies. You have to forgive
all your abusers." Baloney! Spiritually, that is most difficult for
a healthy person to do. And these people are far from healthy. To lay
something like that on them would be absolutely stupid--it would drive
them back into despair and back into their guilt. The religious
community needs to be very wise and mature in this matter.
Comstock: Religious faith and spiritual experiences change lives.
They can be the steady points of reference from which DID patients can
heal and to which DID patients can return for strength, purpose, and
comfort. On the other hand, some interpretations of biblical scriptures
can be used against the patient to punish, humiliate, or frighten the
patient. Reports of spiritual experiences can be used to
"prove" how deluded, psychotic, or sick the person is.
Spiritual experiences can be overwhelming for a person when the enormity of a personal prayer or meditation experience is more than the
person's emotional resources can presently bear. The church or
other spiritually inclined people can help to frame the experiences in
the larger context of God.
Friesen: Psychology is a good thing. It helps me know what to pray
for. It does little good to find psychological wounds and simply re-live
them. That can be re-traumatizing. We do better to find the wound,
re-process it in a supportive situation, and ask for the Lord's
healing in prayer. That helps a lot. Healing wounds is essential for
these people, and healing is God's domain. We need to turn to Him.
Spiritual experience undermines people's progress when
Christians are simplistic. That is, when Christians falsely believe that
they know how to solve other people's problems. When they say that
a person who is hurting should do this or that--whether it is praying in
a particular way or tithing or submitting to authority or even in
renouncing spiritual curses and vows--that will be destructive. There is
no formula for "getting better" found in the Bible, and there
is no promise in it that people are going to feel good. There is no
quick cure. The Bible is full of stories where people find that
God's way is best, even through suffering, but it is not what the
person expected from God! There are times when it is very discouraging
for DID clients to see other Christians getting over their problems, but
DID clients have wounds that do not get healed very quickly. They do not
need to do this or that. They need (a) to belong to a family that is
safe and encouraging, (b) to strive for maturity, which is something we
all must strive for, and (c) to seek God's healing for their
wounds. They need God, they need His family, and they need a lifetime to
become the people that God intended them to be.
Mungadze: Good, vibrant, religious faith and a biblically based
spiritual experience can be the most effective pathway to healing DID
clients, especially those with SRA, provided the client is ready for
incorporating their faith into their healing. Faith can help DID clients
have hope when things look very bleak. Faith can also provide DID
clients a solid basis by which they can dispute their distortions about
God, self, and others. Religious faith sometimes can undermine healing
in DID clients, especially when it is forced upon them by other people
or when the host personality forces it upon those alters who are not
ready to embrace it. Religious faith can also undermine healing when it
is used as a way of denying the truth and over spiritualizing trauma and
pain.
Rosik: I have written extensively on this topic (Rosik, 2000b) and
so will not repeat my thoughts here. Suffice it to say that in terms of
interfacing with the patient's psychodynamics, genuine Christian
faith and spiritual experience serves to lessen defenses while
increasing self-awareness and self-acceptance. Theologically, this means
growth in the experience of being deeply and securely loved by God,
leading to the promotion of humility before God as well as an active
empathy for others. Religious and spiritual espousals not resulting in
these characteristics fall, in my view, under the rubric of "having
a form of godliness but denying its power" (I Tim. 3:5).
5. How has our understanding of the treatment of DID changed over
the past twenty years?
Bowman: The field of DID treatment is maturing. As a field, it has
passed a stage of countertransference fascination with DID as a special
or exotic condition. Consequently, secular therapists are more careful
to maintain firm boundaries and avoid dual roles in DID treatment
(Hundert & Appelbaum, 1995; Peterson, 1992).
Treatment is no longer seat-of-the-pants untested frontier
transmitted by oral tradition. Treatment guidelines (2) for adults have
been published by the International Society for the Study of
Dissociation (ISSD, 2000a) and child/adolescent guidelines (ISSD,
2000b). As more therapists treat DID, DID treatment is no longer viewed
as unique, but is seen as a technical modification of the three-stage
treatment of psychological trauma and chronic severe PTSD. Accordingly,
more emphasis is being placed on stabilizing DID patients and building
ego strength before moving to address trauma. Currently, less emphasis
is given to abreaction of trauma and more to the pacing of treatment to
avoid crises. More care is being taken to preserve functioning during
the prolonged treatment of DID and to modify underlying pathological
personality structures.
The field went through a media-influenced stage of uncritical
acceptance of SRA reports, but these reports have diminished in light of
corroboration studies that fail to support them as historical accounts.
As there is less fascination with SPA, the frequency of patient reports
of it appears to be decreasing except in a few geographic areas and
treatment centers.
The most important change has been increased caution about memory
veracity, in response to lawsuits filed by accused abusers. Hypnosis
continues to be used in treatment, but is now out of favor as a means of
enhancing recovery from traumatic memories. Therapists are more careful
to monitor suggestiveness and are more cautious about uncritical
endorsement of the veracity of recovered memories. Confrontation of
abusers is no longer encouraged, since it has led to lawsuits and has
doubtful efficacy in promoting healing. Awareness of possible memory
contamination on inpatient units and in trauma group therapy has risen.
This awareness, combined with the advent of the managed care industry,
has diminished enthusiasm for inpatient dissociative disorder units.
Inpatient abreactions in restraints are now viewed with caution as a
possible sign of inadequate pacing of treatment.
Novel techniques such as Eye Movement Desensitization and
Reprocessing (EMDR) that speed processing of trauma are beginning to
gain acceptance. Research advances are now helping therapists recognize
factitious presentations of DID.
Carlson/Wilfrid: Hopefully, we are wiser, more patient and
empathic; less confused and fearful. The human mind is a wondrous
creation; a wonderful gift. How fortunate we are to see the miracle of
the Mind!
Comstock: In the 1980's, clinicians focused on gathering
information about patients and about treatment. In part, we re-enacted
Freud's journey. We first believed our patient's memories to
be accurate, we attributed their present symptoms to past events, and we
saw memory work as being curative. We then rediscovered that neither our
patients memories nor their perceptions are necessarily accurate. With a
more integrative understanding of the dissociative process, we now see
one person, a coherent, although not consistent, complex individual with
a variety of resources, responses, needs, feelings, and ideas. We know
that patients' reports of internal separateness are feeling and not
the physical reality. We no longer create maps, or take histories and
names of each part as if it were a separate person. We focus less on the
past and more on a personally rewarding present day life for the
patient.
Friesen: We know enough right now to provide good treatment for DID
clients. Of course, we are still learning, but here is the point. This
is no longer a new field, and there should be no hesitation to use what
we already know. The problem is that there are too few clinicians
providing treatment. It is necessary for clinicians to specialize in
working with this disorder, largely because the work is different from
treating many other disorders. One problem is that clinicians are having
a hard time finding training so that they can learn how to carry out
interventions that work with DID clients, like uncovering dissociated
memories, encouraging cooperation between dissociated personalities, and
integrating them. There needs to be mote attention given to teaching
what we already know about treating DID clients.
Mungadze: The most significant changes in the understanding of the
treatment of DID have resulted from the research of PTSD, memory, and
the brain. Currently the focus in treatment has moved from processing
memories to behavior management and cognitive restructuring. In the
past, therapists were quick to accept client memories as fact, but today
therapists are careful to stay neutral and perhaps even help the client
confront apparent distortion in hard-to-believe situations. In the past,
some therapists may have spent a lot of time and energy trying to figure
out intricate systems of personalities in their clients, whereas today
the focus is more on resolving significant conflicts, the traumas
underneath them, and helping the host to manage his or her system of
alters.
Rosik: The dissociative disorders field has undergone significant
evolution since I first began treating these patients in the late 1980s.
DID remains controversial in some quarters, but it can no longer simply
be considered a "fad" diagnosis. Contributing foremost to the
evolution of our understanding of DID is the rapidly growing trauma
research literature that is shaping theory and practice. Simplistic
abreactive models of treatment have given way to more complex paradigms
that include greater emphasis on psychodynamic issues as they manifest
in the patient's present psychosocial functioning (Kluft, 1999). A
more nuanced perspective on patient memories has also replaced earlier,
uncritical approaches that treated traumatic recollections as
disconnected from the developmental, social, and neurobiological contexts within which they occur. This does not signal a return to undue
skepticism of patient accounts. Rather, these factors should serve to
help place the responsibility for determining a patient's histo
rical narrative where it belongs--with the patient. While Christian
counselors are ahead of the curve in terms of recognizing the value of
spiritual and religious issues in DID treatment, I fear that too many
are not adjusting their approach to this disorder to reflect such
important developments in the broader field. This could potentially
increase legal liability, create unnecessary religious disillusionment in patients, and lead to the reinforcement of negative stereotyping of
Christian counselors within the profession.
What do you foresee in the future of the dissociative disorders
field?
Bowman: Critics of recovered memories are beginning to fade in
prominence and this will slowly continue as mental health clinicians are
now beginning to respond to these attacks in an organized manner. The
burgeoning of research on memory, dissociation, and PTSD will continue
to elucidate the nature of traumatic memory and dissociation. The
recovered memory controversy will leave the dissociative disorders field
permanently more cautious about memory veracity, but with a new wealth
of research that will place it in a more scientifically sound position
than it was before the controversy.
Increased concern with pacing of treatment and with memory veracity
will continue and treatment of DID will become more mainstream. More
therapists are now being trained to recognize DID, so the current trend
toward more therapists treating it will continue. DID is being
increasingly recognized on other continents; this trend will continue.
The DD field in other countries is beginning to see some backlash by
advocates for accused parents, but the DD field outside the US will
benefit from American experience with memory and likely will not suffer
the massive lawsuits seen in the USA.
Brain (PET and SPECT) scanning will further elucidate the
neurological basis of dissociative amnesia and personality switching,
and may enlighten us about the biological basis of dissociative amnesia.
Research on DID will become more allied with physiologic research on
PTSD and dynamic understanding of borderline personality disorder. EMDR
or other novel techniques likely will come into more use.
The development of the dissociative disorders field will be wed to
the acceptance of trauma as a major paradigm in the etiology of mental
illness. Overall, the dissociative disorders field will unify more with
the trauma/PTSD field and dissociative disorders will become even more
mainstream than they are now. It is difficult to predict the role of
spirituality in the future of the DD field except to say that it will
mirror the increased awareness of the importance of spirituality in
mainstream mental health and medical care.
Carlson/Wilfrid: Historically, the church is where many troubled
people have come, and in the future, they will continue to come for
help. How positive it could be if there were workshops, etc., where
members of the religious community can dialogue with people in the
fields of psychiatry, psychology, medicine, and where counselors,
therapists, and recovering patients and families could participate.
Comstock: Knowledge about dissociation will be increasingly
integrated into other fields and will be seen as a component of many
disorders such as impulse disorders, eating disorders, borderline
personality disorder, and posttraumatic stress disorder. I think the
emphasis will shift from seeing dissociation as an end result or symptom
to seeing dissociation as a coping process used when the ego cannot
contain the feelings engendered by the event. As research results and
outcome data support some forms of treatment and not others, we will be
better able to help each patient understand and control his or her
dissociative responses.
Friesen: To quote someone, "The more things change, the more
they stay the same." I am a veteran in this field, and my hope for
widespread improvement in the treatment of DID clients has been
practically snuffed out altogether. There are so many DID people who
need help who are not getting it because there are too few clinicians
trained to treat them! Jesus was right when He had compassion on the
crowds he saw. They were "harassed and helpless, like sheep without
a shepherd. Then [Jesus] said to his disciples, 'The harvest is
plentiful but the workers are few. Ask the Lord of the harvest,
therefore, to send out workers into his harvest field'" (Matt.
9:36-38).
It looks to me as though the general public will continue to avoid
pain and, therefore, people who have suffered severe abuse will not get
the attention they need in order to recover. People would rather
question their stories than listen to them. The prevailing attitude of
the general public is very similar to how the general public feels about
poverty-struck countries--"We don't want to think about
it!" The popular method of handling reports of severe abuse is to
shoot the messenger. It also looks to me as though most Christian
clinicians are not willing to pay the price to get trained to treat DID
clients, nor to risk being sued for helping people whose presenting
problems are controversial. Perhaps there is a little more acceptance of
working with DID clients today than there was 20 years ago, but not
much. There seems to be little room for treating DID clients in the
caseloads of most clinicians, and there seems to be little energy in
most churches for helping people who have been seriously wounded. I se e
that the future will be about the same as the present. There are some
really good DID clinicians who are helping many people. The vast
majority of therapists do not know how to treat DID clients, and
probably will not learn how to do so. The harvest is plentiful but the
workers are few. Ask the Lord to send out workers into this harvest
field.
Mungadze: I foresee some good and perhaps bad things on the horizon
in the treatment of dissociative disorders. Starting with the positive
side, very good research on the treatment of DID, memory, and trauma
keeps coming and confronting the false memory syndrome foundation's
ideas that used to threaten the treatment of DID. Our treatment is
getting better and there are more and more DID clients getting well. On
the negative side, managed care continues to force some clinicians to
document their treatment goals and procedures to fit their cost needs.
If this continues, managed care will determine treatment instead of
skilled, experienced clinicians that specialize in DID. Managed care
will also influence what some doctors and clinicians conclude as
diagnoses for their DID clients in fear of managed care's bias
against the disorder. Some dissociative disorder specialty programs are
already changing their names to trauma programs to avoid the dreaded DID
term. This is sad because once again leadership in this fi eld needs to
remain in the hands of the treating clinician rather than the managed
care reviewer.
Rosik: Treating dissociative disorders is not for the faint of
heart! It is easy to be intimidated by experiences of patient rage,
reports of therapists being litigated, and colleagues questioning your
diagnostic acumen. As a result, many therapists who in years past
treated DID because it seemed fascinating and garnered some professional
notoriety have stopped treating these patients. Now that the societal
climate surrounding DID treatment no longer promotes much secondary gain
for therapists, those who remain in the trenches must have a sense of
calling. For the Christian in this field, I believe the ingredients of
such a calling are twofold, involving (a) a deep and mature faith in God
and (b) an unyielding commitment to professional practice.
The field of dissociative disorders is here to stay. However, it is
still in a period of relative adolescence and I anticipate we will
witness as many new developments in the next decade as we have seen in
the past one. Some of this evolution will stem from developments
occurring within the field (i.e., new research data and clinical models)
while some will be dictated by trends in the culture (i.e., those
involving judicial decisions and health care funding). Prepare yourself
for further adventure!
Finally, I also believe Christian theological and anthropological
insights need to be represented in the future of this field. Jesus'
own incarnational mandate (Is. 61:1-3; Luke 4:16-20) speaks to so many
of the emotional and spiritual needs of DID patients: proclaiming
freedom, releasing from darkness, binding up the brokenhearted, bringing
comfort and gladness to the mourning, and enabling praise where once was
only despair. Christian counselors, animated by God's Spirit and
informed by modern scholarship, are clearly acting within this tradition
when they treat persons suffering with DID. We, like the Lord before us,
desire healing and wholeness for these individuals so that "they
will be called oaks of righteousness, a planting of the Lord for the
display of his splendor" (Is. 61:3b).
CONCLUSION
The responses solicited from this panel reflect some areas of
general consensus and other issues where significantly divergent
perspectives exist. The respondents appeared to agree on the need for
caution when dealing with traumatic memories and the need for patients
to determine for themselves the historical veracity of their
recollections. Counter-transference concerns were frequently noted in
the use of exorcism, with a suggestion of motives that included rescue
fantasies (Bowman), seeking a short cut to difficult developmental tasks
(Carlson/Wilfrid), ego gratification (Bowman, Rosik), and the avoidance
of pain and suffering (Friesen). There was consensus on the beneficial
impact of faith communities where positive social support is offered and
a theological emphasis on God's love is provided. All panelists
believed that the church has also been a place where religious and
spiritual abuse can occur with potentially devastating consequences for
DID parishioners. Finally, there was general agreement that th e DD
field has seen significant evolution away from a treatment model that
focuses primarily on abreaction of traumatic memories toward a greater
clinical emphasis on ego-strengthening and the maintenance of adequate
functioning in the present.
Despite these areas of concurrence, some topics evidenced continued
sharp differences in understanding and approach. Perspectives on the
utilization of exorcism varied widely, ranging from a strict prohibition
(Bowman, Comstock) to an endorsement of its regular tactical application
(Friesen), with others seeming to affirm its potential usefulness while
maintaining that it should occur infrequently (Mungadze, Rosik). The
veridicality of memories of satanic ritual abuse also appeared to be
viewed quite differently, with Bowman suggesting that these
recollections are almost always unreliable, whereas Friesen appears
willing to grant them historicity as the patient develops a sense of
this. Finally, in evaluating the future of the DD field, some
respondents (Bowman, Comstock, Rosik) reported guarded optimism that the
field is gaining greater acceptance and a more firm scientific
foundation, whereas others (Friesen, Mungadze) expressed a mixed to
pessimistic viewpoint due in part to managed care and a dearth of co
unselors with specialized training.
It is quite possible that some of these differences in perspective
can be explained by the dissimilar patient populations with which these
panelists probably work. Many patients will seek out or be referred to
therapists and clergy whose approach matches their own general worldview
and specific theological expectations. This potential effect of
selection bias is intensified when the practitioner has published
literature in the field that can also serve as a vehicle for patient
self-referral, as is the case for most of the respondents. Thus, the
panelists' sentiments may diverge where they encounter clinical
responses or therapeutic concerns that are more reflective of the unique
subpopulation of patients to which they are exposed.
This article has intended to provide a venue for dialogue and
understanding among a panel of religiously sensitive therapists and
clergy, all of whom share a common concern for the well-being of those
within the community of faith who struggle with DID and other
dissociative and post-traumatic disorders. As our scientific and
theological comprehension of this field continues to expand, it is
sincerely hoped that many more opportunities for such professional
interchange will occur.
(1.) Three significant exceptions to this rule arc a 1992 special
issue of the Journal of Psychology and Theology (Vol. 20, No. 2) which
focused on satanic ritual abuse, a 1993 issue of the now defunct journal
Dissociation (Vol. 6, No. 4) examining possession and exorcism, and a
2000 special issue of the Journal of Psychology and Christianity (Vo.
19, No. 2) on Dissociative Identity Disorder.
(2.) These guidelines arc available electronically at:
http:\\www.issd.org\isdguide.htm.
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American Psychiatric Association (1994). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: Author.
Begelman, D. A. (1993). Possession: Interdisciplinary roots.
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Bowman, E. S. (1993). Clinical and spiritual effects of exorcism in
fifteen patients with multiple personality disorder. Dissociation, 6,
222-238.
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AUTHOR NOTES
BOWMAN, ELIZABETH, M.D., is Clinical Professor of Neurology and
former Professor of Psychiatry at Indiana University School of Medicine and a Past President of she International Society for the Study of
Dissociation. She received her M.D. from Indiana University and a Master
of Sacred Theology degree from Christian Theological Seminary in
Indianapolis, Indiana. She has professional interests in dissociative
disorders, conversion seizures, and in religion and psychiatry.
Rev. Harry Carlson, retired Lutheran pastor, lives in Rio Linda,
California. He received his M.Div. in 1953 from Wartburg Theological
Seminary, Dubuque, Iowa. He has served for several years on the
Sacramento County Mental Health and Alcohol/Drug Advisory Boards. He met
and has consulted with Dr. Ralph Allison since 1979.
Christine M. Comstock received her Ph.D. in Clinical Psychology
from The Fielding Institute. She specializes in treating survivors of
abuse and has a research interest in the Rorsehach Ink Blot Test. She
has published and presented extensively in the fields of child abuse,
dissociation, and hypnosis, is a fellow of the International Society for
the Study of Dissociation, and has won several awards for her work in
the field of dissociation.
James G. Friesen, Ph.D., is a psychologist who has been working
with dissociative disorders for 14 years. He is the author of four
books, including Uncovering the Mystery of MPD, abest seller in the
Christian community. He has spoken at more than 80 conferences
worldwide.
Jerry Mungadze, Ph.D., specializes in the treatment of dissociative
disorders. He is the founder and director of the Mungadze
Association's nationally renowened outpatient and inpatient
hospital unit in the Dallas/Fort Worth area. He is also an adjunct
professor at Dallas Baptist University in Dallas, Texas, and much of his
time is spent traveling both nationally and internationally presenting
seminars, workshops, lectures, and case consultations.
Christopher H. Rosik received his Ph.D. in clinical psychology from
the Graduate School of Psychology at Fuller Theological Seminary. He is
currently a clinical psychologist working at the Link Care Center in
Fresno, California. His professional interests include dissociative
disorders, bereavement, and psychotherapy of missionaries and ministers.
Rev. Carl Wilfrid is Senior Pastor of Lutheran Church of the Good
Shepherd in Reno, Nevada. He previously pastored Faith Lutheran Church
in Chico, California. He received his M.Div. in 1969 from Luther
Theological Seminary, Sr. Paul, Minnesota. He also received his S.T.M.
in Pastoral Counseling from New York Theological Seminary in 1973. He
has worked with several DID sufferers, some for an extended period of
time.
Correspondence concerning this article should be addressed to
Christopher H. Rosik, Ph.D., Link Care Center, 1734 West Shaw Avenue,
Fresno, California 93711. Electronic mail may be sent via Internet to
Christopherrosik@linkcare.org.