Dear NESSD Members:

On the eve of the new millennium, I am writing my first column as the incoming president of NESSD, succeeding Seth Segall, a wise and gentle man who I refer to as "The Buddhist who led us into the 21st century." We all owe Seth a debt of gratitude for the very thoughtful, serious, respectful way he has worked to bring us up-to-date: creating and maintaining our web site, making sure the members who represent NESSD publicly are protected by liability insurance, amending our by-laws so that they conform to our actual current practice, and, at the same time, talking in this column about the moving and inspiring and challenging experience of working with dissociative patients--our common bond, after all. So I want to take this opportunity to thank Seth from the bottom of my heart for all he has done for us, to talk a little bit about the future of this organization and then to tell you a story about a particular patient who was my first teacher about pain and inspiration.

As the New Year and the new century begin, NESSD faces questions about its mission and its future. We grew rapidly in the early 90s when dissociative diagnoses and syndromes suddenly could be spoken about, which in turn meant trying to figure out a way to treat them. As colleagues who felt very alone in the mental health community and who were struggling to find answers to complex questions about diagnosis and treatment, we banded together, brought in those who knew more to share what they had learned, and shared what we were learning as we were learning it. Today, NESSD's membership is at its lowest point in many years; dissociative symptoms and diagnoses are relatively commonplace now; there is a body of literature and a set of treatment guidelines available to anyone; and the litigious climate continues to make therapists cautious about becoming "known" as experts on dissociation and therefore open targets. Ironically though, despite the negative stereotypes still proliferating about dissociative disorders (as evidenced by the demoralizing Christopher Lydon program aired this fall), trauma is now recognized as an endemic problem in our culture, profoundly affecting children and adults, and, in hospitals and clinics, patients are routinely asked about histories of abuse and neglect. Graduate students and post-docs more often have been exposed to issues of trauma and dissociation and therefore do not need us in quite the same way I needed NESSD ten years ago when I first came to a Quarterly Meeting. What then is our mission in this next decade? We have created a professional home for therapists who work with trauma and dissociation: how do we invite new members into this home and make them welcome? How do we continue to bring credibility to this very important work we do? How do we teach our colleagues about dissociation in ways that help them see that they too work with dissociation every day of their professional lives?

Which brings me to the story of Barbara, one of my very first dissociative disorder patients, who died peacefully this past April of cancer at the age of 63 after a forty year history of having tried in countless ways to end her life violently. Barbara was first hospitalized in 1949 at the age of 13 when she refused to go to school because, she said, "I don't want anyone to see me-anyway, no one would believe me." Fifty years ago, no one thought to make the connection between a child's inexplicable, overwhelming, incapacitating shame and her fear that she would not be believed if she told anyone what had caused her shame. As a result, Barbara spent over half her adult life in mental institutions, being repeatedly re-traumatized by the primitive treatments and jail-like conditions of mental health institutions in the 60s and 70s. She was re-shamed countless more times by diagnoses of paranoid schizophrenic, manic depressive illness, and, most humiliatingly of all, borderline personality disorder. Psychodynamic explanations of her symptoms and behavior only confirmed for her that her pain must be "her fault." When she first attempted suicide at the age of 20 after a Christmas visit home from college, today's mental health system might have recognized her symptoms as manifestations of a traumatic legacy of which she had only a small fragmented recollection. In those days, she was encouraged to drop out of college in favor of months-long, sometimes years-long periods of institutionalization. Barbara saved her soul over those years by virtue of being able to use her mind as a refuge-no surprise to those of us who work with trauma and dissociation. She retreated to imaginary places in nature using pictures she cut out of old magazines; once a gifted elementary and high school student who loved math and sciences, she spent hours figuring calculus problems using an old textbook; and, most importantly, from Barbara's point of view, she used her deep connection to the God of her understanding to sustain and comfort her.

How then did Barbara eventually come to die a natural and peaceful death surrounded by people who cared about her? Only because her caregivers finally made the connection between her symptoms and her childhood trauma-forty years after her first cry for help. It was my privilege to meet Barbara at that time and to begin to help her re-define herself through the lenses of trauma and dissociation. She in turn was my teacher about pain and about faith. Re-defined as someone who had been making valiant efforts to cope with pain caused not by her evil but by that of others, Barbara was slowly able to become more stable, to live in a halfway house, to make her first real friendship there, to become a mental health consumer advocate, and to write and actually publish articles about spirituality and mental illness. When I wonder what my mission is in this field, as we all do at times, the memory of Barbara is a reminder that those who suffer the effects of traumatic neglect, abuse and abandonment depend upon our growing understanding of their complex symptoms and behavior and upon our continuing to develop ways of treating those symptoms that give them back meaningful lives.

Janina

President, NESSD

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