Authors: Torey Hayden
It is also normal to dissociate in stressful situations, to try to subvert pain or a negative situation by “thinking of something else.” Indeed, this is generally considered a good thing; self-help books show us ways to do it effectively; parents often encourage children to cope in this manner; and people who show such abilities are often regarded as creative, adaptive, or intelligent. So the question is not, do you dissociate or not? Or even, how much do you dissociate? Rather it is, at what point on the continuum does it move from being resourceful and helpful to maladaptive and damaging? This is a difficult question to answer, not the least because that point isn’t in the same place for all people, and not all dissociated states, even on the far end of the spectrum, are bad.
Multiple personality disorder in childhood is an even more complicated issue. As part of normal imaginative play, most children dissociate easily and, indeed, quite completely, to try out different identities as police officers, astronauts, cowboys, parents. Likewise, many healthy, well-adapted children have imaginary companions who show a different personality from the child. Some construct whole imaginary worlds, elaborately detailed and peopled with a diversity of characters. These creations can last throughout childhood, adolescence, and even adulthood without any implication of psychological disturbance. On the other hand, there are completely unrelated organic factors—drugs, allergies, physical illnesses—that can also cause dramatic behavior changes that mimic dissociation, such as the inability to recall recent events, abrupt changes in attention span, or “cloudy” thinking. So multiple personality disorder isn’t a straightforward diagnosis to make.
As a consequence, I very much needed Dave Menotti’s input, because my own background was inadequate for such a diagnosis. He’d been away for much of the previous week or I probably would have snagged him to look at the tape at the point when I first became suspicious of this possibility. Now, after my most recent session with Cassandra, I definitely needed his opinion.
Dave watched the tape with great interest. It was a dreary afternoon, quite late in the day, and darkness came sooner than it should have because of a heavily overcast sky and icy rain. Our video cameras filmed in black and white only, and the tape I’d used to record this session was an old, much-used one, so it was full of snow and flickers. This only added to the gritty, rather bleak ambiance.
Left arm across his belly, right elbow braced on it, Dave absently twisted his lower lip as he watched. His brow furrowed as Cassandra began talking about Minister Snake and Cowboy Snake.
“Even when a child has a diagnosis of MPD, it isn’t very common to have clearly defined alter egos,” Dave said. “That is more of an adult phenomenon. The alters tend to become more complex and significant as the individual matures. I’m not sure why, whether it is simply part of the maturational process and reaching abstract thinking levels, or whether it is because the behavior becomes entrenched. In my experience, however, the alters are quite nebulous in most children. Not really ‘personalities’ per se. Which makes them harder to track down, harder to recognize. But it also usually makes them easier to reintegrate with the main personality, because they haven’t become so detached.” He let out a long breath. “But yeah, I certainly get the feeling this is what we are dealing with here.”
“There’s a very high correlation between MPD and severe trauma, isn’t there?” I asked.
Dave nodded. “More than just severe trauma. It usually implies repeated severe trauma. Trauma of the sort the child perceives as life-threatening. And that the kid can’t get away from. That keeps happening over and over again with no real opportunity to heal in between. Yeah. I think it’s in the nineties—96, 98 percent of kids with MPD have suffered that level of abuse.”
He sighed. “So even if she never reveals what happened to her during her abduction, we need to assume Cassandra has been a severely and repeatedly abused girl.”
W
hile these insights into Cassandra’s perplexing behavior were a diagnostic breakthrough, they were, sadly, a breakthrough only in terms of our perceptions of her, but not in terms of what she was doing. I’d hoped that she and I had at last started to form a positive relationship, that our quiet conversation and my deeper comprehension of what was going on would provide the much-needed connection and we could start to move forward. Not so. Cassandra remained as challenging and hard to like as before.
As seemed to be the norm these days, she was in lock-down when I came to get her for our session together. Once again it was over Selma. Selma’s vulnerability made her a magnet for Cassandra, who, on the one hand, seemed genuinely to like the younger girl, and on the other hand, seemed completely unable to stop from bullying her. This wasn’t helped any by the fact Selma wasn’t very bright, and, as a consequence, was hopelessly gullible, taking everything said to her as literal truth. This gullibility itself simply fascinated Cassandra, who then became even more outrageous in her lies, as if to see just how ridiculous she could become before Selma would call her on it.
Even more fascinating to Cassandra, however, were Selma’s hallucinations. I was quite certain Cassandra was identifying with all this—identifying not only Selma’s hallucinations as the same kind of voices she herself had with Minister Snake or Cowboy Snake, but also identifying Selma’s overtly psychotic behavior as evidence that voices in one’s head
did
mean one was crazy. Thus, she too was in this category.
In reality, Selma’s hallucinations were of a much different nature. They focused almost exclusively on demons, vampires, ghosts, and other supernatural evils. Being around her was like being trapped in the world of
Buffy the Vampire Slayer
. Selma genuinely saw and heard these things. In addition, the voices continually whispered to her about who among the rest of us were demons or vampires in disguise. As a consequence, Selma had to perform countless rituals to keep the world safe from the activities of all of us secretly evil entities. Indeed, Selma seemed unable to say or do anything that did not revolve around the paranormal. This made her a disconcerting partner in any conversation, because she was inclined to inject complete non sequiturs about vampires or witches into even the most mundane exchanges.
Until meeting Cassandra on the ward, Selma had had no particular sexual content to her vampire obsession. Consequently, it was initially easy to tell what images Cassandra had planted, because Selma simply parroted back Cassandra’s tales of abusive and sadistic sexual activity verbatim, except she usually inserted “ghost” or “vampire” for a person’s name. Things quickly started getting scarier, however. Perceiving that molestation was a really nasty thing, Selma began to incorporate it into her general concept of ghosts and vampires, even though she seemed to have no real idea what the actual words meant beyond “something scary.” Thus now, along with vampires jumping out at you, biting you, and making you undead, they might anally penetrate you or “suck you off” as well. Selma began to say these things earnestly to anyone at any time and in any conversation.
Understandably, Selma’s parents were not at all amused by this new development. They felt it was solely our fault Selma had been exposed to this kind of thing. They were also as terrified as the staff that someone who didn’t know what was going on would take Selma’s comments seriously, feeling there couldn’t be smoke without fire, and accuse an innocent adult of sexual abuse.
So the unit was in an uproar. Cassandra was strictly forbidden from interacting with Selma, and efforts were made to keep the two as much apart as possible, so that Cassandra couldn’t break this rule. This wasn’t easy. The unit wasn’t enormous and to enforce this separation, Cassandra’s movements had to be very controlled. Because of her endless accusations of sexual assault, we remained on a “paired supervision” order with her, meaning that every interaction required the attention of two adults.
All these restrictions made it virtually impossible to have any kind of normal dealings with Cassandra on the unit. Everything was necessarily defensive. We were containing her more than treating her, and it was difficult to know how else to go about it. It also greatly impeded my efforts to treat her psychological problems. While I now had a conceptual framework—that she was showing signs of early multiple personality disorder—it was still next to impossible to have any kind of continuation between sessions, as each day when I came for her, there was a new crisis to be confronted and resolved, and that took up most, if not all, of our time.
So there we were yet again that morning. Cassandra was back in lockdown, having been caught in Selma’s room, and, indeed, having been caught actively bullying Selma.
I paused a minute outside the seclusion room. The door had a small window, and I looked through. Cassandra was sitting cross-legged on the floor with her back to the door. I opened the door and went in.
She didn’t turn around.
“It would be more helpful if, when it was time for our session, you were on the ward and not in lockdown.”
She sat gloomily and didn’t answer.
“I don’t like losing our time together, but it isn’t really right that every time the staff puts you in lockdown, I then come and take you out.”
“It’s not my fault,” she muttered. “I didn’t do anything. I can’t even
breathe
around here. I hate it.”
“Well, come on.”
She got up sullenly and we left.
As with the previous session, however, by the time I closed the door to the therapy room Cassandra had recovered her spirits. “I want to do that feelings thing,” she said as cheerily as if nothing had happened out on the unit. “You know that one where we’re giving names to the feelings. Do you got that here? Where is it?”
“You seem much happier when you come in here,” I said. “On the unit, you always seem very angry. Once we are in here, it looks to me as if you have forgotten all about it.”
“Well, yeah. Wouldn’t you?” she asked in a condescending voice and went to the shelves to rummage around for the feelings drawings. “It sucks in seclusion. Of course, I’m glad to be out of it.”
“I find when I am very angry or upset, I can’t make those feelings go away just by walking into another room.”
“I can.”
“How?” I asked.
She shrugged. “I don’t know. I just do.”
“What kind of thoughts do you have when you are in the seclusion room?”
She shrugged again. Her back was to me, as she was still poking around in the papers on the shelves, and her shrug was casual and dismissive.
“What kind of thoughts were you having just then?” I asked again.
“I dunno.”
“Cassandra, turn around. Come here and sit down.”
“I want to do the feelings thing. I can’t find it.”
“I want to do that, too,” I said. “And we will. But first I want you to do this. Turn around, please, and sit down.”
“I want to do the feelings thing.”
“Okay, that’s fine. I’ve got it here in my box. But sit down first, please.”
Immediately she turned around and reached for my box.
I put my arm over it. “Sit down, please.”
There was a long moment’s hesitation, and then she slumped into the chair opposite me in a rather surly manner.
I opened the box and took out the list of feelings she had named and illustrated. As I laid it on the table, I kept my hand on it, as it was clear she intended to run the show herself.
“Okay, I’m going to demonstrate how we actually play this,” I said.
“I don’t want to play anything. I want to draw. I want to put names on the rest of the feelings. That’s what we’re supposed to do. That’s good psychology, huh?”
Which very nearly made me laugh. Or it would have, had she then not grabbed for the papers and said in an irritated voice, “So give me it.”
“No.”
“I want to draw.”
“No, that’s not what we’re doing today. We’re doing something different. We’re using the list today as a list, not as an art project. Remember the poker chips? Here.” I spilled a pile of red ones out.
“I
want
to draw.”
Why, WHY could we not just do things?
I was so tired of fighting her every inch of the way. “Okay, here are the lists of feelings,” I said. There were three sheets of paper, each divided into five columns and twelve of the columns contained a feeling word—
anger, love, disgust
, and so on—most of which she had already illustrated and renamed as “baby feeling,” “dog puke feeling,” and so forth. I laid them out side by side and then pressed my right arm across the top of them so she couldn’t move them. “Okay, I’ll take my turn first and show you how this is played,” I said. “My cousin is coming to visit me. I haven’t seen him in a long, long time. In fact, not since he was twelve and I was eleven.
“Now, here is how this game works. I’m going to put poker chips under the different columns that show how I feel about my cousin coming to visit. For instance, I feel happy he’s coming, because even though it was a long time ago, he and I had a lot of fun together when I last saw him and I like my cousin. So I’m going to put some poker chips on ‘Happy.’ Maybe about five. But
also
, I feel worried, because it’s been such a long time since we met. Maybe he’s changed and I won’t like him now. But I’m not
too
worried, so I’m only going to put three poker chips on ‘Worried.’”