 The purpose of this article is an attempt to bring into awareness the potential for harm when either prescribing or taking medication where there is little or no understanding of the implications and variables involved for treatment of people who have been diagnosed with Dissociative Identity Disorder (DID). This is not an attempt to speak to anything new or groundbreaking as far as the subject in the title, rather it is perhaps a voice for those who have, and are, experiencing questions about the effects, pros and cons and reasons around medication in the treatment of DID. The incidence of Dissociative Identity Disorder has been grossly understated in the statistics offered to the general public, and this is, unfortunately, due in part to the disbelief of mental health Professionals who do not believe in the diagnosis, do not believe the reports of those whose memories are perceived as false and fabricated and who have no true understanding of the condition itself. In some countries and specific locations within those countries there has been more awareness, acceptance and some success in breaking the taboo and skepticism towards a stereotypical concept that anyone with Multiple Personalities must be "crazy", "weird", and "off the wall". However, there are also countries where such awareness and acceptance has been completely ignored, purposely destroyed and vehemently denied so those who live with multiplicity are forced into a crippling isolation that in turn forces a double lifestyle where they are publicly trying to sustain a facade of "normality" while living their private hells in secret. Medication is an adjunct therapy in the treatment of DID and needs close and careful consideration by both the one prescribing drugs and the patient. The patient is not only the person presenting him/herself in the office but brings with him/her a system of other personalities embodying their own physiology that must be included in the assessment for treatment. It is my hope that in writing about some of these considerations this article will reach a few who have not considered the seriousness and harmful results arising from the common assumption that medication is a panacea that will "make it all go away" when faced with a complex and little understood condition. These considerations are not complicated nor hard to understand even though DID itself is an extremely complex phenomenon. The reader may have already thought and talked about them, yet the ignoring of the issues related below can cause the Client, Physician and Therapist to focus in the wrong direction and turn the use of medication into misuse and abuse, with disastrous and sometimes fatal results. It will disappointing for any reader expecting a list of drugs, names, dosage and indications for use etc.,because it will not occur. It would be impractical and unrealistic to do this for any person requiring medication without an evaluation of the patient by the Doctor who must gather history and data to inform him as to the best choice of drugs. Names, dosages, indications and contraindications can be read in any PDR for whatever category of condition is presenting. This article is an attempt to elucidate some of the variables that need to be taken into account when prescribing for people with DID. General Considerations Multiplicity brings it own set of special considerations when it comes to prescribing medication. The Physician is not dealing with a single body controlled by one mind and thinking. He or she is not in an enviable position when faced with what is best for the DID patient. Research has documented that alters within a system may evidence a different EEG reading than that of the host, may be allergic to food, drink or other substances that do not affect the host, or vice versa, and differing lifestyles within the system can contribute to how medication is received physiologically by the body. For example: If there is a substance abuse alter(s) who is addicted to alcohol, street drugs or OTC medications, Physicians need to consider compatibility of additional chemicals with those the body is already dependent on. There is also the need, unlike a singleton who has only her/himself to think about, of discussing any decision with all parts in a system for cooperation and consensus regarding decisions made about new drugs prescribed. This discussion can take place in the Physician's office if s/he is the Psychiatrist doing therapy with the client, or if the GP has no knowledge of the diagnosis then the discussion can be brought to session with the Therapist, or if there is co-consciousness and cooperation among the parts and with the host personality, this can be talked about at home. Survivors who have worked long and hard know that such cooperation and consensus in these kind of discussions does not happen overnight. Being able to form an inside committee who can take the responsibility and role for safety issues and relate them to the rest of the system has invaluable benefit when dealing with such important topics as medication. Let me give an example here of one scenario. Keeping in mind that every system is different in size, community, levels of co-consciousness between parts and the host, cognition (age and development of the parts) and ability to understand the ramifications of meds.as well as the considerations mentioned above. Some systems who are unaware of the groups or individuals within the body need to think about this and when new medications or changes in regular ones occur. The scenario I wish to describe can only be accomplished after much practice, much cooperation within the system, and close monitoring by both Physician and therapist as to benefical effects, possible side effects and need for dose changes if titration results are not within the therapeutic range. Where such intersystem cohesiveness is not present this might give a blueprint for a format to use later. It can be modified according to individual and collective needs. Scenario: There has been a change in one of three medications and that has been followed by the discussion written above, with therapist and physician to be clear about all aspects of the change. It is assumed that there is an established habit of referring to a med schedule so that day, times and meds are clearly known and adhered to. When med time arrives, someone is designated to to call all parts who need the med, example, for depression, to come to the front so that they, and only they, are present. This way the anti-depressant will enter the bloodstream of only those for whom it is meant. There is an agreement that if possible, these parts will be willing to stay forward for at least 15 minutes to allow the medication to have good effect. Where there is resistence to this, have an agreement requesting they stay surfaced for at LEAST 5 or 6 minutes, but the longer the better. With Littles, a reward could be offered for compliance - a special story time etc. (However, knowing children and their ability to turn a reward into a bribe in which the thought that "I only have to refuse my meds and then if I say OK, I'll take them I'll get a special treat", it needs to be clear that this behavior does not reap reward. Gentle but firm instructions and going over slowly and clearly the pros and cons of taking their meds needs to take place). This intervention is repeated for each medication an hour or so after the first one to ensure those on it do not receive the wrong one. It might be helpful for someone to make a list of who comes for which med. then, if someone is missing and they can be tracked down. They might have forgotten, not heard the call, or be resisting, in which case they can voice their concerns and talk it over, especially if there is anxiety, fear or confusion around a change or side effects. Resistance is not neccessarily stubborness. With the change to a new medication, at the first roll call, it is helpful to go over the reason for the change once more and repeat the name, dosage and possible side effects to the recipients. It is always good to ask the prescribing physician exactly what side effects might occur with each medication. Thus, changes in behavior, physical symptoms, personality changes (literally, no pun intended here!) can be noted and not mistaken for switching where behavior is completely different from what the person has been doing minutes before. With switching, the blood composition will also have changed to that of the presenting part and immediately affect blood levels altering the effect of the medication. One misunderstanding, in my mind, that Doctors often succumb to is not realizing the danger of over medicating a DID patient. By this, I mean, that the presence of anxiety or depression will undoubtedly present when dealing with memories and flashbacks, and the tendency of Physicians in prescribing dosage for these is to give a far higher dosage than is necessary. In doing so, this affects the ability to process in therapy. It is important to give the smallest dosage to the part(s) needing it, enough, not to abolish the anxiety or depression since this would be impossible with the continual surfacing of new memories, night terrors, flashbacks etc., but to bring the anxiety and depression to a tolerable level where processing can be accomplished. A point for consideration here pertains to those living with DID spouses or relatives, who, in their love, concern and distress at seeing their loved one suffer, encourage them to take maximum dosages of what they think will relieve the suffering. In actual fact, and where multiple medications have been prescribed, e.g. Antidepressants, tranquilizers, and analgesics, etc., this not only affects the body's capacity to function at its potential due to side effects, but also aggravates the condition by diminishing the ability to process what is going on. Support people and families of multiples need to be educated along this line and hopefully can meet with the therapist who can answer questions of how to best help their loved one in times of stress and in the healing process. My personal philosophy is to deal with root causes and not treat symptoms, and herein lies another pitfall for professionals, psychiatrists in particular, who see only the symptoms - depression, anxiety, dissociation, trigger effects and so on, and jump to relieve these without looking at the cause of them. Extra session time given to someone who is presenting intense feelings whether they be seen as anxiety, fear, depression, hallucinating or acting out, would be far more helpful and beneficial than a new prescription of Valium. Prozac or Haldol. It is the cause (s) of the symptoms that resulted in dissociation and the creation of alters that needs focus and there needs to be a much fuller understanding on the part of prescribing Physicians to understand that the healing process is not about relieving symptoms but about being able to find a safe environment where the cause(s) of distress, terror and pain can be spoken about, believed and worked through. It is vital that in seeking to do this the mind is able to be at its optimum capacity to process, and this is not accomplished when memory processing is interfered with due to medication. ALL drugs whether natural or synthetic affect the ability to process memories to their fullest potential, which raises another consideration. It is a very common phenomenon that when harrowing and terrifying images, memories and experiences surface, there are also body memories that bring physical pain, welts, marks, and stigmata associated with the experiences. Again, there is a tendency to prescribe strong analgesics to minimize physical pain, but in doing so it also interferes with memory and processing. It is often the case that an increase in anxiety, panic and fear will increase the physical pain. Observing this produces the desire to eliminate the physical symptoms while ignoring the psychological need of understanding what it is all about. Perhaps it is relevant here to mention the Littles, or child parts/alters, when the body is suffering physical pain of severe intensity. These young ones do not necessarily hold the body memories associated with the pain, though many do, but it can be felt by them and be very scary and painful. An asprin or two, while not alleviating the pain, can bring comfort to these Littles in that they feel they are being taken care of and someone understands they hurt, so the placebo effect is a psychological comfort and palliative remedy for them. Considerations for Cult Survivors and Mind Control Victims. A physician considering medicating anyone who has been programmed by a cult needs to have an understanding of the programming process and know or assume what drugs have been used during this. Since experimentations of mind control have been ongoing for so many years (now documented and available to the public) and because of the "expendables", those who were used to determine the best drug or combination of drugs to produce a given result for a given assignment, it would be difficult to pinpoint exactly what drugs may have been used. Sometimes parts/alters who are co-conscious and willing to share, can help to confirm what they were given if they know. The host may or may not have this knowledge. Street drugs, heavy usage of narcotics, date-rape drugs, cocktails of drug mixtures such as Librium, Haldol, narcotics, muscle relaxants -- anything and everything with the goal of achieving full control, have to be assumed as having been ingested over a long period of time, thus making programmed alters more susceptible to programming goals as well as the side effects of medication. These considerations make med. evaluation difficult for the Doctor, but if there is no awareness of past drug history in cult activities, much harm can arise with prescriptions. Medication Considerations This section will not list medications by name or category since it would be unrealistic or impossible to state specific drugs as being optimum across the board for DID treatment. People have individual physiological reactions to drugs and differ in how these are metabolized. With multiplicity there are more variables involved, most notably, the factor that there are concurrent responses occurring to the same medicine. It is this phenomenon that creates a real dilemma for the prescribing Physician, but the informed Doctor will have more success in helping the Multiple to relieve the distress and pain. Stress, fear, depression all influence body chemistry, thus it is important to remember that with the progress of therapy over time changes resulting from working through past traumas will affect chemistry levels and drugs that were ineffective at first could later be helpful. As mentioned above, specific drugs could not be promoted as being the drug of choice for specific conditions due to individual responses to medication, and past drug history, but some have found Depkote 1000mg b.i.d. (twice a day) to be helpful where simultaneous flashbacks occur, or in anticipation of difficult times around ritual dates. However, it will be necessary to reach this level of effectiveness and this isn't done over night. Those taking Valium need to be aware of addiction potential or withdrawal effects. One option that has been effective with some sufferers has been the administration of anti-inflammatory medication. This can relieve joint pain that can arise but does not interfere with memory and processing, a very important factor to consider. Again, the key here is to remember that often, an increase in physical pain can mean the person is getting closer to a memory or memories that are ready to be dealt with. Hence the need for clarity of thinking. This phenomenon will be continuing throughout the healing journey as more and more memories surface, and because certain parts of the body are affected more, those parts become weaker so the pain is felt more. This will not disappear e.g. stress-related arthritis or other connective tissue conditions - thus it is important to prescribe only the smallest dose possible to reach a tolerable level of physical pain and allow for clearer mental processing. Clonopin has been effective for some who feel they are getting hammered over self-harm or there is a hostile take over starting to brew. Some Psychiatrists have found this drug the closest for optimal results when medicating Multiples seeking to calm down the system. For systems who have formed a Safety Committee or any inside group cooperating as protectors and guides, these parts are helped in stressful times by the calming effect of Clonopin to where they can stay in control and use other options. The standard dosage of 1mg three times daily may not be as effective as taking it prn (whenever necessary), rather than regularly. The user can go from taking the Clonopin whenever they feel a particular need for calming and if this is not effective, discuss with their Psychiatrist about taking it on a regular schedule and see if this meets the need. Sleep has a critical part in healing and yet so often night terrors, stress and other concerns prevent this. Some have found Trazedone beneficial for this distress but, as with all drugs, the reminder that what helps one is not effective for another needs to be noted. One option where meds do not seem to help, is to have a discussion inside to find a part who is able to sleep either naturally or because they are depressed and sleeping a lot, and have that part use the body for sleeping even though others might override the sleep meds or the meds are not working. Again, there needs to be cooperation and co-consciousness between host and the system to hold such discussions. Neuroleptics, so often misused for DID patients, (especially in hospital settings), are often prescribed when more often or not there is perhaps only one part, not necessarily the host, experiencing a transitory psychotic episode. A small dose of an anti-psychotic medication might be needed for the suffering part but to prescribe a neuroleptic for a lengthy period is not only contraindicated for DID but can be, has been, harmful, retraumatizing and detrimental for both host and the system. IMPORTANT notes: 1. It is critical to be extremely vigilant about any medicine considered to be addictive. This is especially significant where there are addicted parts in the system. 2. It needs to be remembered that when a person has once been documented as an addict and then later, in need of medication. e.g. analgesics for pain ( real or imagined), they are likely to find it impossible to obtain. 3. The system needs understanding where all new meds are prescribed. Multiples, where there is good communication and cohesion amongst host and parts, would find it helpful and good to sit down with everyone so parts can learn what meds will be utilized, how they are supposed to help, how much will be taken, what side effects might arise, and who they are for. Making sure that the part for who the meds are needed gets them is vital. 4. Some alters have allergies, or disabilities or may be high from taking street drugs, influenced by alcohol etc., and these variables need to be included in evaluating what drugs are used, compatibility of medications prescribed, dosage, duration and side effects. 5. When taking medications, an important task to maintain is to keep a written record of responses to each medication. This will be useful for the prescribing Psychiatrist as well as the client. 6. Remember. You have the right to refuse any medication with which you are uncomfortable, are uninformed about or know the prescribing Physician is unaware of the complexities related to DID and is trying to force compliance against your own instincts. Beware of anyone who is married to one idea, e.g. " Take a pill and get rid of the multiplicity and get on with life". Or " We have a chemical problem here so we will deal with chemicals and they will go away". 7. Use of medication can also be a diagnostic tool. Meaning, the Physician in monitoring the effects of the medication where there is none that would normally result, can read that as an indication to look at something else other than, depression, for example, and rule out erroneous conclusions so often MISdiagnosing DID as Borderline, Schizophrenia, Manic-Depressive etc. Follow up is essential when taking drugs, not only for the above reason, but to monitor side effects, presence of allergic reactions, therapeutic blood levels, and change of dosage where needed. 8. Because so much is going on a psycho-physiological level there is always the task to discern between what is organic in origin and what is memory/body memory caused and how to handle this. How much outside intervention is needed in terms of medication and what would be more beneficial to work in a session with a therapist. For example, approaching medical staff presenting abdominal pain, the patient would expect to have tests ordered to rule out organic origins which, in turn, creates stress and fear around possible hospitalization, usually very traumatic for DID sufferers. Panic attacks and hearts attacks can present similar if not, identical symptoms and thus, the Therapist not medically trained liaising with a Psychiatrist can avoid unnecessary stress and distress when ruling out the physical vs. psychological priorities. Final Note: For those who might have comments or who would like to add to this article from their own experiences with medication and DID, suggestions, or anything of interest around this topic, the author would be happy to communicate and can be reached through the web site, " http://www.goessoftlyishere.com My interest in DID has brought me in contact with some wonderful men and women who struggle with multiplicity and who have also suffered at the hands of uninformed medical professionals prescribing drugs more to decrease symptoms than to deal with the causes. This article is a voice to help sort out some of the things that can prevent unnecessary suffering. Goessoftly Retired Therapist www.goessoftlyishere.com (permission for reprints is required)  | Normalizing and Demystifying DID | DID and Littles.(Child/Young Alters) | ISOLATION | Mono's Disbelief | Distortion: Good and Evil | ASPECTS OF BODY CHANGES | Relationships | Across The Board | Across The Board | FORGIVENESS | I am BAD | Headaches | LYING AND DECEPTION | LOST and LOSS | EYES | Controversy. Research projects. | Feeling is Healing | Alone and Aloneness | VICTIM or VICTOR ? | TEARS | Medication and DID | DID Emergency Room/Casualty and Crisis Center Guid | Acknowledging The Inside Community | The NO TALK Rule. Silencing. | | THE HEALING PROCESS | DISSOCIATIVE IDENTITY DISORDER | POETRY | Biographical Entries | THE OTHER SIDE OF LIFE | STORIES FOR LITTLES (Pigmus and friends) | SEEDLING THOUGHTS TO WATER | | Return Home | Great Links | Sign/View Guestbook | |
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