Transcript: Episode 116
116. Debating Structural Dissociation
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So one of the people that we met last winter at the Healing Together conference was Sarah Clark. Sarah Clark and her sister run a YouTube channel, as well as a website—which is powertotheplurals.com—and they were also the ones who invited us along with the Crisses to plan and develop the Plural Positivity Conference that we held this summer. And at that conference we talked about two things. One, we did a session on the polyvagal theory. And one we talked about the history of DID and sort of how that has come through hundreds and hundreds of years to where things are now as we understand it. And one of the things that is understood about DID now, and one of the leading theories that is sort of considered the current top theory, or the model that many are really adhering to these days, is the Theory of Structural Dissociation. We talked about this a lot on the episode called Dr. E On Shame after we heard Kathy Steele present in Kansas City last spring. And then we also spoke with Kathy Steele a couple of weeks ago. And so that episode has just released.
What's important to know and understand about the Theory of Structural Dissociation is that it has the idea that everyone is sort of born with these self-states and different parts of themselves that are for different needs, and different roles and different functions, and that part of growing up is integrating these into sort of one solid consistent understanding of, experience of, an expression of self. And that's a really tricky thing, as Kathy Steele pointed out when we talked to her, because self is not something that you can take outside of yourself and examine and look at. And so it's very much about expression. It's very much about experience internally. And it's very much about sort of that understanding of consciousness.
But with the Theory of Structural Dissociation, what they say is that that's how everyone is born. And what happens with trauma is that it interferes with, or neglect or abuse, whatever, these interfere with the natural process of integration. So what the Theory of Structural Dissociation says about trauma is that abuse and neglect, and other issues with parenting and attachment, interfere with the process of integrating those self-states naturally. So rather than the old model, or the misconception that there's a core self, or a first person, or something that is shattered or broken or split off, that everyone is already born that way and trauma just interferes with the process of integrating naturally as you grow older.
And let me clarify, the three or four authors of this theory are absolutely leaders in the field and very highly respected. But at the same time, it is still a theory.
One of the most common things that we hear from survivors is that they struggled to understand how this fits them because they have experienced the creation of new altars. Which is a different experience than finding alters that were already there that you didn't know about. So there's some confusion about how does that happen in the context of this theory.
The other part about this theory is that it talks about ANPs, which stands for apparently normal parts, or Kathy Steele calls them “daily living parts,” meaning the parts of yourself that avoid trauma in order to maintain functioning. Okay, so, so for us, ANPs would be the part that goes to work, and the part that is a mother, and the part that is a wife, these things that are about functioning. And then the other part is called EP, emotional part. And these are parts that do not function so much in daily life, but they are trauma holders, or emotion holders, or specific memory holders, and work in a different function regarding the trauma specifically, as opposed to apparently normal parts which focus on functioning, which requires an avoidance of the trauma.
So there's a lot of talk about why are there only two kinds of parts in this theory, ANPs and EPs. And some people feel like there's sort of this backlash against that, because it's hard to categorize everybody into either this or that kind of part. But the reason that they say that is because they're talking about either the parts of the self that deal with the trauma and the parts of the self that avoid the trauma. And underlying the traumatic experience with parents, that's really what the conflict is: how do you deal with this trauma while also having to function in this family that I'm still in where trauma is still happening? Does that make sense? So when you take the model out of context, then it can get confusing why there would be only two labels for different kinds of parts. But if you understand what the theory is talking about as far as the dynamic of trauma itself, and part of you having to face the trauma or endure it, and part of you having to avoid it just to function, then it makes more sense what they're talking about. And other kinds of altars, like protectors or littles or or whatever, sort of fall under those categories. So that's sort of what the theory of structural dissociation is about in a very, very brief review of it and description of it, right?
So Sarah Clark published last week or the week before, an article that the headline just blew me away. It totally caught me off guard. I was not expecting at all. Even though I know she is one who's absolutely an advocate, and she and the Crisses draw a lot from the disability community and the LGBTQ community to focus on rights and on advocating for survivors in the context of treatment, and needed changes for the rights of survivors, and and fighting stigma with the general public besides just advocating for changes in treatment with clinicians. So their work is very unique that they are often collaborating on and talking about, and has been part of the Plural Positivity Conference from the beginning. But this headline of her article caught my attention, and that's why I wanted to talk to her about it. She said, the title was: Why the Theory of Structural Dissociation Is Ableist. Right? Oh, my goodness. And so I was like, “Wait, what? Where is this coming from? And where is it going?” And it was fascinating, sort of reminiscent of the history of DID session that we did at the Plural Positivity Conference this summer. She went back to 1987, and talking about how the writers of the theory already we're referring to us as parts rather than using personalities or alters. And that's one thing that they've really talked about is that we need some changes in language. So they want to, Sarah Clark and the Crisses and others involved in advocating for some change in treatment, want different verbiage for insiders, for parts, instead of saying personalities or states or alters.
They've also brought up issues like the treatment guidelines saying “patient,” which isn't really necessarily used as much anymore in common terminology. Although Dr. Barish talked about good reasons why “client” doesn't really fit either. And we totally understand some people not wanting to identify as survivors. So it absolutely gets tricky.
But then she says that the first time and ANPs and EPs, apparently normal parts and emotional parts, were used was all the way back in 1916 by Charles Samuel Myers when he was writing about trauma after World War One. So she's saying the people who wrote the Theory of Structural Dissociation borrowed those terms from the original writing in 1916 and should not get credit for introducing the terms. This is documented in the book The Haunted Self, and it also says that structural dissociation involves a hindrance or breakdown of a natural progression towards integration of psychobiological systems of the personality that have been described as discrete behavioral states. So after Charles Samuel Myers in 1916, it was actually Putnam in 1997 who talked about as not being broken or not being split off, but already introduced the idea that we are born with different states in early childhood trauma survivors, who could not integrate in early childhood because of that trauma. So it's really important to them that credit is given where it's due, and that survivors understand sort of the history of where these theories have come from and how they've unfolded.
The other thing that she says in the article is that the Theory of Structural Dissociation is not actually about DID or alters. She says that the Theory of Structural Dissociation is talking about dissociative parts of the personality caused by any kind of trauma, not just early childhood trauma. So it has theories, primary, secondary, tertiary, to talk about trauma in general, like when there's just one incidence. So like, people who, like first responders who have a difficult call that they respond to and so then have trauma and have to maintain functioning while sort of the emotion of what they're going through in the moment is having to be put in the background that would give them an ANP and an EP, just for primary trauma in general that has nothing to do with early childhood trauma. Ongoing trauma repeated in adulthood, like if that continued to happen and they didn't get help for it, or other issues like borderline personality disorder or OSDD, would sort of be secondary or Type 2 structural dissociation, where they're still just one ANP, but there's lots of EPs. And then tertiary or Type 3 dissociation would be CPTSD or DID where there are several different ANPs and lots of EPs. So she's bringing it full circle saying that all traumatized people have dissociative parts of the personality, and that that—dissociative parts of the personality—that that is just a collective phrase for saying EP and ANP.
And so what she's saying is that plurality does not happen just in DID. And this is where it gets really big. Because it's become a cultural thing in the community online, and something that clinicians need to be aware of whether they agree with it or disagree with it. She quotes from the same book where it says, “In severe cases of secondary, and in all cases of tertiary dissociation, more than a single part may have a strong degree of elaboration, such as names, ages, genders, or preferences.” So what Sarah Clark presented in this article is that clinically, and as a survivor community, we need to be aware that there may be alters in systems who are not DID. According to this theory. That people with OSDD, or complex PTSD, or even borderline personality disorder, may also have alters. So then she goes back to The Haunted Self and says that structural dissociation has become chronic in those patients with trauma-related disorders.
Now, let me clarify Sarah Clark is someone who will say that even DID is not actually a disorder if you're not distressed by it. Because she's using the literal Words of the DSM-5 that talks about being distressed by it as one of the qualifying symptoms. So you could have DID but not actually have a disorder if you're not distressed about having DID. Does that make sense, as far as following her line of thinking?
So she does the same thing here, and says that structural dissociation itself is not actually a trauma-related disorder on its own, because The Haunted Self says that structural dissociation becomes chronic only with patients who have trauma-related disorder. So what they're saying is that there can be other reasons besides trauma for someone to be multiple, or for someone to be plural. Are you still with me, and following her line of thinking, and why this is being spread through the communities?
Because the reason this matters is that not everyone wants to choose integration as the end goal of therapy. They are calling for functional multiplicity as being an option for therapy, or even without therapy. So she's saying the Structural Dissociation Theory is ableist because it idealizes integration. And although they say in the theory that quote, “no one has to go away,” end quote, they also consistently tell therapists not to engage with us as dissociative parts of the personality unless absolutely needed. And it's it's taught to therapists to clinicians to speak to the ANP who's fronting. And what what she talks about is that's not always accurate. Who the clinician thinks they're interacting with is not always all of who's listening, or all of who's present, or even who they think it is. So she quotes Kathy Steele who says to use integrative language. That parts language is okay, but emphasizing parts of you; parts should not be treated as individuals. And specifically that this is the treatment target.
So what Sarah Clark points out is that the problem with this is that they are taking tertiary DID, tertiary dissociation, and trying to force it to look like secondary dissociation. So that rather than treating DID, what they're actually treating is OSDD where one part regularly fronts and the other speak through them. And so what, and so what Sarah Clark is saying is that although there is a dissociative spectrum, changing the diagnostic criteria we meet from the diagnosis of DID to OSDD will not necessarily lead to healing. And she points out that requiring all communications to go through one particular or favored altar sounds a lot like silencing, and is actually triggering, too many systems with DID.
And then she goes on to talk about how it mentions shame, but that ANPs may not feel comfortable repeating what they hear inside. And so the information may also be overwhelming to them, which may actually cause them to dissociate more, so that therapist may not actually have access to all of the information or even accurate information.
And in the book they talk about integration being like ice cubes melting. So there are lots of ice cubes, but as they melt, the water comes together. And so there's just one body of water. But what she's saying is that in everyone in a system, especially a system that has been around for a long time and has lots of ANPs, that it's more like soup. Because not everyone is the same and there's different kinds of integrative levels to where you could function as a whole, but still have their own individual unique pieces like in a bowl of soup. She says in her article, and I quote, “Although soup is great, it's not the same as those loose ingredients. A potato is a potato, a carrot is a carrot. But potato carrot soup is something new and different altogether. You cannot remove the potato from the soup, and is no longer a whole potato. A potato carrot soup cannot do the same thing that original potatoes and carrots could do.”
And she quotes from a six year follow up study that only 12% of participants were able to reach full integration, and points out that that's a very low percentage, and any scientific research for medicine or therapy, a 12% outcome would not be tolerable. So what she presents is, as her thesis really, is that “A chronic disorder that is often debilitating with a much respected and idealized healing option with only 12% success rate sounds ableist, favoring OSDD over DID comes from a singular normative bias thinking. The Haunted Self has a chapter dedicated to phobia of dissociative parts. Maybe the writers should reread the chapter and apply it to their own way of thinking. It also sounds to me as if clinicians say something else to our face than what they write in their books, especially when it comes to alter integration or ‘final fusion’ as Kluft calls it.” So she says that “personalities” is a derogatory and dehumanizing word that takes away from our autonomy roles and then authenticity as individuals. And she says, “It also makes sense to claim that no one has to go away if they never believed we were separated in the first place, because it is the experience of separation, not actual separation.” And she says that “the Theory of Structural Dissociation is being used popularly because it's a way of saying we never split off; that we're still all one. And because we never split off, then the separation that we feel from each other is actually just an experience. And so is used in a way that is ableist, that diminishes us, gaslights us, and silences us.” So these were huge things.
And then she calls out to the DID community, and says, “If you don't want integration, or you're not able to do it…” And even at the smallest continuum are people who do not have access to help or treatment and so live many, many years having to function as a multiple. And so even we took 10 years to find our therapist, and then three more years to get started with her. And so during that time, we are functionally multiple because we're having to maintain function while we are still plural. And so she is actually saying that “we should go ahead reject the Theory of Structural Dissociation because it cherry picks the easy parts while neglecting the trauma and actually the internal experience. The theory comes as a package deal by explaining a progression of structural dissociation.” And so she's saying that the three layers of structural dissociation are actually formed as a continuum, with the treatment goal to move you back down the continuum. And that people need to pay attention. Because if you think you endorse the structural dissociation theory, that you need to pay attention to why, and she says, quote, “Because if you just like the part about how we are not split off, but born with different self-states, then quote Putnam instead of quoting the Structural Dissociation Theory. And if you like the idea of something like PTSD including ANPs and EPs, then you can quote Myers instead of quoting the theory of structural dissociation. But if you like integration, then those are the people who are quoting structural dissociation. But if you don't want integration or functional multiplicity, or feel oppressed by integration being the ultimate goal of therapy or of treatment, then you don't need the structural dissociation because the other pieces of that theory are already described by Putnam and Myers. So you could just use those pieces without having to defend structural dissociation. That's pretty big and pretty powerful.
So stay tuned later this week for an episode for Sarah Clark from the Stronghold System.
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