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“We therapists often make inaccurate assumptions about people living with DID and DDNOS. They often appear to be “just like us,” so we often assume their experience of life reflects our own. But this is profoundly untrue. It results in a communication gap, and, as a consequence, treatment errors. Because the dominant culture is one of persons with a single sense of self, most with multiple “selves” have learned to hide their multiplicity and imitate those who are singletons (that is, have a single, non-fragmented personality). Therapists who do not understand this sometimes describe their clients' alters without acknowledging their dissociation, saying only that they have different “moods.” In overlooking dissociation, this description fails to recognize the essential truth of such disorders, and of the alters. It was difficult for me to comprehend what life was like for my first few dissociative clients.”

Quote by Alison Miller

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Healing the Unimaginable: Treating Ritual Abuse and Mind Control

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Alison Miller

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“Trauma-related structural dissociation should be distinguished from more ubiquitous phenomena that are often termed dissociation, but likely have a different underlying process. Over the past several decades the original meaning of dissociation has been quite extended by the addition of other phenomena not typically considered to be dissociative. These include alterations in consciousness such as absorption, daydreaming, imaginative involvement, altered time sense, trance-like behavior, and “highway hypnosis” (e.g., Bernstein & Putnam, 1986).”

“000-x02 Dissociative reaction This reaction represents a type of gross personality disorganization, the basis of which is a neurotic disturbance, although the diffuse dissociation seen in some casts may occasionally appear psychotic. The personality disorganization may result in aimless running or "freezing." The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc. The diagnosis will specify symptomatic manifestations. These reactions must be differentiated from schizoid personality, from schizophrenic reaction, and from analogous symptoms in some other types of neurotic reactions. Formerly, this reaction has been classified as a type of "conversion hysteria.”

“Now that she had the diagnosis to explain her sense of reality, she sorted some of the chaotic jumble of thoughts and memories. "I'd feel funny having 'daydreamed' my way through whole seasons," Jo said, "but then I'd hear someone say, 'Time flies,' or 'How did it get to be three o'clock already?' and I'd think that everyone was like me.”

“Finally, those who do not meet the SCID-D-R standard for "distinct identities or personality states," but who do meet the SCID-D-R's other four standards (for DSM-IV's Criterion A and Criterion B) for DID, receive a SCID-D-R diagnosis of DDNOS-1a.”

“The DSM concept of pathological dissociation has evolved from the early inclusive concept of a dissociative reaction in DSM-I to five distinct dissociative disorders in DSM-IV: dissociative amnesia, dissociative fugue, depersonalization disorder, DDNOS, and MPD/DID [Dissociative Identity Disorder]. The first four disorders are rarely challenged, but the existence of MPD/DID has been more or less continually under attack for more than a century. I perceive many of these attacks as misdirected at a mass media stereotype that does not resemble the actual clinical condition.”

“Comparing the hippocampal volume of mentally healthy subjects and patients with PTSD, DDNOS, and DID, thus patients with increasing levels of dissociation, an increasingly smaller volume is observed: PTSD (primary structural dissociation), approximately -10%; DDNOS (secondary structural dissociation), approximately -15%; and DID (tertiary structural dissociation), approximately -20%. These findings are characterized by a remarkable relationship: the more severe the structural dissociation of the personality, the smaller the hippocampal volume. Furthermore, Ehling et al. (2008) found high correlations between the volume of these brain structures and psychoform and somatoform symptoms, as well as with the severity of the reported potentially traumatizing events. Correlations between the volume of these brain structures and the degree of general psychopathology and fantasy-proneness were lower or statistically nonsignificant.”