Dissociative Disorders and Homeopathic Treatment

Dissociative Disorders and Homeopathic Treatment

Presented at the 1993 AIH Conference, Falls Church, VA

Abstract: The assessment and homeopathic treatment of dissociative disorders and multiple personality disorders (MPD) is discussed. Guidelines are offered to facilitate recognition of survivors of sexual, ritual, and cult abuse. Advice is provided to aid the practitioner in managing the phenomena of transference and counter-transference. Reasonable goals in the therapy of MPD are identified. Materia medica of some remedies commonly useful for survivors of abuse (Staph, Anac, Phos, Med, Nat m.) are given; case illustrations are included.

Keywords: Dissociative disorders, Multiple Personality Disorders, Incest, Sexual abuse, Ritual abuse, Cult abuse, Dissociative Experiences Scale, Transference, Counter transference.

Remedies: Anacardium, Medorrhinum, Natrum muriaticum, Phosphorus, Staphysagria, Thuja

Let us start by talking about assessment of dissociative disorders. A very complete discussion about dissociative disorders and MPD preceded this presentation. This material can be overwhelming. One tool that I find very useful is the DES, the Dissociative Experiences Scale. I recommend that anyone who suspects that he or she has a patient with a dissociative disorder should consider using this form. It provides a more tangible, concrete method of evaluation. The form takes about ten minutes to fill out; it takes the practitioner a minute to score. Instructions on scoring are included. It helps one develop an understanding of what dissociative experiences really are and whether such experiences are occurring in patients. I feel that accurate assessment of dissociative disorders is important. Most patients with multiple personality disorders and most ritual abuse survivors have little or no awareness of the fact; and if the practitioner can ascribe a name to their puzzling symptoms, they can ultimately gain a lot more power and control over their symptoms. I might even suggest that practitioners take a sample test to understand dissociative experiences in terms of their own experience.

I should now like to direct our attention to the identification of cult and ritual abuse. The definition of ritual abuse is a set pattern of repeated abuse, usually done in a group, with the goals of mind control, isolation, deception, confusion, and exploitation. Cult abuse adds worship of Satan or evil leaders or doctrines. Some of the symptoms that one may see in patients who are ritual abuse survivors are extreme fear of bathrooms, toilets, refrigerators or freezers; also fear of circles of people, rituals, chanting; eating disorders, especially specific aversions, such as to meat or tomato sauce or spaghetti; aggravations at holidays, especially Halloween or satanic holidays; fear of dying or of killing oneself at a certain age or birthday. This is something that is actually programmed into cult survivors. Additional symptoms are bizarre images or nightmares or flashbacks of these specific things: being locked in a cage or jail, being buried alive or placed in a coffin, being held underwater, other forms of suffocation requiring resuscitation; threats of having family members or pets killed if the abuse is revealed; having witnessed the death of a pet or person to intensify the threat in order the keep the abuse secret; being drugged or injected; being photographed during abuse; being hung, tied, or spread on an inverted cross; being frozen; being electrically shocked; unusual travel, for example, in planes or submarines during abuse; being abused in churches and graveyards; underground torture; being forced to eat feces and human flesh, or to drink urine or blood; witnessing the murder of babies and adults, dismembering; rituals of placing the devil or the devil's baby inside the patient. Everything I have just described is from actual stories that I have heard from survivors.

How common is ritual abuse? My suggestion is that, once recovered from the horror of hearing such tales, the practitioner, hearing even one of these very unusual kinds of symptoms or flashbacks, begin to consider that this person might be a cult survivor. Very often cult survivors want to determine if the practitioner knows enough to help, so they will drop one of these little clues and then await a knowing response. If it isn't forthcoming, they will say nothing else, for many different reasons. It is really not known how common cult abuse is in this country. The media often suppresses reports of cult abuse. Some may remember the case of Lisa Steinberg: she was a seven- or eight-year-old girl who was abused to death in New York City. There was a great deal of media coverage of her death and of the trial of Joel Steinberg, but one of the things that was not brought out was that she had cult symbol scars on her skin, leading to the suspicion that she was a cult-abused child. However, that suspicion was not well-publicized. There are many such cases which have been similarly suppressed.

Through my contact with self-help groups for incest survivors in New York City and in inpatient units for dissociative disorders, I have learned that about half the people there have been ritually abused. My suspicion, therefore, is that there is a large number of people who are severe incest and abuse survivors.

Where does this ritual abuse take place? It can happen in autonomous groups of men who foster abuse of their daughters (members of the KKK have allegedly been involved); it can occur in highly organized, powerful international, intergenerational organizations with links to child pornography and prostitution it can happen on military bases, in daycare centers, in satanic cults, etc.

Briefly, I would now like to discuss transference and counter-transference. One of the reasons I sought to take a psychiatric residency was to learn about transference and counter-transference in a very careful, prolonged, and supervised way. Such knowledge is critical to a healthy and effective therapeutic relationship. Transference is the projection of the patient's emotions, usually feelings about parents, onto the therapist. Anyone abused and neglected enough to develop a dissociative disorder is exquisitely sensitive to any betrayal of trust. The first time one of the thirteen-year-old girls that I work with disclosed that she was a cult survivor, she was taken away from her family, put in foster care, and immediately, her first night there, abused in the new home by the cult leader and his wife. I tell you this to give you a sense of how difficult it is for these people to trust anyone enough to talk about their abuse. To this girl's credit, she later disclosed her abuse and left the family at the age of thirteen, which is an amazingly courageous act.

One strategy is for cult members to dress up as doctors and nurses and then abuse the children to make them afraid to disclose their abuse to doctors. The cult members will also dress up as policemen or other authority figures. Another obstacle to disclosure is that disclosing abuse to the homeopath will trigger a terror of punishment; this applies not only to ritual abuse survivors but also to incest survivors and sexual abuse survivors. People have talked a lot about how to build trust with patients. I would just like to mention the obvious, which is to be trustworthy, scrupulously honest, consistent, and available yet clear about your limits. Setting appropriate boundaries also creates safety. It is important to show patients how to titrate their disclosure based upon their comfort level.

Abuse survivors have boundary problems and may, if they trust you, disclose a lot of abuse to the practitioner very rapidly, without any boundary around it; subsequently they end up feeling incredibly vulnerable, wonder if they have overburdened the practitioner, and, in some cases, may feel a need to get away from him/her because of how much they have disclosed. If they have been severely abused and ritually abused, they may have been involved in perpetration incidents in which they were forced to perpetrate abuse; they may have murdered, either in self-defense or as part of a ritual, and they will have a very hard time remaining with the homeopath if they disclose that information before there is sufficient trust established. Consequently, if the speed of their revelations is tempered, ultimately it will be of benefit to them.

I think it is also helpful to communicate and establish a united front with the patient's therapist, especially if the patient is ambivalent about either his (or her) therapist or you, the homeopathic practitioner. This will help to avert their feeling split between you and the therapist, one week one of you being the good guy and the other bad, and vice versa. This homeopath-therapist union is also helpful if there is any question or history of self-harm or harm to others. Otherwise you as a homeopath, who may be seeing this person once a month, will simply be overwhelmed by worrying about whether he will hurt himself during the month. It is good to be able to call his therapist and have him check out such concerns. It is also useful to call if you or the patient are feeling too anxious or overwhelmed. It is also very important to communicate with the last homeopath or, if you referred, the future homeopath. I had a case where the patient told me about very severe abuse, something he had perpetrated, and then fled from me and went to another homeopath. I kept trying to call that homeopath, but my calls weren't returned. I knew the patient needed Anacardium because of the situation. I can only hope the homeopath considered that remedy.

Also, I refer any patient with a history of abuse to individual and group therapy and to self-help groups, which have the advantage, at least in New York City, of being free and very available. Survivors need to resolve existential questions: Why me? How can I make meaning out of this meaningless violence? How can I feel connected after my extreme isolation and difference? And this is where the power of grouping with other survivors comes in; it treats the self-esteem, that core blow to self-esteem. I also recommend that survivors read books as part of their therapy, and I especially recommend The Courage to Heal by Ellen Bass and Laura Davis.

In terms of counter-transference, I think the biggest mistake a practitioner can make is to overestimate his (or her) ability to save. The issue of codependency has been brought up at this conference. During an earlier presentation I thought of an amusing incident that happened to me. A patient I had successfully treated became a well-known entertainer. I went up to her backstage after a performance, and she didn't know who I was. I had treated her for years. As soon as I told her my name, she remembered who I was, and she said, "Oh, my God, homeopathy changed my whole life. You know, I've referred many people to you. I tell everybody how homeopathy changes your life." What that incident taught me is that it was not me, it was homeopathy that cured her. It was a funny way to be reminded of that truth.

With regard to treatment and prognosis I would like to raise the question: Are dissociative and multiple personality structures really a disorder, or is abuse the disorder and dissociation an orderly and very effective response to it? People have survived the most horrendous abuse and remained very highly-functioning, which is part of what makes this syndrome hidden.

What is recovery? What is possible? Referring to George Vithoulkas' basis definition of health, recovery is freedom, increased choices. Dissociation remains an option for a defense when needed; thus, a reasonable therapeutic goal can be the establishing of a well-functioning team of personalities rather than necessarily a single personality structure. What are the patients' goals? Is it to stop hurting herself, to get out of abusive relationships, to stop losing time, to get through medical or law school, to develop an intimate relationship, to improve sexual functioning? Some of the common goals that are described by survivors are: the ability to confront abusers; integration; the ability to forgive abusers; and "regaining all (their) memories." I think there are potential negative consequences associated with all of those goals. For one thing, the confrontation of abusers may contain the hidden agenda of seeking accountability and apology, but the most common response is more abuse, threats, and ostracism from the entire family.

Survivors may hold forgiveness as a goal to avoid the enormous store of rage at the abuser or neglectful parent. A more useful goal for the survivor is to forgive herself. The horrifying trauma was forgotten for a reason, and a rush to retraumatize oneself to speed recovery recapitulates the incested child's premature aging. A more useful goal, in the words of a ritually abused client of mine, is "to regain only those memories I can use right now to improve my life." It is also important to allow the patient maximum control where possible in setting goals.

I like to use the word survivor in preference to the term victim because it implies that disclosing abuse, letting go of self-blame, and working to improve options in life are what is going on. Some survivors call themselves call themselves thrivers, and I would affirm that any goal is possible. Many thrivers state that their goal is to be as highly-functioning and happy as any civilian or non-abused person, and this is possible, given homeopathic treatment coupled with long, hard work and therapy. How long? If the abuse and neglect is severe enough to cause multiplicity, therapy can take years. Often, however, rapid improvement in mood and functioning can be achieved. If the person was ritually abused, therapy takes and entails a more complicated course; treatment often becomes a matter of unpeeling the "layers of the onion." The practitioner may start with a patient who remembers physical abuse, only to uncover sexual abuse several remedies later, then incest by the father after another remedy(ies), then even the fact that she is a multiple, and then perhaps that she is a survivor of ritual abuse, and so on. So the practitioner should be prepared for a long course of treatment possibly requiting several remedies.

How do we prioritize what to treat in such patients? I would first like to emphasize safety, that we really want to look at safety issues first; in other words, we must evaluate the potential for suicide and self-injury, including alcohol and drug abuse and unprotected sexual behavior, and for the existence of ongoing abuse, physical or emotional, from the family of origin or from contact with a cult or a lover, towards the child. We must ask about these things; they are very common among abuse survivors.

After safety issues, the question becomes, what limits this person the most? Is it the insomnia, the body memories, the constant weeping, poorly controlled rage, physical sequelae of abuse, or what I call the core-process symptoms of dissociation, such as amnesia, fluctuating abilities, inner conflict, or leaving the body. Also, we must be careful not to treat the dramatic, presenting issues, the crises, too long without getting to the root dissociative issues. This means that we have to step back and provide the unified perspective that the dissociated person cannot necessarily provide for him or herself. We should not prescribe on personality traits, which are the most fluid: the sweet, yielding child calling one mommy today may be the murderous man tomorrow.

This brings us to the question of who to treat in the case of a multiple. There is a hypnotic technique for giving a specific remedy to a specific alter that is used in inpatient settings. It can be suggested that this healing go on simultaneously and separately from the other alters. Healing the urgent suffering on top gains the trust of at least one personality. However, I would like to argue for single-dose classical prescribing, and this is where we need to provide a unified perspective that the patient may be unable to do for the purpose of identifying what limits the patient as a whole unit the most.

Many therapists of multiples believe that multiples have an inner self-helper, abbreviated as an "ish," which is a personification of what homeopaths call the "vital force." Drug treatment of multiples is complex because different personalities respond to medicines in different and often contradictory ways. Homeopathic treatment should be directed to the vital force, or the ish, which hopefully oversees and sends the healing effects of the remedy to the appropriate personality in appropriate intensity. Overall energy increases as draining suffering of individual personalities is lessened. I find it very helpful to remember that idea of an inner self-helper because it can get so overwhelming listening to all the problems with multiples. However, it is important to remember these people have survived, and they will survive our small mistakes.

Some case examples follow, beginning with more simple cases. The first case is an example of leaving abusive relationships. This is a woman with multiple physical complaints, including severe menstrual cramps that had her screaming and writhing on the floor and included extreme rage; she revealed a history of repeated gang rapes by her brother and his friends as a child. She told me all of this smiling. After the remedy I ran into her and she asked, "Could this remedy make you realize the person you've lived with for years isn't treating you right?" I tentatively answered, "yes," and she responded, "Well good, because I've left my fiancee." One dose was curative of her cramps, many other severe pains, days of blackouts and vertigo (which I now wonder if they were dissociative), pain along the entire digestive tract, pain during sex or masturbation, nightmares, low self-esteem, suppression of all emotions, and a desire to die. Over the next two years she developed a strong sense of self, a satisfying career, and interest in a loving relationship. Staphysagria was the only remedy this woman needed, although she needed a repetition. This is a very common presentation of Staphysagria, and a very common presentation of an abuse survivor. Suicidality and self-injury are common to Staphysagria.

This is another very common presentation of an incest survivor with a pleasant manner and a submerged, angry edge. Her chief complaint was frequent suicidal desires and incidents of self-injury, either by cutting herself or by smashing her hands into walls in anger. This was often accompanied by insomnia and increased after contact with her family of origin or any other situation in which she felt powerless and unable to express herself. The remedy not only stopped the suicidal thoughts and self-injury, but could be used during or after a crisis in the 30c potency to prevent insomnia or self-injury. This case received Staphysagria also, although Stramonium was a good possibility. I told her in the first session to stop drinking and attend AA as she was drinking alcoholically and came from an alcoholic family. After two months of sobriety, she came in and her only complaint was that she felt hatred for all people, resulting in a severe sense of isolation; and she was seething with such rage that she could barely say more in the session. I prescribed Anacardium.

Materia medica on Anacardium

Anacardium is often used for the consequences of extreme, prolonged abuse, ritual abuse, torture, and double bind situations, especially for choices where the patient is forced to be cruel to other people. It can also be used for so-called "milder" cases of severe humiliation, and the essence of Anacardium, as I see it, in this usage is conflict. Externally what that means is: hatred for abusers; obsession with vengeance, which may enable people to survive; murderous rage; and stimulation by cruelty. The internal conflict is a conflict of wills; such is the way it is described: torn between rage and restraint; torn between a desire to prove oneself and the certainty that humiliation and shame will result again; torn in the original experience of torture between a double bind where either option leads to life-threatening punishment or to soul-threatening cruelty or shame. This is the most tortured indecisiveness. So in a psychotic patient what can be seen is the classic hallucination of a devil sitting on one shoulder yelling, "Kill him," while an angel sits on the other screaming, "Stop!" More frequently, I have used this remedy in multiples, often multiples misdiagnosed as schizophrenic, who complain of voices arguing inside their heads, and warring personalities who injure and sabotage each other. Anacardium treats the interjected, persecutory, abusive, and violent personalities, and it also treats the conflict between the personalities.

This remedy also deals beautifully with the other core-process symptoms of multiplicity: memory loss; loss of time; loss of previous abilities; loss of identity; and feeling separate or split off, or dissociated from the world; feeling unreal; spaciness. It deals with the other core issues of survivors, such as shame, self-hatred, the most severe lack of self-confidence imaginable, horror at the cruelty or abuse that they perpetrated. In a well-functioning survivor, the lack of confidence may look like Lycopodium, the spaciness like Thuja, the suppressed emotion like Staphysagria, the inability to forgive like Natrum muriaticum. The tipoff is either the depth of these symptoms or their combination.

The first time I ever gave Anacardium I had a grandiose dream, and in the dream I was the doctor to Hitler, and my job was to give him Anacardiurn and prevent the Holocaust. The grandiose things we believe we can do!

Here is another very typical presentation, one of substance abuse, spaciness, and fear of insanity: an incest survivor who drank alcoholically. (What I mean in this case is without being able to stop, several times a week, to the point of blackouts.) Her chief complaint was severe spaciness, memory loss, and fear of insanity. She was the only member of her family who had not been hospitalized for bipolar illness, also known as manic-depression, or substance abuse. One dose of Medorrhinum, because of the family history and the keynotes, restored her clarity and spontaneously allowed occasional, moderate drinking, which is a little strange -- is alcoholism really curable or not? For the next year she grieved over her losses and needed to part from a substance-abusing partner whom she was supporting. I gave her Natrum muriaticum for that. And her third remedy was simply for an eczema of the right hand, precipitated occasionally over the next six years by severe stressors involving caring for the ill members of her family, which I think is remarkable. I have now followed her for seven or eight years, and for the past four years all she has is eczema on her right hand when she gets stressed out, which really speaks to the power of homeopathy and the power of her vital force. The remedy for the eczema was Lycopodium.

Let us now turn our attention to the treatment of families and how the different symptoms will interrelate in a family. I had an older son come in with enuresis and headache; he was about six or seven when I first saw him. These symptoms would only occur when his mother had an extramarital affair, which he supposedly did not know about. Natrum muriaticum cured him. At the same time his father would come in with a rash, also cured by Natrum muriaticum. Lycopodium would cure the younger son of learning disabilities and lack of confidence. Obviously, though, the key was addressing the mother's sexual addiction, which was causing her to have these affairs and which stemmed from past incest. She would describe feeling so lonely, empty, and anxious that she would go on a crowded subway just to feel other people pressing against her. Phosphorus cured her sexual addiction, as well as her migraines and recurrent cystitis. What is interesting is that although only the mother admitted to knowledge of the affairs, the other members of the family were symptomatic only during the affairs.

Materia medica of Phosphorus

Phosphorus is another important remedy for dissociated patients and for sexual addiction; another remedy for sexual addiction is, of course, Medorrhinum. The essence of Phosphorus in this usage is lack of boundaries. Survivors' boundaries have had holes punched in them by the abuse. The repeated defensive tactic of leaving the body and of fluidly shifting identity to conform to the demands of the abuser leave the patient without a center or a solid, contained self. If Thuja defends by hiding, Natrum muriaticum by walling off, and Staphysagria by submitting, Phosphorus defends herself by dispersing, which the patient may have learned to do during near-death experiences resulting from the abuse. A useful image for Phosphorus is that of a child who is shocked or startled out of her body and has never settled back in as an integrated whole. To survive, Phosphorus has learned to merge sympathetically with her abusers. A dispersed self is hard to destroy, but becomes frighteningly difficult to find. Having been constantly sexually and narcissistically stimulated and used since birth, the Phosphorus incest survivor gets terrified when alone. She lacks self-soothing and containing methods. This leads to sexual and relationship addictions where she literally needs the touch and feelings of others to surround her in order to contain her. A cured Phosphorus survivor talks of finding her center, of feeling good alone, of understanding appropriate behavior and boundaries, of feeling focused and grounded, of integrating, and knowing where she ends and begins.

Another family case history: This was a father who was an incest survivor, diagnosed schizophrenic. He had a very intense sexual manner, even in the interview, and he had a lot of secret sexual behavior. What he told me about was visiting peep shows, but I believe there was a lot more. He was impossible to understand because his speech trailed off in the middle of all of his sentences and because of a severe thought disorder, although he was a brilliant man. He had actually read casually about homeopathy and figured out his remedy -- Thuja. That remedy improved the inaudible speech and much of his secret sexual behavior. A year later he complained of severe insomnia with a suicidal emptiness; he wandered the streets of Harlem all night long, finding relief only by talking to prostitutes, supposedly talking. Phosphorus amazingly cured the suicidality, the insomnia, and the thought disorder. I prescribed that remedy not as a result of repertorization, but because to me he was describing an emptiness similar to that of the woman who went on the subway and had to be surrounded by people touching her. He lacked almost any social contact and had no sexual outlet, and his daughter was the only intimate person in his life. I knew him before the birth of his daughter, and I directly inquired about and observed father and daughter together and apart for evidence of incest for years. I became convinced he was an excellent father with appropriate sexual boundaries, and the child is just fine today.

I will end with another family case: the mother came in basically for memory loss; Anacardium was curative. Later she had two foster children come into her home. Knowing Anacardium's tendencies, I made a point of observing her with the children. I wanted to make sure there was no physical abuse going on in the family, and, in fact, she was hitting the children. Basically, the children she took in had a long history of physical and sexual abuse. One was a hyperactive daughter with an inability to bond to the mother. She was given Sepia and is now doing very well. Her older brother suffered depression and headaches and was cured by Natrum muriaticum. The key in this case was to stay on top on this family and regularly observe them. Every time I saw them I would ask the children about being hit and the mother about any violent impulses, then give her Anacardium as needed.

Materia medica of Medorrhinum

The key to recognizing Medorrhinum in an incest survivor is the family history of incest itself; also a family history of mental illness, especially bipolar illness, and alcoholism. Substance abuse, sexual addiction, extreme mood swings, spaciness, and fear of insanity confirm the remedy.

Materia medica of Natrum muriaticum

In Natrum muriaticum, the key to its recognition in sexual abuse survivors is often the inability to forget or forgive the pain of abuse. The memory constantly haunts Natrum muriaticum; they remain in continuous mourning. They may refuse to speak to their abusers or parents for years. Sexual problems are often the chief complaint, even if the patient feels too awkward to mention them. This is a common healing stage for most survivors and appears to be the main non-dissociative response to abuse.

American Institute of Homeopathy.

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By Kacenka Hruby

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