I have become super-annoyed by any mention of the 3 phase approach to treating Dissociative Identity Disorder (DID). As put forth in the DID treatment guidelines by the International Society for the Study of Trauma and Dissociation (ISSTD), these are considered the gold-standard recommended steps for therapists who are treating someone with DID:
1. Establishing safety, stabilization, and symptom reduction.
2. Confronting, working through, and integrating traumatic memories; and
3. Identity integration and rehabilitation.
It sounds like an easy formula for assisting those with DID, but like previous treatment recommendations for DID, this 3-step phased approach is seriously flawed and needs updating (it’s been 10 years of minimal success).
Unfortunately, the vast majority of DID patients get stuck in stage 1, or if they manage to get out of stage 1, it is too easy for them to get knocked back into the stage 1 need for safety and stabilization by triggers in life and therapy.
Talk therapy and learning new skills is not effective enough in helping people with DID to successfully master the phase 1 goal of safety and stability because it is too easy for them to fall back into deeply rooted familiar neural pathways that make them unstable again.
The deeply-rooted neural pathways of someone who has DID is what keeps them stuck in a dissociative reaction to stress, which is why it is critical to address rewiring the brain of a DID person in stage 1.
Instead of therapists challenging themselves to figure out how to successfully help their clients master phase 1, they are actually told by these same guidelines that some people just don’t have the capacity to get out of stage 1, and so they can therefore feel ok when their clients stay stuck in phase 1 and a life of misery. This is completely wrong and cruel to those suffering with DID.
It is quite frustrating that the majority of trauma therapists will identify Bessel van der Kolk’s “The Body Keeps the Score” as the book that has most influenced them, but strangely, almost every trauma therapist has little to no expertise in helping with the neurobiological effects of trauma, which is kind of the point of this book.
I believe there is a small percentage of people who can successfully manage this 3-phase approach as it is, but what I see from the vast majority of people I know who have DID, people get stuck in the phase 1 need for safety and stabilization. They may get stabilized, but either by working on trauma or some other life trigger, they slide right back into the need for safety and stabilization, which leads the person with DID to feel like they are failing therapy because it seems impossible to maintain enough forward momentum to make progress in therapy.
When your brain is wired for dissociation and PTSD, you can’t simply rewrite the way the brain functions through talk therapy and skills.
What if the very first step is impossibly flawed because therapists have been giving their clients the wrong advice on how to reach stabilization (DBT skills, mindfulness, CBT therapy, corrective therapeutic relationship, blah, blah). These methods can be helpful, but they don’t help the client achieve a strong enough mastery of safety and stability.
The type of stabilization achieved by talk-therapy and skill building is too weak to endure the triggers faced by the highly traumatized person.
Is it possible the answer to phase one stabilization is outside the traditional therapist’s wheelhouse, and involves neurobiology instead? Something that will rewrite the neural pathways?
Is it also possible that stabilization can occur in days-to-weeks instead of the years therapists typically spend on this with desperate clients?
I believe it is possible there is a much more effective and efficient way for traumatized individuals to get stabilized quickly.
An open mind and a belief in miracles is required at this point.
As the pandemic was nearing an end, I found myself loosening up on my fight-or-flight mode of survival that served me extremely well during those stressful months. As good as that might sound, what followed for me was a quick dump into the gutter of mental health hell. Apparently, my mind needed to do something with the build up of 14 months of limited parts activity I experienced to hold it together. If you are confused by this, try to understand that I was in the trauma of the pandemic, and to survive, I could only have around parts who were strong and didn’t feel, just like most of my childhood. The emotional and vulnerable parts were tucked away. The parts of me that had been frozen during the pandemic crisis were starting to rapidly thaw. Their emotions were overwhelming.
I rather quickly became depressed, suicidal, anxious, dissociative, and unable to deal with the stress of my children. Each day, I was becoming more unstable. I had reached a point where I had decided I was going to kill myself or go into a hospital (note, there are no hospitals that treat or believe in DID within my state, or even several states away, which makes this option less likely).
On a scale of 1-10 (10 being the worst), I was a 10 on the suicide scale. I couldn’t even hold onto the love for my children and what my suicide would do to them to prevent me from doing it. I was too far gone, and my suicide was becoming imminent.
How I stumbled upon Ketamine, stopped a serious suicide attempt, and saved my insurance company $30,000
In a complete fluke, a holistic doctor I work with for health issues had just prescribed generic ketamine nasal spray for depression and anxiety, and had no idea of the severity of what I was suffering because I hid it from them like I do most people outside a therapist’s office. I made the decision that I was going to try it as my last ditch effort before I checked out. The imminent risk and permanency of suicide outweighed any reservations I might have had.
The Ketamine Experience
I simply took one small spray of the ketamine in one nostril. I could immediately feel it coming down my throat as there was a slight burning feeling that lasted for a few minutes. After the burning sensation, I could quickly notice I was starting to feel what I would call a manufactured dissociation as it didn’t feel how I normally feel when I dissociate.
The dissociation lasted for 30-45 minutes, and then I felt kind of high. I was feeling emotions like funny, happy, and curious —funny and happy are definitely not normal feelings for me. I knew not to drive my car or make any big decisions. Though I did shoot off one very wordy email I kind of later regretted 😎.
The dissociation and high were gone within 2 hours of the nasal spray. I was left with a sense that my mind had been cleared of cobwebs I didn’t even know were there. I very dramatically had a mental clarity I wasn’t used to. I was much more aware of everything happening in my environment.
By the 3rd hour, I began to evaluate my thoughts and feelings because I knew this was a test to help me figure out what to do with my suicidality and depression. I scanned my brain for thoughts, emotions, or voices of parts, and to my amazement, my suicidal feelings were completely gone, and I had no sense of any depression, anxiety, or even dissociation. I was completely grounded in the present with a strangely crystal clear mind. I was actually worried I was going to have a manic episode because I was feeling so oddly good.
My suicidality went from 10 to 0 in just a few hours.
Later, when my kids each did their behaviors that had been over-stressing me these past few weeks, I felt like a super-parent who was not the least bit phased by their antics.
As it was approaching bedtime, I was worried I wouldn’t be able to go to sleep because: 1. I always struggle with insomnia (and sleep meds don’t always work for me), and 2. I was worried the feeling good and crystal-clear thinking was going to make me want to stay up all night being productive at some random thing. Surprisingly, I took my normal low-dose sleeping pill and easily fell asleep. Even more surprising, I was able to sleep-in the next morning, something my anxiety hadn’t allowed me to do for years.
When the day of my first ketamine dose began, I was looking at either a $30,000+ psychiatric hospitalization, or ending my life and traumatizing my family and friends.
Instead, one spray from a $45 bottle of compounded generic ketamine completely removed me from that suicidal crisis and stabilized me.
My mind has stayed clear, like really sharp, and my emotions have been extremely easy to regulate.
My ability to emotionally regulate was put to the test almost immediately. The day following my first ketamine dose, I was scheduled for a therapy session with my therapist who I was having some serious attachment conflict. The session was indeed volatile, and one that would have normally sent me into a suicidal tailspin. Instead, I noticed I had a few fleeting suicidal feelings during the session, and I moved on, and they didn’t stick with me post session. A highly stressful situation was completely manageable, which is unheard of when it comes to me having attachment conflict in therapy.
Maybe some of you don’t see how big of a deal this is. Before ketamine, I was emotionally wobbly every day. I never knew what little thing might send me off into depression, suicidality, overwhelming anxiety, or into my constant dissociative response pattern that creates quite a bit of amnesia in my life.
My use of ketamine is like someone handed me a brand new life. A life that has been missing for over 30 years. I was finally free of the debilitating existence I had known almost my entire life.
I am finding the experience of my new brain extremely foreign. I don’t feel emotionally overwhelmed. I don’t feel depressed, suicidal, or even dependent on a therapist at this point (I have struggled with severe disorganized attachment, so this is kind of a big deal for me). My mind just feels clear and calm, which I really am not used to.
I waited a couple of days and did a second nasal spray of the ketamine. I was still feeling completely stable before this dose, but I wanted to do what was recommended by the doctor who prescribed it. With the second dose, it was barely noticeable and I didn’t experience the dissociative and feeling high side effects.
I have researched ketamine a lot since then, and I know others typically don’t respond for a week. There are several ways to take in ketamine, and an array of different dosing strategies. The doctor that prescribed the ketamine I used was a believer that low-dose and through the nose to get closest to the brain was the best method.
Ketamine seems to be a miracle for me. Although I live near a big research center that has all sorts of clinical trials going on for ketamine, I know I would be excluded from those studies because of my dissociative disorder (a familiar narrative for those of us with DID). We are just too much with our diagnosis for a lot of things..
Alternatively, there are many ketamine clinics that have set up shop in my state so that they can make a lot of money off this new treatment. Typical treatment prices seem to be around $400 a session, and insurance rarely covers it according to their websites.
For once, the compounding pharmacies seem to be the most economical place to get it, but finding a doctor who will prescribe it this way may be the challenge.
If you are a long-time sufferer who has given up on treatment for DID/CPTSD, or someone who suffers from chronic depression and/or anxiety, I would give ketamine a try if you can get your hands on a legitimate form of the medication. I am not recommending the street drug that is a higher dose of ketamine and will do who knows what to you. Try Googling ketamine near you and see what comes up. There’s lots of research, books, and articles about the way it works and what it has been used for.
There is a fascinating article about using ketamine with complex PTSD trauma survivors here.
I have to believe an angel dropped ketamine in my lap when I was at one of my lowest points. It clearly saved my life, and it just may be offering me the chance at living with a non-traumatized brain. As each day ticks by, I am still amazed at the calm and clarity I feel.
As a takeaway, I hope that each of you who reads this will consider that maybe people with DID aren’t succeeding not because they aren’t working hard-enough, committed enough, smart enough, or don’t have the ego strength or attachment stability to succeed in therapy. Maybe it really has more to do with how their brain is wired, and maybe there are easy fixes such a ketamine that will address the neurobiological effects of developmental trauma.
Just maybe, the most difficult repair is easier than everyone thinks.