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Everyone dissociates. Dissociation is a common defense mechanism that is available to all of us. Children quite commonly use dissociative defenses and most dissociative disorders start in childhood. Yet, many clinicians are unaware of how prevalent dissociative disorders are or even how to assess them. Dissociative Identity Disorder was formerly known as Multiple Personality Disorder and was considered to be rare. Only Sybil and Eve suffered from it according to the majority of psychiatrists and psychologists. When we look at the prevalence of sexual abuse, domestic violence, and child abuse, it makes sense that there are many more people who suffer from dissociative disorders than are diagnosed.
Having worked for 10 years with adults who suffer from Dissociative Identity Disorders, it has become apparent to me that these adults didn't wake up one morning as an adult with multiple personalities! In listening to their stories, each one of them had started dissociating as children; but nobody knew it. Consequently they continued to dissociate into their adult years leaving a trail of pain and suffering for not only them, but for those intimately around them as well. If they were fortunate enough to be diagnosed as adults, their healing process became even more complex because of the many years of not being properly diagnosed.
Dissociative Children educates the readers as to what dissociation is and how it works. Lynda Shirar also teaches us of the difficulty in distinguishing behaviors that often get mis-diagnosed as Attention Deficit Disorders, oppositional or conduct disorders, anxiety and panic disorders, Post Traumatic Stress Disorders, depression and suicidal ideation, and substance abuse. As adults, the most common mis-diagnosis is Borderline Personality Disorder. If for no other reason than to learn how to recognize and properly diagnose children, Dissociative Children is worth reading. For if we do not properly diagnose these children, how can we help them?
Beyond teaching how to recognize and diagnose dissociation, the author also provides treatment plans and techniques useful in helping to work with Dissociative Children. She emphasizes the importance of helping a child to remember and resolve the trauma from their history of abuse in order for them to heal and function as an adult. Included in the book is a dissociative checklist along with the common signs and symptoms which are helpful in identifying these children who so desperately need someone who can start them on the path to healing. The drawings included are an added bonus. They help us to see how the children see their world and of the importance of art therapy in the healing process.
When counseling children who have dissociative disorders, family involvement is imperative. Shirar addresses that issue and gives specific direction in how to educate parents and how to assess families as to whether they will be able to help their child integrate. Diagnosing is not enough. Parents must become educated and take an active part in order for the child to heal. Without the support of the parents, the prognosis of healing as a child becomes less likely to happen.
Realizing the prevalence of diagnosing children with ADHD and medicating them with Ritalin, I often wonder how many of them are improperly diagnosed. I believe it is time to take a closer look at some of these children and ask, " Could it be that this child is dissociating...and if so, why?" It is becoming all to easy to say they are hyperactive and pop 'em a pill.
Reading Shirar's book made me stop and think differently about the way I work with the children in my practice. What I have learned is that the majority of them are dissociating from their feelings. As they continue to disconnect from their feelings, they have repressed their hurt and pain which eventually develops into anger and often rage. If not addressed, that anger can sometimes be the path to acting out suicidal fantasies or murderous rage. We only have to listen to the news or read the paper to be aware of the prevalence of violence in our society by children. As clinicians, we have a responsibility to identify these children as early as possible to help them reconnect with their feelings and work through their pain. Maybe they don't have multiple personalities that have developed, but teaching children and their parents about dissociation and the problems that can develop in continuing to use it as the primary defense mechanism is a must.
Perhaps the most powerful paragraph in the book is on page 27, where the author says, "The penalty of childhood trauma and the necessary dissociative coping become increasingly costly for the child growing up, even after the trauma itself has stopped. Any child who has dissociative symptoms, whether, mild or severe, can benefit from identification and treatment of those symptoms. Given the opportunity, children can heal while they are still children."
Think about how drastically this could change our society in the reduction of pain and suffering and violence when children can see the world through healed eyes. I highly recommend this book to not only clinicians, but teachers and parents. It is clearly written and easily understood. Any adult who relates to children on a regular basis would benefit from reading Dissociative Children.
Vicki has been in the field of mental health for over 16 years. Since 1990 she has worked in private practice through Jung, Jung and Associates in Bothell, Washington. As co-founder of the Youth Suicide Prevention Center in 1985, she counseled over 450 youths-at-risk of suicide through group intervention until it closed in 1990. Her work has a broad range of experience including not only suicide and self-harm behaviors, but grief and loss, survivors of sexual abuse, victims of crime, anger and violence, marriage and family counseling, Post Traumatic Stress Disorders, and Dissociative Disorders. Through her career she has worked extensively with individuals, couples, and groups including children, adolescents, and adults. In addition to traditional therapeutic skills, she utilizes art and sand tray therapy and has a special interest in pet-facilitated therapy. Her Chihuahua, Sarina Marie, works as her co-therapist.