Ideally, it provides a therapeutic structure that helps you deal with all the intense memories and emotions at a tolerable pace. In reality, however, it’s not always possible to control something that is like a lit stick of dynamite. Your memories can take on a life of their own, and when they appear, sometimes neither you nor your therapist are aware of what’s about to happen.
Symptoms of Complex PTSD
Symptoms of Complex PTSD can follow any ongoing traumatic experience, from childhood abuse to extended combat to a long-term abusive marriage. When trauma overwhelms the mind, there are many potential human reactions, depending on the age, personality type, coping style and skills, and level of family and community support, etc. Let’s explore some of these reactions here.
Remember, if you’re overwhelmed, you’re prone to using various defense mechanisms that Freud theorized about, including denying that the trauma exists or believing that it isn’t that bad, not remembering any part of it, or perhaps feeling that it happened to someone else (projection) or maybe that it happened to someone else that you created (multiple personality disorder, now known as Dissociative Identity Disorder, DID). So, it happened to other parts of you, but not you.
You can deal with your trauma by not dealing with it—yes, Mr. Avoidance again. And you may avoid it by abusing chemicals or compulsively doing something (working, social media, worrying, checking on things like door locks, praying, and even exercising). You may have your own way of avoiding it, or you may employ run-of-the-mill avoidance behaviors like listening to hours of new music, shopping until you and your net worth drop, binge-watching episodes of “Naked and Afraid,” or some such preoccupation that separates you from your trauma.
But your body and nervous system is still aware of it. The Body Keeps the Score52 is the title of a great book on trauma that communicates how emotional trauma manifests itself via physical symptoms. Your nervous system is aroused by a perceived threat (as you will remember by now) and remains in resistance, fighting the perceived stressors, until you later fall into exhaustion. You may also experience intrusive thoughts regarding your trauma which bring you back to the reality that (A) it did happen; (B) you have never dealt with it; and therefore (C) it will torment you in some manner until you do.
So I’d like to walk you through one case of a complex PTSD client, Leslie, who has been gracious enough to allow me to tell her story in uncomfortable (for her) detail. Her permission to allow me to write about her life demonstrates that she is happy with the progress that she made, and most of all, her hope that her story will inspire you to healing; she trusts that you’ll recognize that if she could do it, then so can you.
Complex, ongoing trauma and the brokenness that abuse can wreak upon young children is treatable. By telling a very small part of Leslie’s seven-year journey, I hope to convey that it’s possible to rebound from even the most heinous of human experiences.
Leslie’s Story
Leslie appeared to me to be a very depressed woman of almost fifty, a health care professional with an alternative life style and a profound sense that there was something wrong. Her depression symptoms contained the usual suspects: Dysphoria (low mood), anhedonia (loss of pleasure in the things she once enjoyed), apathy, sleep disturbance, negativity and pessimism surrounding the future, and a self-worth at the very lowest level. Besides all this, she hid her cocaine habit from everyone.
But Leslie had many other secrets that she kept not only from others, but also from herself. For one, she presented with a “psychic numbness;” she was not feeling much of anything and certainly nothing good. She knew there was something dark beneath her self-created anesthesia. It was as if she were learning to distance herself emotionally from the traumatic events from her past, although at the time, she didn’t even know consciously that she had experienced any trauma, let alone a childhood chock full of horror.
There was another clue which served as a rather bizarre manifestation of a deeper problem than depression. Leslie was losing time in a form of amnesia. There would be chunks of time missing from her day, periods of hours that she simply couldn’t account for or remember. Most people experiencing this problem would talk to their doctors and hope there were no neurological issues such as a tumor or traumatic brain injury. But neither Leslie nor I thought her brain was damaged—we both believed the depression, the numbness, and the lost time were part of something sinister lurking beneath the surface. She thought so because she sensed it. I thought so because of the many similar experiences I had previously had in my office where the symptom of lost time signaled that traumatic memories were about to surface.
Still, I suggested that Leslie be tested, and the neurologist confirmed that Leslie was asymptomatic: she had “a normal, healthy brain.” But another symptom manifested itself: Leslie began experiencing flashes of being in another place and time. A childhood scene involving her father was appearing to her during her waking hours and then again in her dreams. I wasn’t asking her to do any memory work, but rather was placing my emphasis on providing the safest atmosphere possible for Leslie to do whatever work she needed to do.
For instance, she was addressing her depression pharmacologically with antidepressants. I also worked with her using a cognitive behavioral approach, emphasizing that her thinking needed to be positive, problem-solving, and realistic, and that she should steer away from catastrophic thinking, self-deprecatory thoughts, and giving up. Behaviorally, I wanted her to do whatever was necessary to stop the cocaine. Ideally, I wanted her to trade it in for exercise, but she would not even consider giving up her occasional fixes with the white powder—we tend to hold onto what we think we need—and in the short term, Leslie believed she needed the cocaine.
Some clinicians would have made this a deal breaker and told her not to return until she was ready to give up her habit. I don’t work that way. Recall in story that emerged with Rick, the man who was raped as a child by the magician, the healing work needed to be done first for him to give up the alcohol. This chronology is also true in other people I’ve treated who are suffering from co-occurring disorders such as PTSD and cocaine abuse, or depression and alcohol abuse. For them, some or all the trauma needed to be successfully extracted and healed to arrive at a place where the substance abuse could be addressed and stopped.
Again, I needed to be the safest person in the world for Leslie to get to where she needed to go. I set boundaries—she couldn’t be high or drunk for our sessions, for instance. At the same time, I deferred to her in terms of timing—I recognized that Leslie wasn’t going to do what she needed to until she was ready, not when I was ready. People like Leslie need to proceed at their own pace. Survivors of trauma, especially childhood abuse, often feel they control very little. Good therapy should not replicate the abusive relationship. Instead it should demonstrate that not all men are controlling and abusive (where the therapist is male) and that it is safe to partner with a therapist to proceed anywhere they need to go to heal from their traumatic childhood.
I told Leslie, “We will put on our hard hats with the flashlights on the top, hold hands, and venture forth into any dark rooms or caves that are necessary.” But again, I had to earn that trust by demonstrating that I was a safe, experienced, and knowledgeable clinician, especially when it came to deal with unresolved traumas and pain in the past.
Leslie began experiencing fast-moving memories and further time lapses relatively quickly. The memories were horrible, involving a sick, perverse, biological father, who seemingly progressed in his pathology as Leslie’s childhood went on. At first, her memories included scenes of incest, where her father would visit her bed in the middle of the night and drunkenly demand sexual services of a naïve, innocent preadolescent who was being introduced to a world that she was ill-prepared to survive, let alone thrive in.
Soon the memories were darker and even more painful to hear, involving scenes of human trafficking and multiple abuse
rs. Eventually, Leslie began to remember scenes where she was taken to a farmland compound and introduced to people in a devil worshiping cult. She endured torture, abuse, and sacrificial ceremonies.
I had to walk a therapeutic tightrope. On one side, I was listening and believing my client, caring about her, and demonstrating genuine compassion for a type of suffering that was out of the realm of most human experiences. On the other side, I needed to find out what had taken place. I had to create a therapeutic distance between me and the horror stories, not me and Leslie. I could not feel her pain or fall victim to her terror. I had to be connected to her and compassionate about her suffering, but at the same time be therapeutically immune to the suffering. Failing to establish that curtain would expose me to the risk of experiencing what is called secondary PTSD or “compassion fatigue.”53
And I was not alone in needing protection from Leslie’s memories—Leslie herself couldn’t deal with the abuse memories. For that reason, she created alternative or “alter” personalities to help her carry the memories, the emotions, and the behaviors that she couldn’t handle alone.
Alter Personalities
Can humans really create separate selves or alter personalities, or is that merely the stuff of Hollywood movies?
From my considerable experience with trauma sufferers, alter personalities are not only real, but not as rare as you might think. Although fascinating, the presence of alters is not typically a high drama action film. It is much more common for the bulk of alter personalities to be internal ‘children’ who are hidden from the trauma sufferer (and everyone else), which would also mean that they wouldn’t often surface when adults were around. Their jobs are to protect the core person from the horrors of the trauma and to harbor the memories, feelings, and even functions that the core personality cannot contain.
Let’s try an example: if you were relocating your home or office, you would need to move lots of stuff. Most of us are ill-equipped to do all of that packing, carrying, and cleaning by ourselves. It is too big a project and normally requires helpers, otherwise known as friends and acquaintances. Carrying a couch to the truck, for instance, which is probably almost impossible for you alone, is much more feasible with a friend’s assistance. Multiplicity (alter personalities) is not much different.
The horrors of trauma, especially if they are frequent, can also be too much for you to carry alone, and so you employ a host of others, though less than consciously, to aid you in surviving when you might otherwise be drowning in the terrible abuse.
Once you realize how effective an alter personality can be and how easy they are to create, you can use one or more to handle all of the challenges in life that historically would fall on your shoulders. I have seen people create alters to deal exclusively with cult activities, to deal with unwanted sexual experiences, to perform professionally (for example, Florence Nightingale was an alter personality housed in the body of an RN), and even alters who specialize in house cleaning. Some contain the anger from the abuse, some carry suicidal ideation and a plan to end the suffering, and some may even side with the abusers and strive to please them. But virtually all of the alters contain memories of which the core person is unaware, along with the accompanying feelings.
For you to heal from having multiple personality disorder or dissociative identity disorder, you need to use the very same Fritz method of remembering each one of the memories (one at a time), feeling the specific feelings, expressing them to someone, and then releasing the horror in favor of a new perspective on the pain and suffering from the trauma. It’s the same method that works for a single trauma, but now it has to be applied to several or many memories.
Of course, it is often the alter personality who tells the story and expresses the feelings, as the core person is unaware of the horror story until it is finally expressed. When an alter personality shares the story(ies) that it contains and appropriately expresses the accompanying emotions, the alter becomes much weaker, to the point of losing their power and becoming ready for integration.
Repeat the process of remembering, feeling, sharing and expressing, releasing emotions and integrating (blending or fusing) the alters back into the person they were at birth, the core person.
In other words, by applying the principles of the Fritz, even a severe condition like multiple personality disorder (DID) or complex PTSD is treatable and in many cases, curable. As mentioned in the introduction, I have treated numerous trauma survivors and more than two dozen multiple DID clients. Seventeen of the latter are now finished with treatment, and they have now integrated their alters into one person, the way they were born to be.
A little insight as to who develops multiple personality disorder and why: Lawson (2018) found that approximately 95 to 97 percent of individuals with DID report having experienced severe childhood sexual and physical abuse.54 In my experience, 100 percent of my DID clients were repeatedly sexually abused. Many experienced other atrocities as well.
Leslie’s Trio
Within the first several months, I was exposed to three of Leslie’s more primary “alters,” beginning with Rachel, the late adolescent female who served as an internal guide or an “inner self helper” to me. If there were harbingers of things to come or omens of things that Leslie wasn’t prepared to know, Rachel would provide me with that information. More than just an informant, Rachel was also seductive—she did the sultry voice, crossed one leg over the other upon her arrival in the office, and referred to me as “blue eyes,” not Dr. Cortman. The irony of Leslie’s being a fifty-year-old, self-described “butch” lesbian wearing jeans and a T-shirt was not lost on me. But Rachel was an important component of Leslie, the way oxygen is an important yet not easily detectable part of water. And needless to say, the appropriate response to Rachel’s seductions was exactly what you might expect—warmth, but with no need to respond to the seductive elements. And as a result, Leslie felt more safe and secure, as I wasn’t looking to prey on her or take her up on her awkward invitations. In this way, therapeutic trust was increased by my continued professional behavior.
“Eric” was Leslie’s six-year-old male alter, who watched me from the inside before emerging as my little friend and consistent visitor. For a couple of years, no session was complete without a guest appearance from Eric. He took part in so many memories because he seemed to have a propensity to deal with dark, confined spaces. For instance, Leslie’s mother would often punish her by locking her in a trunk much like a hope chest, and Leslie would reportedly disappear into the chambers of her mind, only to be replaced by little Eric. Eric was very attracted to my collection of stuffed animals (all of them gifts from former clients, most of whom had graduated and were now completely integrated multiple personality clients). His favorite was a snowman he dubbed “Frosty.” Eric would never need to announce his appearance; he would simply stand up from my very low couch, rush over to Frosty, and sit on the floor in the corner, rocking his frozen friend. He was completely oblivious to the fact that he resided in the body of a fifty-year-old woman with bad knees, someone who was not inclined to sit on the floor at any other times.
The third member of Leslie’s trinity of prominent alters was Maria, the older and more stable of the group. Maria carried the bulk of the horrible content. She was sweet and unimposing, essentially all business and protective of Leslie. It was not unusual for Maria to tell me a horrible memory and caution me that, “Leslie does not know anything about this memory—when she absorbs what I’m telling you, she will have a very difficult time.”
Secrets from the Self
I would often listen in amazement that a human being could be sharing the most horrific of stories with me, yet also inform me that she herself did not (yet) know the story she was telling me and therefore had not been able to digest it. When employing the Fritz, you must remember (i.e., expose yourself to the trauma), but then feel, express, and release the toxic feelings before reframing
. In cases like these, Maria and Eric would be remembering a trauma for Leslie and expressing that memory to me completely. Unfortunately, the emotions that accompanied these traumas were often left for Leslie to process. As a result, after particularly horrible and traumatic memories (and they were all horrible), Leslie was faced with calling upon whatever coping skills she had in her arsenal, whether healthy or unhealthy.
For instance, after remembering that her father had begun to sell her sexual services to his friends and cohorts after realizing that he could make a handsome profit from his daughter’s innocence, Leslie not only spent her weekend drunk and high, but also took out a razor blade and carved bloody lines on her left calf, a behavior she shamefully admitted she had not resorted to in more than a year at that point.
Ms. Avoidance
She also spent her days between sessions calling upon her own version of Ms. Avoidance (not an alter) by for instance watching hours of mindless TV, sometimes after a cocaine binge. She found evidence (and later learned from Rachel) that Rachel had made a contact to engage in a threesome sexual tryst with a man and a younger woman; Leslie returned to find $300 and drugs on her hotel bed. While Leslie was perplexed and horrified, Rachel was thrilled to think that she could make money for selling Leslie’s fifty-year-old body.
Leslie made many other efforts to avoid the acute pain of realizing that she had been forced to participate in rituals of a devil worshiping cult in the Midwest. She would take extra work shifts to keep herself too busy to feel. At other times, she would dog-sit loving animals that could appreciate her kindness without expecting anything in return.
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