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My Friend Needs Mental Health, But Her Mom Doesn’t Believe Her

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I have a friend that I have gotten very close to over the course of a year. She recently told me about a problem she has at home. Her parents are divorced, she lives with her mom and sister, who lives with her mom’s parents in their house. She sometimes wakes up in places she doesn’t remember being in. She texted me and told me she woke up in her closet with a cut on her face. When I asked her how she got there she told me she didn’t know. One time when she was younger and her parents fought the next day she woke up under her bed holding a picture of her parents with tears on her face. We were hanging out and she told me she doesn’t eat or sleep as much as she used to. Recently she told me that her mom told her she kicked her grandma. When I asked her why she kicked grandma she told me she genuinely didn’t remember kicking her grandma. She texted me one night and told me that she thought her mom was mad because her mom told her that she would rather have cancer than have her. I started doing research online to try and help her. Based on some of her symptoms I came to the conclusion she might have DID. I told her this and she took a test online that says she probably has it. I told her to talk to her mom, so she could get medical health. She told me that her mom said that she was a liar, was disrespectful, and had behavior issues. Her mom also told her that she was a full-blown manipulative liar. What really worried me was when today we were texting and she said that she won’t be able to remember what her mom said the next day, I asked her why and she said they wouldn’t let her. When I asked her who they were she said the people, when i asked who the people were she told me that one of them was Lola and that she was talking to her right now and the Lola wants to die and sob, she said Luke is gone and that she can’t hear him, Rachel wants to scream and argue, and she can’t hear Tyler. She said that everyone hates her and the world wants her to die. She then said “I don’t want to die. She does” She then said her mom is sending her to a psychiatrist to shame her. She said the only reason her mom is sending her is that her mom wants the people to tell her that she is being disrespectful.

Before we begin to look into your friend’s needs, I want to take a moment to talk about you and your character. You friend is very lucky to have you in her life. I’m not sure what advice I’ll be offering that will be helpful, but I can assure you that your friendship is something that is admirable and a very powerful and dynamic example of your concern for her well-being. That said, there is also a delicate balance between wanting to help and being able to. For your own well-being please remember to take good care of yourself, and that because of the extreme nature and difficulty your friend is having — you may not be able to help her as much as you like.

It sounds like you’ve done your homework in helping to understand more about your friend’s symptoms. Dissociative Identity Disorder (DID) is an identity disorder that needs to be diagnosed by a mental health professional. So the fact that your friend is going to a psychiatrist is good because, in spite of her mother’s reason, she can explain her symptoms and the psychiatrist will be able to follow up from there.

It is called an identity disorder because there is a disruption in the individual’s identity. This can mean that other personalities can come through and “take over” this individual. When this happens there can be profound changes in their emotions, behavior memory, consciousness and senses.

The gap in memory makes everyday event hard or impossible to recall and it make normal continuity with friends and family and daily functioning at work and at school very difficult.

However it should be noted that there can be other causes for these symptoms, and while I agree there seems to be many factors here that point to DID, there is a very real need to have your friend see a mental health professional so these other possibilities can be ruled out.

This brings us to what you can do. You can continue to be a support, offer to go along with her to the psychiatrist’s office if that feels okay and your parents agree. If your friend wants to talk to a school counselor you can offer to support her in that and walk their with her as well.

Your friend sounds like she is going to need a great deal of help because she is coping with a difficult mom and also needs a psychiatric evaluation. As a friend you can help by being a good listener, and assisting her in getting to the people who can figure out what is happening. Beyond this, you have to take care of yourself. Don’t make her your only friend and only concern. That can be very draining for someone 13 years old, and it has the potential of causing you distress. Help her but not at the expense of depleting yourself.

Wishing you patience and peace,
Dr. Dan

 

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With My Therapist 18+ Years, But I Haven’t Been Able to Make It to Treatment

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

My therapist and I had been working with different parts/alters of my system (D.I.D. diagnosis) when 1 of them decided that therapy wasn’t allowed anymore. That was almost 2 years ago! Thankfully my therapist has been amazing and will still speak to me in crisis (unless she gets hung up on by “someone”) and/or email/text with me when needed (if not deleted). We’ve set appointments and those either get cancelled or just don’t show up.

This part writes in our Notebook/Communication book such awful things. To me directly, about my friends as well as my therapist. Through our years of working together my therapist and I have had such major success in working with other parts… up until this specific one decided that it was going to be her way or the highway. My therapist has had an abundance of conversations with this part and basically she is one of the original protectors. From what we gather she was hurt the most and bought in to the rhetoric of my abuser. It makes sense as to who she is, what she stands for and why; however, those old coping mechanisms aren’t applicable to my life today. What worked then to survive isn’t needed now. She refuses to see that or to even consider it. Her reasoning for blocking therapy and treatment is because “it’s not honoring him” and “one day will see the truth of the light that shines so bright.”

I’ve done several voluntary inpatient treatment programs but even those get cut short. “Someone” decides we’re not doing it anymore and checks out.

My life is stuck where it is and there is SO much more work to be done… with my system as well as my own personal struggles. The hope was that something/someone would eventually shift (at least just enough) and I would be able to go back to treatment. That was almost 2 years ago at this point!

Any thoughts or input you could offer would be of the greatest appreciation. I feel very stuck and like things won’t change. (From the USA)

 I can imagine how difficult it feels to be at war with yourself in getting treatment for D.I.D. The “Someone” sounds hypervigilant as the protector and needs to be validated. Your therapist sounds wonderful and it might be useful to discuss considering inviting “Someone” in to express his view directly — to be honored by having a voice in the process. This may help create a therapeutic double bind for “Someone.” By honoring him and inviting him to have a voice he would get to speak up — which is likely to be part of the correction he is seeking, and in doing so engage with the process.

My thoughts on this are just suggestions, as there are many factors that may make this approach unfeasible that I wouldn’t know of. You and your therapist can discuss the merits and see if you can broker a meeting with “someone” to help with the integration you are looking for.

Wishing you patience and peace,
Dr. Dan

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Untreated Dissociative Identity Disorder

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’ve been diagnosed with DID, psychosis, intermittent explosive disorder with homicidal thoughts & PTSD by VA psychiatrist. The VA has no problems diagnosing me with DID but they won’t treat DID. I’m in a constant state of extreme rage I can’t leave my living space because I can’t control the rage when I’m around people.

I am sorry that the system of benefits from the Veterans Administration (VA) hasn’t given you the help you deserve and need. It sounds as if your service has caused a number of severe reactions, including Dissociative Identity disorder (DID). While I’m assuming most of our readers understand the symptoms associated with the other disorders, I am going to focus on the DID since that is the one you are saying the VA will not treat.

Dissociative Identity Disorder (DID) is something diagnosed by a mental health professional, typically a clinical psychologist or psychiatrist. There are several symptoms that underlie DID and the primary one is that it disrupts the person’s identity as other “personalities” or personality states manifest. These often include different voices, and in some cultures can even be identified during these states as being possessed.

These states disrupt the individual’s identity because there is a gap between one’s sense of self and motivation toward one’s goals with changes in emotional expression, behaviors, memories, feelings, and perceptions. Often these gaps result in memory loss of everyday events, including the specific features of one’s own personality and identity. The role of wife, sister, student, girlfriend, etc., that might make up the individual’s identity are usurped by other, interfering and often competing personalities. These disruptions cause gaps in memory that are beyond what would be considered normal forgetting. These indicators typically cause significant stress in the person’s life because it directly impacts the quality of relationships, and aren’t the result of other medical issues such as seizures.

In the past DID was known as (and is still sometimes referred to as) Multiple Personality Disorder. The disorder is a way the psyche tries to deal with trauma or abuse, and the personalities have emerged to help cope with different aspects of life. Very often these personalities are compensatory for something the individual is unable to do in their life. As an example, an unassertive person might form an aggressive or highly assertive personality to compensate.

A common symptom is for an individual with DID to lose track of time and there may be significant intervals that are lost due to one of the entities takes control. It is typically not commonly diagnosed in the population, and the best methods of treatment often involve psychotherapy aimed at integrating the identities into the core personality. You can learn more about DID here.

Your service to your country was a significant enough sacrifice and finding a way to get treatment for these condition through the VA is the job of a patient advocate.

A patient advocate for the VA is a person that will take up your concerns as a VA patient. You have rights that an advocate can intervene on in your behalf. Typically they work with every department involved with the VA and are given the authority to address your needs and issues in a faster manner. They typically get involved when there is a gap between needs and services and are familiar with problems, issues, and complaints such as yours. Typically they are individuals who let you know that once they start working with you — your problem becomes theirs to solve. I’ve located the patient advocate program closest to your geographic area. Here you can find specific names, phone numbers, and emails to contact. I sincerely hope you connect with them so they can help you get the services you need. You deserve them and are entitled to treatment.

Wishing you patience and peace,
Dr. Dan

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There Are Three People Inside of This Body & I’m The Only One With a Desire To Kill

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Inside of this fleshy prison live the three of us: Harry, George, and me. Normally, we get along perfectly, each respecting one another’s problems, such as George’s ‘depression’ and Harry’s ‘schizophrenia’ (both of which have not been diagnosed or discussed with a professional). Unlike the other two, I seemingly lack a few emotions, such as grief, remorse, and empathy. Normally, this is more of a strength than a weakness, but as of late, it has been rather difficult to deal with.
It’s perfectly normal for me to experience urges to kill living creatures or to break inanimate objects, and these urges are understood by Harry and George. However, with each passing day these urges seem to grow stronger, and Harry and George seem to grow more…’on edge’. When we discuss the subject, the others seem to react with more fear, or aggression, than they used to, and they don’t seem to understand my situation as well as they used to.
Previously, I could control my urges perfectly. I fidget a lot, which used to calm the urges, and I can also be quite destructive if I want something (I chewed through a television remote so that I could play with the rubber buttons inside), which also helped. Leaving windows open and then killing the insects that entered the house was another good way to calm myself. However, none of these methods seem to do much good anymore. I want something more, something bigger. Hunting is out of the question for me – there isn’t anywhere to go in my local area and if I ask an adult it will arouse suspicion (they all believe that Harry, George, and myself are a singular, ‘normal’ entity).
With each day these urges growing stronger, I also grow more impatient and frustrated with tiny details. Things – and people – are bothering me more and more, and this is encouraging my fantasies of killing them. There’s only two people I would never be able to kill, and they’re not a part of my family, which means I have to control myself greatly each day around the people I’m supposed to ‘love’.
With all of that said, it brings me onto my questions. What can I do to calm my desire to kill? And, lastly, is calming my urges that only way to make Harry and George feel comfortable with me again? Thanks.

You state that these urges are becoming increasingly difficult to control. They are signs that you should seek professional help. Don’t ignore these important warning signs.

I receive many questions from people with similar problems. As I’ve mentioned in my response to each of those writers, I have studied the biographies of many people who kill. They have often described feeling increasingly out of control leading up to their crimes. I’m thoroughly convinced that had they sought professional help, many of those people would have never killed.

Right now, you’re spending a great deal of time indulging your fantasies and interacting with Harry and George. Avoid this. You need to find other ways to expend your energy that are nonviolent in nature. There are many activities that could occupy your time. Here are a few ideas: hiking, running, sail boating, learning to play the guitar, drawing, sewing, cooking, podcasting, making a documentary, writing, photography, meditation, and so forth. The idea is to redirect your energy towards positive thoughts and behaviors. Choose healthy activities over unhealthy activities.

Of course, hobbies are not a cure for homicidal ideation, but distraction can be powerful. Ideally, you should consult a mental health professional who can address this problem in a meaningful way. That would be the most responsible course of action.

Finally, contact the authorities if you feel that you are at risk of losing control. They can protect you from doing something that you would later regret. Depending on the nature of the violent act, you could be sent to prison for life or be executed for your crimes. Should you go to prison you will regret the actions or inactions that got you there. Prisons are very violent places. They are designed for punishment. Get help if you need it. It is not an exaggeration to say that mental health treatment has the potential to save lives. Please take care.

Dr. Kristina Randle

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I Switch Between Two Different “Me’s”

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Hello, it’s a quite pleasure to meet you. I’ve just recently realized that I think I may have a problem. It never struck me as odd before, yet it was so obvious. There are two different “me’s” besides the normal me. They are two extremes. There is the extremely obsessive and overly emotional one that I have nicknamed “Loony.” Then there is the emotionally empty, intellectual, and analytical one that is the “Bored” one.

“Loony” and “Bored” are the ones I switch between a lot. Loony often becomes unhealthily obsessed with things or people. They obsess about those things for a long time, thinking about nothing except for how perfect those things are and how inferior they are compared to that thing or person. They have an extreme inferiority complex, always harshly critical about themselves. But they aren’t depressed. They love the fact that they are tearing themselves apart and that those people/things are vastly more superior than them.

Bored is, well, extremely bored with all of their relationships and everything they do. Yet they go into intellectual debates a lot. They also collect data and information on all kinds of different subjects, just learning more and more for no real reason.

The thing that made me realize that I even switch between these two was something that I noticed. When I learnt that I had a UTI infection for basically eight years and that those things are able to kill people; I was extremely disturbed and worried, of course. But then later, I became completely indifferent to the information, not really caring what happens to me. After that, I became overjoyed by that information and openly embraced the idea of myself dying like that. It took me awhile, but I spotted the different reactions. Then I saw more differences pile up. I can’t control when the changes happen, they just happen and I get out of them when they want to end. I’m not “me” when I’m them. I’m not “awake,” I guess is the best way to put it.

Even my brother at one point told me that I “have no personality,” because mine changed so often. So, it’s not just me thinking this whole thing up and convincing myself that it’s real. It is real. I don’t really know what to do or what this is. Could you help me?

Thank you for reading.

The ”you” who wrote this letter is neither Loony nor Bored, yes? So how is that? The you that wrote this letter is a true self, an observing ego, the real you. Differences in thoughts and feelings — even when they have a wide range — are not necessarily separate selves. The fact that there is a “you” that knows about it, can discuss both completely, reflect and critique each, and desires change is the part of you that you want to develop. I recommend you ask your parents for some therapy sessions to help this process along.

Wishing you patience and peace,
Dr. Dan

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Multiple Internal Voices

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have 4 “versions” of myself. The main one (me) is the artistic one and sees everything in a positive light but can get depressed easily. The second main is Jake who is logical and sees everything more realistically but can get angry easier than the rest of us and is the strongest. The third version is Jack who is a over confident person who has no emotions for others and gets things he wants for the body’s benefit. The fourth one jakey is the happiest out of all of us and is very careless about the body. jakey sees things as “life is short so why not” type of attitude.jakey comes out in a very happy scene or when I get into a deep depressed state. We are all aware of each other and we all share the same memories. They started to exist after an overwhelming event of getting out of a bad relationship, going home to angry parents, and going to school was hell. I was 13 at the time and I kept my sadness inside because I didn’t want to worry my parents even more. I have a history of suicidal actions, and self-hurting actions. There are times where we all fight like siblings but nothing too harsh. They don’t look different from me however they act a lot different from me. I hope this make sense. Its not multiple personality because they look like me but they act very different from me (hence they are called versions) However, I know that it’s not nothing. I’ve decided to accept them and let them have full control of the body for one day throughout the week. Please tell me if this is a mistake or if there is something better I should do. Thank you for your time.

You stated that this is “not multiple personality”, but you should avoid self-diagnosis. The only way to know with certainty if you have DID, or any disorder, is to be evaluated, in-person, by a mental health professional.

You may be describing dissociative identity disorder (DID), formerly known as multiple personality disorder. What’s most concerning is your history of suicidal and “self-hurting actions.” Studies indicate that people who have tried to end their lives or to hurt themselves in the past have an increased likelihood of trying it again in the future. That’s concerning, especially in the context of the distress associated with your “four versions.” When you recognize that a problem may be present, it is best to consult an expert.

Relative to other types of mental health conditions, dissociative disorders are not well understood. In general, it is thought that some people disassociate in response to traumatic experiences. You mentioned having a history of trauma. It’s possible that these “versions” developed to buffer the trauma in your life, to protect you from experiencing psychological pain. In other words, it’s a defense mechanism. Defense mechanisms only last for so long. Trained professionals will know what to do and can guide you through the process of integrating the “versions.” Choose a therapist who has experience with dissociative disorders. Good luck.

Dr. Kristina Randle

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