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Open Book

Foreword for SPLIT 

by Dr George Blair-West, psychiatrist and author, Girl In the Green Dress

I hope you will find that the book you are about to read engages you and fills you with fascination in equal parts, as it did me. It is also at times, a harrowing read, but then if it was not there would be no inspiration, no ‘rising above’ – the valuable gift that real-life accounts such as this have to offer us.

Allow me to put Maggie’s experiences into some degree of human and medical context. This requires a crash course in the condition of Dissociative Identity Disorder (DID) and its contextual history.

If I was asked to capture DID in one sentence, I would say: it’s a testimony to how the human mind really can develop superpowers … and fly away. This is the most important thing to understand about this condition, previously called Multiple Personality Disorder (MPD). It is not a mental illness. This is worth repeating as not only is it not intrinsically a mental illness, it is, perhaps, the most powerful adaptive response that the human mind is capable of when it is faced with the most destructive trauma that humans are capable of.


The capacity to mentally dissociate and create another part, or personality in a child who is being abused serves two key purposes. First, it allows the child to hand off to this newly created part all the horribleness of the rape experiences – becoming, what we call, an exiled part. The exile can then be banished from day-to-day awareness. This allows another, ‘executive’ part, to present a ‘normal’ face the outside world without being overly troubled by the horror of what’s happening at home. Then rinse and repeat, creating part after part after part.


The high-level dissociation required to create DID relies on two preconditions.


Firstly, a plasticity of the mind that is typically only found under the age of eight, or thereabouts. As our brains mature past early childhood, we cannot dissociate so pervasively as to create separate personalities.


Secondly, it requires ‘betrayal trauma’. This is where the peak perpetrator is a primary caregiver. Typically, this is a parent. Nearly always secondary caregivers are under the control of the abusing parent. This means they are not going to even give the child meaningful care, let alone save them. In my experience, the abusing parent reliably chooses partners who are abuse victims themselves who know how that the game is played in secret. (Equally, it may be that healthy partners simply sense there is something deeply disturbing about would-be abusers and reject them.)


Betrayal trauma means the child must do something that literally tears them apart, they need to create a personality that will behave positively towards the abuser. Try to imagine the mental gymnastics involved as a seven-year-old girl, minutes after a violent rape, has to respond warmly to her father to ensure that she continues to be fed, kept warm and housed. Perpetrators reliably threaten to abandon their charges – better the devil, literally, that you know.


You will meet Slut Girl as this story unfolds. Do not judge her. Understanding is the antidote to judgment. She is simply another aspect of betrayal trauma. Being raped, orally, vaginally and anally as a young child is excruciatingly painful. If you do not cooperate you then get physically bashed and emotionally threatened. Typical emotional threats revolve around the time-honoured threatening to hurt someone the child cares about. It’s stunning how protective young children are prepared to be. “We do this to either you or your sister. It's up to you,” works reliably, even when the other sib is older.


As one of my patients put it, “The pain stops when the smelly stuff comes and it’s better to make this happen sooner rather than later.” The skill and apparent ‘desire’ for the sexual act, required to do this inspire Oscar-winning performances, which in turn, creates a shame of the highest form. This shame marries with a deep sense of being rotten to the core, creating a potent force that convinces the now adult child, that they are not worthy of therapy, let alone taking legal action over the most heinous of crimes.


Sadly, if the adult with DID is courageous enough to seek therapy, their chances of finding a skilled therapist is low. When I started my psychiatry training nearly 40 years ago, MPD, as it was then known, was not even vaguely understood. It was seen as a weird footnote at the very extreme end of ‘crazy’ in psychiatry. It is only relatively recently, over the last twenty years or less, with the interest in trauma therapy that DID came to be understood as being the result of ‘early complex developmental trauma.’ Indeed, DID, now rightfully, is finally recognised, at least by those of us who specialise in trauma, as the ultimate form of a post-trauma syndrome.


How common is it? Sadly, much more common than was thought – just over one percent of the population here in the West – giving us at least 250,000 cases in Australia. It’s prevalence, predictably tracks extant child abuse. For this reason, the limited data suggests it is most common in less developed countries where children’s rights, and the protection of these rights, are not upheld. More concerningly, these survivors are typically diagnosed as ‘possessed’ and treated with exorcism. There is no worse example of ‘blaming the victim’. This treatment modality ‘treatment’ neatly ‘solves’ the other problem, that for every person with DID there is by definition at least one person who should be in jail for a very long time.

In ‘The Girl In the Green Dress’ co-authored with my patient Jeni Haynes, who also has DID, we recount, that for the first time in Australia, and apparently, the world, Jeni and her different personalities were allowed to give testimony on the basis that her condition was evidence in itself that serious crimes had been committed. Her diagnosis was the very basis for the prosecution. In all previous cases, DID was used as a defence, typically against homicide charges.


Tasked as the expert witness to explain DID to the court, I was impressed at how readily the judge recognised that Jeni’s condition, in and of itself, was both necessary and sufficient to bring the case. In the end, Jeni’s father was jailed for forty-five years, which would well exceed his natural life.

Finally, the world is changing and DID is coming of age both in medical and legal realms.


The reluctance of my colleagues to diagnose this condition is very simple. It’s the same reason that has allowed this condition, which has a similar prevalence and disability as schizophrenia, to be overlooked and underfunded for so long. None of us, doctors and the general public equally, want to acknowledge that horrible sexual abuse of the worst kind is being perpetrated on young children. We just don’t want to think so little of human beings. It’s perfectly understandable – until someone with DID sits down in front of you and decides to let you in to the reality of their life.


Indeed, DID is the only psychiatric condition in which, if the patient does not want you to make the correct diagnosis, you can’t. They have to let you in to glimpse their system of management. Even then, therapists with their own high expectations of the human race, and with almost no routine formal training, will struggle to make the diagnosis. The clarity of abuse recall, decades later, can also be hard to believe. It makes sense, however, for a therapist who understands dissociation, that a part of a person banished in exile for thirty years, can exist with no intervening memories. It makes sense when you understand dissociation and how for a part that has been banished in exile for thirty years, they have no intervening memories. They can recall the last thing that happened to them like you and I can recall what we had for breakfast.


Most of what I have learnt in treating trauma and dissociative disorders has been taught to me by my patients. Routine training of young medical doctors wanting to specialise in psychiatry still largely ignores training in diagnosing and treating DID. I would like to finish with sharing a lesson Jeni taught me as we worked together. I was describing to her the two purposes of creating alternate personalities - exiling the destabilising trauma almost completely from awareness, and being able to appear ‘normal’ to the world - when Jeni added a third. This was the most important, and to me the most inspiring, benefit.


The perpetrator takes pride in dismantling the child, literally breaking the self, so as to have a totally compliant victim, in every sense of this word. DID allows the true, innocent essence of the child to hide, safe from the unknowing abuser. It is a truly glorious ‘fuck you’ to the abuser who has no idea of the light, self-love and strength that is protected and quietly waiting ...


This essence knows the truth. It knows that this abuse was neither deserved nor just at any level. It waits, with great patience, knowing this truth, until one day the war is over and the quest for healing can begin. From the healing, the ‘rising above’ happens in which that innocent child finally gets to flourish into the life that it incarnated to fulfil. And in rising above, it carries with it a strength and a resilience that those of us who have had ‘normal’ lives cannot imagine. This is Maggie’s story.


In closing I would like to say: Maggie I am humbled before the courage and vulnerability it took to write this book. Fronting up to your pain and doing the therapy work is equally awe-inspiring. Yet again I find myself asking myself, with some self-doubt, if I had had your experiences, would I be up for these challenges? You have my deepest respect and I’m sure the gratitude of those many others who have had similar but different versions of this powerful narrative you’re about to share.


With much admiration

Dr George Blair-West


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