CHAPTER 10
A WOMAN WHO DECIDED NOT TO REMEMBER

Terry was the first advanced-degree professional with MPD I met. Since then I have met five physicians with MPD among a variety of other professionals with the disorder. Terry came on referral from her internist because of periods of missing time and was aware of my work with MPD and the possibility that that might be her diagnosis.

She was functioning well at her job with a minimum of switching and none of her colleagues had ever suspected she had serious mental health problems. The same was not true in her marriage, which was rocky. There were a number of alters that interacted with her husband in an inconsistent fashion, including one who was very sexual, one who was angry and rejecting, and one who was the calm professional. Her husband, by her description, was a self-absorbed insensitive narcissist, and probably unfaithful.

Terry didn't feel personally secure enough to risk a separation and was therefore locked into an unsatisactory marriage. She derived most of her pleasure in life, self-esteem and sense of identity from her work, which she discussed in an animated fashion. She was obviously gifted at her work and very creative. She wrote technically interesting poetry that was intelligent and moving. As well, Terry was poised, attractive and well dressed in not-too-conservative business attire. She had ash­ coloured hair, acquiline features and striking eyes. She was the only MPD patient I ever worked with in Canada who dressed more professionally than I did.

Terry remembered absolutely nothing of her childhood before age ten except for two brief snapshots of events that did not appear to have any particular significance. Otherwise her amnesia for childhood was dense and complete. Most people with MPD have extensive but incomplete amnesia for childhood, although complete blocking out of the first ten or more years is not rare. I have also encountered this form of amnesia in women who did not appear to have MPD but who had many posttraumatic, depressive and psychosomatic symptoms.

Terry had a disconcerting personality system. There were about five different Terrys who were amnesic for each other and who were difficult to distinguish from each other. There were subtle differences in facial gestalt, tone of voice, and personality style between them, and careful questioning confirmed that each was amnesic for conversations with the others within the same session. Each Terry denied that there were any other Terrys and insisted that she was the only one that existed. There was a distinct switch with eyeroll, eye closing and head nod during the transition from one Terry to another.

Each Terry had a different perspective on work, the marriage and life in general. At times the amnesia seemed to slip a little and one Terry would acknowledge that "she", referring to one of the other Terrys, handled certain aspects of life. It was perplexing to observe clear switching and intrasession amnesia combined with such a high level of denial. I spent time enquiring of each Terry about her amnesia, about why she couldn't remember walking in and sitting down, about coming out of blank spells not knowing how she got to her present location, and pointing out inconsistencies and gaps in her information. These efforts were responded to with statements about having a poor memory, or the amnesia was just dismissed as inconsequential.

The first few sessions had a humorous, jousting flavor to them as we sparred back and forth about how the Terrys understood what was going on and how they disbelieved my suggestions about there being different parts inside. I steered the conversation towards a discussion of how we might work together, what the point of therapy might be, and what the goals and conceptual framework of therapy might be, without establishing a common ground.

Terry thought that I was rigidly fixated on one way of doing things, that I was inflexible and that I was unwilling to make a treatment contract on her terms. She wanted to start a therapy without defined goals or methods just to see how it went, and didn't want me to impose a preconceived structure on our conversations. My view was that she wanted to visit me and have interesting, unstructured conversations without a clear treatment plan, and that although this might be mutually pleasant, it didn't justify payment of physician's fees by the government. I had the feeling that "therapy" would be no more than a government-subsidized intellectual love affair.

One reason I felt this way was that Terry insisted her husband not know she was seeing me. She couldn't give a clear rationale for her insistence on this arrangement, other than the fact that her husband would get angry, belittle the therapy, yell at her, and try to get her to stop coming. Although that might have been an accurate assessment of his reaction, I felt uncomfortable about a therapy based on this kind of secret, both because the perpetuation of secrets is rarely healthy for abuse survivors, and because it gave our therapy relationship a clandestine quality.

It turned out to be a moot point, because Terry did not engage in longterm therapy. The key factor in this outcome was Terry's decision that she did not want to remember. I reviewed with her the almost complete certainty that the purpose of the amnesia was to hide childhood trauma, that this might include sexual abuse, and that there were likely parts of her hidden behind the amnesia barrier who remembered the trauma. She accepted the concept of "parts" hidden behind the amnesia barrier as a plausible postulate, although she still denied the existence of parts that took turns being in executive control during her adult life. Terry did not want to remember for several reasons. She felt that she was under too much stress in her married life, and that she did not have a husband who could support her emotionally during the recovery of her trauma memories. Also, she was concerned that uncovering the memories would upset her somewhat precarious equilibrium and result in her losing her job. If this happened she would then be financially dependent on her husband and even more locked into the marriage.

The most important reason, though, was that Terry did not want to remember being abused by either of her parents. Her relationship with them, although long distance, was relatively nurturing and stable, and she did not want to lose that. She felt that if one or both of her parents had abused her, and she remembered, she would hate them. It was the prospect of hating her parents and losing her positive image of them that made Terry decide not to remember.

We discussed her options over several sessions and concluded that we would not do any memory work. She still wanted to come to see me just for conversation, but I declined, as I declined her suggestion that we meet occasionally for coffee. After eight or so sessions, I never saw Terry again.

I thought that Terry made the right decision. Although in theory it might have been best to launch into a full MPD treatment with a goal of memory recovery and integration, for Terry at this stage in her life, and in her personal and social situation, that would have been a bad decision. She needed to keep her denial up and her amnesia intact. She appeared to be functioning at a high level in her job, and there did not appear to be a realistic prospect for significant change in her marriage.

Although she sometimes felt suicidal, she was never close to acting on these feelings, and she was not experiencing severe posttraumatic symptoms. No alters were acting out destructively. Therefore she was right to leave well enough alone, for now and perhaps forever. Terry reminded me of another woman I treated for depression as an inpatient. This woman remembered nothing at all before age fourteen, responded fairly well to an antidepressant, and was discharged back to her family doctor for medication followup, and to her therapist for support and counselling. I advised the therapist to leave the amnesia alone for now, a plan with which the therapist was in wholehearted agreement.

This second woman was stretched beyond the limit of her coping skills by an ongoing hostile divorce, financial problems, acting out teenagers, lack of social supports, and her own fatigue. There was no way she had the energy or stamina for active memory work.

There are many reasons to leave dissociated memories alone. One person might have had several heart attacks or suffer from an untreatable cancer, end-stage obstructive lung disease, or advanced AIDS. Another might be too enmeshed in an ongoing abusive relationship, while another might be using too many street drugs too often, with all the associated trauma and danger that goes with a street life. Another might suffer from a concurrent disorder called adolescence and just not be ready to work.

Terry was the person who first taught me that it is sometimes best not to remember. This is a principle which applies intermittently for varing perods of time in all MPD therapies: it is an essential consideration in the pacing of any active uncovering therapy, whether the person has MPD, dissociative disorder not otherwise specified, or pure psychogenic amnesia.

Return to The Osiris Complex.