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TopRELIGIOUS ISSUES PROJECT BRIEFING
FR. JOSEPH MAHONEY
RELIGIOUS ISSUES PROJECT OVERVIEW
The "Religious Issues Project" seeks to develop resources to assist in working with religious issues and concerns when Multiple Personality Disorder (MPD) is present. (In DSM-IV the term was changed to "Dissociative Identity Disorder" or DID. I will continue to use the term "MPD")
This Project is based on the work that I’ve done with MPD patients at Harper Hospital in Detroit, with an MPD support group (The Rainbow), and with members of Rainbow House. It also reflects consultations with therapists from throughout the Detroit Metro area, as well as some consultations requested by therapists in other states and Canada. This project has received funding by the Archdiocese of Detroit through Rainbow House.
These written materials are for clergy, therapists, and patients. Much of what is discussed can also be used in working with other survivors of chronic abuse. These materials are focused on issues and dynamics of special religious concern.
The Religious Issues Project is continually "in process." Sections are frequently written, expanded, or revised. These materials are freely offered as an aid to the continued development of resources for MPD patients.
One serious question has been whether to develop one briefing book or several. Could the description of some dynamics actually hinder the process of therapy or be offensive to the patient? Identification of these dynamics can be used to abuse or manipulate someone with MPD. How open should I be in describing some of those dynamics? How can I most effectively honor the trust of patients who have helped to identify some of these issues? The conclusion I’ve reached is that the best route is to encourage the fullest discussion and collaboration possible.
In working on this project, my perspective is that of a Roman Catholic priest. The opinions expressed are mine, and unless clearly noted otherwise I’m the author of the different writings. Some explanations and comments may be offensive to members of other denominations. Some comments will be criticized as not representing well the theology of the Roman Catholic Church. So be it. I reserve the right to challenge, to question, to encourage discussion. The specific theology of various denominations or religions can best be explored through those religious groups. That is not the primary intent of these materials.
I would note that I refer to those with MPD as "MPD patients." That’s based on my belief in the special responsibility of professionals in working with those who are in some ways more vulnerable to manipulation, paternalism, and abuse. I encourage and will take seriously your comments and suggestions. Thank you.
I’m a Roman Catholic priest of the Archdiocese of Detroit. Ordained in 1975, my current assignment is as Consulting Chaplain with the Office of Chaplaincies of the Archdiocese.
My work with MPD patients began as part of my assignment at Harper Hospital. Working with Dr. Elliot Luby, then Chief of Psychiatry, we sought to open up additional resources and options for those with MPD. Dr. Luby established a "track" or treatment plan for those admitted with MPD, and I’ve been actively involved in providing MPD-specific treatment for in-patients. Dr. Luby made himself available for consults and assistance for patients and their out-patient therapists, as I have. Based on our experience, in 1990 I began a support group for MPD patients under Chaplaincy, called "The Rainbow." In 1992 some of those patients formed a non-profit organization called "Rainbow House" and opened a facility in November, 1992. Rainbow House is the first of its kind as an MPD "clubhouse" totally run and directed by members. Since then, other facilities have opened based on the "Rainbow House Model." I continue as an Advisor for Rainbow House, along with several other professionals.
I have done work toward the development of a "Dissociative Disorders Medical Intervention Team" to assist medical staff, nursing, and patients when major physical illness requires hospitalization. The goal was to help the patient’s medical care to be effective, appropriate, and as non-traumatic as possible by working with both the staff and the patient. To the best of my knowledge, that effort is also unique.
I’ve been asked at times why I’m interested in these patients and their welfare. That’s a fair question. At first, it was a result of a realization that referral resources were minimal and hard to locate. A choice was made to work with MPD patients, with Dr. Luby providing close professional supervision. The learning and growth he encouraged was invaluable. Everything that’s followed has been a pastoral response in a situation where discrimination, alienation, and societal denial has made recovery for these patients much more complicated and problematic than it needs to be.
On a deeper level, outside of the proud tradition of the Catholic Church and Diocesan priests of responding to unpopular causes, there is a simpler response. I hate chains, and these patients are struggling to remove the chains that others have placed in their heart and soul. I want to help that process.
I’ve also been asked whether I was abused as a child. I was not. I admit, however, that I’ve had additional help in understanding the processes of dissociation in my own life experience. Without going into detail, for most of my life I’ve had to deal with periodic intense physical pain. As a child that pain was minimized and ignored by doctors, leading to spontaneous autohypnosis to cope with that pain. That encounter with dissociation has served as a bridge, helping me in understanding the dissociative processes present for those who have been severely traumatized. In going through that pain, I’ve always had family and friends around who cared about what I was going through. I’ve also heard a lifetime of dismissing, ignorant, and unprofessional comments from those who should know better. What would life have been if support was not present? If the pain was a result of abuse? If I hadn’t been able to at least tell others about the pain? "There but for the grace of God . . ."
INTRODUCTION
It is difficult to speak clearly to both clergy and therapists. There are many religions and denominations, but there are just as many approaches to counseling and therapy and subdivisions within the mental health professions. Each group uses specialized language and concepts. In addition, those familiar with the processes of dissociation have developed additional terminology. As much as possible I will define terms when they may not be clear to either clergy or therapists.
I’ve tried to identify some spiritual and religious issues frequently important in working with those with MPD. The processes involved can be very disruptive and tend to reinforce one another.
I’ve reached some tentative conclusions, but I have far more questions and observations than conclusions. Even more than in other areas of MPD treatment, this area is in its infancy, with little reliable background literature, and few written resources.
RELIGIOUS AND EMOTIONAL HEALTH
I don’t intend to review here the theoretical literature about the relationship between mental and religious health. I do support the theory that emotional and religious health reflect one another. Significant healing in one area furthers and encourages healing in the other. Often, the same significant dynamics can be effectively addressed from either perspective using different language and techniques. Clergy and therapists need not work in isolation. Instead, a strong case can be made for collaboration in the process of healing, to the benefit of the patient. Comparable levels of skill and experience are needed for both therapists and clergy to create a truly effective collaboration.
MPD is closely linked with, and results from, situations of childhood abuse. Often the abuse that is reported was severe, long-lasting, and sadistic. Not only MPD patients but other victims of chronic abuse experience a life-long process of recovering from that trauma.
Patients often report that part of that recovery is struggling to cope with personal religious and spiritual issues. Also, many other issues reported appear to me to be closely linked to that spiritual process. There is a profound search to understand, to make some sense out of the experience of abuse. There has often been a life-long pattern of self-condemnation with a sense of worthlessness and shame. Relationships that have been formed tend to be reflections of the experience of abuse. The operative models for those relationships are those of: abuser, victim, rescuer, or bystander who denies what is occurring. Any relationship may be effected by the abuse pattern, including relationships with other people, with society, and with God.
Often the view or image of God has been heavily contaminated. The abuser may have presented bizarre or destructive religious concepts as a justification for the abuse, as a way of placing responsibility for the abuse on the child, or because of his own bizarre religious beliefs. At times the child may have been exposed to a group or cult that supported those beliefs.
With MPD, religious identity and ideation is also fragmented, with different personalities adhering to very different belief systems or struggling with very different religious issues. Quite literally, one personality can state a strong Christian identity and display a level of wisdom, faith, and compassion that can only be described as saintly. Other personalities may present as religiously primitive, without conscience, or evil. One personality may be strongly Christian, another Jewish, another a white witch, another a Satanist, another an agnostic, etc.
Personalities often appear to have difficulty in sharing new learnings or understandings with other personalities, and that holds true for religious issues as well. I‘ve been awed by the depth and wisdom of some of the observations made by specific personalities, and yet those same observations may not be of help for other personalities or may be simply ignored. It truly appears to be a situation of "A prophet is not without honor except in his native place and among his own kin and in his own house." Mark 6:4
Difficulty in internal communication (communication between the different personalities of an MPD patient) is also encountered with more simple or basic understandings. Often clergy can help by assisting in the communication process. When clergy are told of an insight or understanding that would help others in the process of healing, they can support it and help develop it further. Later, when other personalities are present, that understanding can be stated, explained, and discussed, inviting the active involvement of other personalities.
As a caution for clergy, I would note that the observation must be assessed, and not simply accepted as valid. The first step would be to "draw out" and help the patient to express what is meant in the new understanding. In other words, make sure you know what the patient is talking about. Also, recognize that what is said in these contacts is profoundly personal. As clergy, I know that many insights of MPD patients on religious issues have been so powerful that it’s hard to resist the temptation to use them in sermons and other types of public presentations. First, if there is the slightest doubt about whether it is appropriate, ask for permission. Second, disguise the insight in a way that protects the privacy of the patient. Third, take into the account the effect that the insight might have on other abused members of the congregation.
Usually in the course of treatment for MPD the level and quality of internal communication and cooperation increases. More and more personalities may be able to "listen in" to what is being said at a given time, allowing for a more broad-based consideration of a specific topic important to those personalities. That skill can be encouraged and extended to working with religious and spiritual concerns. For example, as well as working directly with child personalities, I routinely expect adult personalities to help the children by translating terms for them, by telling me of their questions, and by trying to explain things to them on their level. When I address an issue in a general discussion, I expect that personalities involved will share the discussion with others, and continue it as appropriate internally. I believe that these approaches encourage a sense of commonality and healthier internal community.
An extended example may help in explaining both the process and some of the dynamics involved.
A patient that I have worked with clinically once left a written question. A personality asked "What did Lazarus do with the rest of his life?" I have since used that question in sermons with the patient’s permission. The dialogue that follows here never happened, but it could have, and perhaps it did happen internally over time—without my help or input. (Each letter indicates a different personality.)
A: What did Lazarus do with the rest of his life?
B: Why did he do anything? Maybe it was enough just to have survived.
C: (Child) Who was Lazus?
D: (Storyteller then tells the story of Lazarus in simple terms.)
E: Maybe God’s tears were needed for Lazarus to live again. Why weren’t the tears of his family enough? Did Jesus cry on behalf of God or along with him? Are tears necessary to end death?
F: Some inside died because there was too much pain or too little hope. Some of them are around now. Why and how did they come back? Was it because of our tears? Or God’s? Or both? How can they get rid of the smell of the dead?
G: If they are back like Lazarus, why did they have to die in the first place? I begged for us before but God never listened or cared. Why should he care now? I cried. Weren’t my tears then good enough?
H: What good does it do for someone to come back if it’s just to hurt like before? It’s better to be dead than to be like they were before they died. For them to come back is just cruel.
A: Maybe Lazarus and the dead children could only come back when there were tears of love more than there were tears of fear. Maybe God was wise enough not to bring them back unless there was something for them beyond being not quite dead. Maybe it’s only cruel to bring someone back when there’s no real chance of a new life. Maybe hope has to be something more than a dream.
I: Why are all of you bothering with fairy tales about a cowardly God who hides in a corner? The truly real is death and pain and hate. The most cruel is the dream of hope. The most powerful is the God of Evil. Even if the story of Lazarus is true, it just meant that he had to face the fear of death in the first minute of coming to life. What Lazarus did with the rest of his life was fear the return of the grave. I laugh at your stupidity.
A: Perhaps to fear death so much is to never really be able to live. Perhaps Lazarus came to be able to live for the first time. More than the death of the body I fear the death of love, of innocence. I, for my part, choose to seek to live. I, for my part, choose to guard the innocence within. My prayer? "Now I lay her down to sleep. I pray God, too, her soul will keep."
In this example, if I had been able to be part of the discussion, my role as clergy would not have been to "supply answers" but to help the communication. Hopefully, I would have been reflecting on my own faith and experiences as much as the patient was reflecting on hers. I would have been careful not to defensively "pull back" from the power of the emotions being expressed. I would have been careful not to offer packaged, prepared conclusions. I would have tried to be honest enough to admit how much I don’t know. (You may want to review "Chaplaincy and MPD").
BOUNDARY ISSUES FOR THE THERAPIST
Professional and ethical stances adopted by many mental health disciplines limit the extent to which members of those disciplines can discuss clearly religious issues. There is valid concern about not complicating the treatment process or unduly influencing the patient’s religious identity. Where such discussion with a patient is seen as necessary, it can lead to an extremely careful therapist hesitantly treading in unfamiliar territory, perhaps being perceived by the patient in those circumstances as secretive or as "inauthentic."
A common exception occurs with "Christian Counselors" or others with a strong religious affiliation who are providing the central therapy. They may routinely integrate religious values into their mental health practice. I would grant that there usually is a careful disclosure of their own belief system to patients. There can still be a question of whether the therapist is primarily a proponent of a particular religious belief system or is following the traditions and "clinical wisdom" of a secular professional role. The situation of a therapist actively dealing with religious issues and concepts could be assessed as the therapist entering into an inappropriate dual role with the patient, and that is ordinarily seen as contrary to the nature of many forms of therapy.
There are special problems in the situation of MPD. With other patients, there is an ability to state the central religious identity—"I am a Christian but don’t go to church," or "I am a Baptist." In the situation of MPD, the person making the first appointment may be a Baptist, but other personalities may have radically different religious identifications or be hostile to the belief system of the therapist. Some personalities may feel that entering the therapeutic alliance at all demands an identification with the belief system of the therapist.
Parish clergy routinely have to establish many-faceted relationships with parishioners and families. Special care is needed when that includes pastoral counseling. They may in fact be in the best position to deal with religious issues while still respecting the difficult relational and developmental problems faced by MPD patients. I would note that parish clergy must be scrupulous in maintaining the confidentiality and privacy of these patients. There is little room for error in that regard.
CLERGY AS PART OF A TEAM
A team approach is one way of addressing the need for clarity in the therapy as well as the need of the MPD patient to clarify religious issues and search for meaning. Perhaps clergy could be identified who would be willing and able to be part of a referral system. They could then clearly and directly represent a specific belief system. They should have both professionally appropriate theological training as well as an extensive orientation to issues in MPD.
In my own situation, I have related to those with MPD from many different perspectives. I have been Catholic Chaplain as well as providing in-patient therapy along with the patient’s psychiatrist. I have provided some out-patient therapy as well as consulted on religious issues. I have been Advisor at Rainbow House as well as being involved in the Religious Issues Project. At times it has been a struggle to keep relationships reasonably clear with patients.
When there was a strong therapy role (as opposed to primarily a religious role) I have rarely prayed with MPD patients, even when requested. When I have prayed with MPD patients in those situations I often found out later that one or more personalities found the experience confusing, or even perceived it as a direct attack or assault. My present operating stance is not to pray unless I am completely sure how the experience will be perceived throughout the personality system. At times, otherwise legitimate specific religious requests have been made by an in-patient with the apparent intention of manipulation, staff splitting, or internal assault. Requests in those circumstances have been clearly and directly refused.
Two situations in my experience do not appear to involve the same issues of boundary or role confusion for the MPD patients I have worked with.
As a related issue in discussing the idea of professional boundaries, I am not comfortable with anyone not in a clear therapeutic role requesting personality switches. These are to me significant, serious interventions, and I believe that the number of people making such interventions should be reduced as far as possible. I am aware that some spouses, nurses, and others consider requesting personality switches to be routine. I would strongly argue against it for the following reasons:
Manipulation of personalities has frequently been reported by patients as a means of sexual or emotional abuse.
RELIGIOUS DYNAMICS IN THE UNIQUE SITUATION OF MPD
Dr. Nancy Cole’s "Theory of Traumatized Thinking" is reflected in religious ideation. Especially important is the idea that in traumatized thinking there is an absence of "conventional context." The normal background understandings and assumptions that the rest of us simply "take for granted" and don’t routinely even think about are simply not in place for the MPD patient or someone who was highly traumatized in childhood. It would be much like my talking about the beauty of a rainbow without realizing that the person I’m talking to is blind or writing about the sound of a violin without recognizing that the reader is deaf. Communications from me to an MPD patient can be hindered. Similarly, statements from the patient to me presume a grounding in the experience of chronic terror. Without my having that experience, it is easy for the impact of what they are trying to communicate to me to be lost. Without awareness of how much of a difference in understanding there is, we may make the assumption that the words that I and an MPD patient may use mean the same thing. They often don’t.
In trying to come up with an example, perhaps I could use one cited by Dr. Cole in a presentation she gave. She showed a clip from the film The Miracle Worker that depicted the first realization of Helen Keller that words had something to do with objects in the world, and that people could communicate using those words. She did not have to live isolated in her world without sound and sight. She realized for the first time that the word "water" meant the cold wet stuff pouring out of the pump in the back yard. She excitedly pumped water and made the sign for it, then ran around identifying and making signs for the other objects she found. She made contact with the "conventional context" for the first time. Without it, others couldn’t share their experience with water and she couldn’t compare it to hers. Without contact with the conventional context, she couldn’t communicate what it felt like to live her life, to be so totally dependent on touch, taste, and smell. Without a conventional context, she couldn’t attempt to relate her feelings, her thoughts, her dreams. The incident shown in the film clip was her first step in walking out of aloneness.
Traumatic thinking often is a global process, involving far more than the trauma itself and the patient’s struggle to cope with it. Instead, many of the basic concepts and understandings of life are based on the highly personalized unique trauma history of the patient. The context that is understood and presumed by the broader society is simply not available for MPD patients. To bridge the gap between the two worlds we must consciously take into account the fact that the patient does not have access to the "conventional context" that is presumed by our society to be present.
A reasonable projection of Dr. Cole’s theory would be that the personalities most involved in holding traumatic memories or strong emotions would also most clearly show the effects of traumatic thinking. However, even those most able to function and relate to the outside world still labor under a need to attempt complicated translations between the two worlds.
THE CONCEPT OF RULES
In more or less rational human societies, a rule or law is made as a way to honor or further a principle or value. In the non-MPD world, when the rule has no reason for being or in a given situation would act against the stated value or violate a higher value, the rule is labeled as irrelevant or simply ignored.
Based on a need to exert some control over the early traumatic environment, the MPD patient often describes an attempt to "learn the rules" imposed by the abuser in an attempt to lessen or deflect some of the trauma. Those rules were mysterious, with no inherent logic. They could change drastically and without warning. Some sense of security came in "knowing the rules" and sensing when change was about to occur. Stable rules, no matter how dehumanizing or abusive, often offered the only safety possible in the presence of the abuser.
The impact on religious ideation is powerful. Statements, rules, or proverbs from the Bible or statements by strong religious authority figures are taken as absolutes, without consideration of the values behind them. Without a sense of predictable consequences for the "violation" of rules, each must be treated as if it is the ultimate priority. Any rule, without warning, may in fact be a matter of life and death.
As an extension of that process, stories and descriptions of events in the Bible are taken as clues for the understanding of life. The interpretation of an MPD patient may be surprisingly different than what would be expected.
Two examples may help in understanding this process.
1. Hearing rules as absolute can be seen in the following logic. If I have MPD and I hear "Honor your father and your mother" the following conclusion may be drawn. "Hating my father for abuse and feeling rage toward him means that I am sinning. I can’t find it within myself to forgive him and love him, so that must mean that I am condemned and will go to Hell. I don’t want to go to Hell, but no matter what I do, the feelings return. I am doomed. I am evil." (That sense becomes obviously more problematic if there is also a history of abuse by the patient.)
The societal presumption is that fathers will act like fathers in fulfilling that role, including nurturing. The abused child’s perception is that fathers abuse their children, or at least are permitted to do so if they want. Other people do not seem so troubled by their relationship with their father, so there must be something wrong with the abused child. The end result is a perception that it is not the father, but the abused child who is truly guilty. Society’s at best ambivalent attitude toward victims of abuse only serves to strengthen the cognitive misperceptions.
Equal or more important biblical prohibitions are never "heard" or not applied. For example, much stronger prohibitions against incest are not applied to the abusive father. Positive values in the Bible about protecting "widows and orphans" or others seen as defenseless are not taken into account.
2. The story of Noah and his sons could provide an example of the projective process. Noah gets drunk at the first harvest after getting off the ark. Ham, his youngest son, sees him naked and tells his older brothers about it. Later, the brothers tell Noah and Noah formally curses Ham, ordering him to become a slave to his brothers. God presumably agrees with Noah.
Most of us would interpret this story as Ham having acted inappropriately and without respect for his father, robbing him of his privacy by indulging his curiosity, leading to the anger and cursing by Noah. Noah would be seen as getting accidentally drunk.
If I had MPD and was going to interpret this story, I might say that Noah got drunk and exposed himself. Ham saw it, was upset, and told his brothers about it in confidence. The brothers didn’t honor that confidence but instead told the father when he woke up. Ham was made a slave of the whole family for telling the secret.
If I had MPD and applied the story to myself and my own life, I might say that I saw my father naked when I was assaulted and tried to tell someone about it. I was seen as the one in the wrong for telling the secret and I was made the scapegoat for the whole family. Anything that went wrong after was my fault. I am also cursed by God for telling, and my father’s denial and condemnation is quite rightly him speaking for God. I am doomed.
HEARING WITHOUT CONTEXT
For someone with MPD there is often no solid framework available for organizing or considering religious concepts or ordering the bits of religious data that are encountered.
In reading the Bible it is hard to take into account the impact of culture or the use of language, or to weigh one concept by taking another into account. It is hard to connect different theological concepts rather than seeing each as independent and absolute. There is little appreciation for the role of speculation in theology, the idea of greater or less certainty in theological concepts, moral ambiguity, or factors that limit moral responsibility.
For an MPD patient, the more clear, direct, and strongly stated a religious concept is, the more attractive and compelling it will be, even if the concept becomes bizarre in the process. Serious questions honestly asked are inherently frightening. And yet, I believe that it is important for the MPD patient to begin to ask those questions as a critical part of walking away from the pattern of traumatic thinking.
The MPD patient will tend to accept a role of religious dependence on authority figures, expecting them to resolve complexity and simply state the rules to be followed, the concepts to be accepted, the statements to be believed and repeated. That is not the route of healing, and can in fact lead to them being "sitting ducks" for manipulation, for cult-like groups, for further situations of abuse.
The best response for clergy and others seeking to work with an MPD patient is to avoid religious clichés, state issues of basic context as clearly as possible, and invite as many different perspectives as possible. The asking of questions should never be discouraged.
PROCESSES OF HEALING
Two dramatic processes toward healing have been encountered as part of a team approach.
1. Unblocking. At times a key religious issue or unhealthy concept will be present. The therapist may have carefully prepared for addressing that issue, or it may come up spontaneously when there is access to clergy able to work with the patient on it.
With unblocking, an amazingly simple or short intervention can lead to the block dissolving. What follows can bring the patient increased hope and a sense that there is the possibility of healing. There may be a cognitive, affective, and behavioral reorientation, with positive changes for the personality system as a whole. There can be a sense of a row of dominoes clicking into place, often with amazing speed.
For example, there is a description in the literature of a patient who wanted to believe in God but was afraid. It turned out that one of the personalities believed that joining a Christian church would mean having to have sexual relations with God. The issue was slow to be identified because it was so far outside of the usual religious problems that clergy are used to dealing with. Once the issue was in fact identified, it was explained that God doesn’t have sexual organs and doesn’t rape children. The patient was then able to begin to see herself as "reborn" and living a new life freed from the chains of the past trauma.
At times the process is less dramatic. As a religious authority, there can be a direct challenge of a specific idea, in effect giving the person permission and freedom to abandon an unhealthy concept. A stance can be taken of "outranking" the abuser.
For example, a patient may have been told as a child in school that children must do what parents tell them. An abuser may have said that it is a sin to disobey his orders. Clergy can explain that children also have rights and that no one has the right to order another to do what is immoral or wrong. It can be explained that the nun in school never meant that literally anything ordered by a parent is OK. As the patient ponders that and applies it, new avenues of growth and healing can be opened.
Clergy can be symbolic. Acceptance by a "man of God" can challenge the patient’s trauma-based self-identification as evil or condemned. Acceptance of questions can encourage asking the secret questions of childhood.
At times, needed unblocking will simply not occur, no matter how carefully the issue is handled. There may be a sense that the patient is holding onto a destructive religious concept as a source or center of security. It may be that additional preparatory work is needed, or there may be an additional belief or fear that is complicating the process.
For example, there may be a sense that if a particular personality drops an identification as evil they will cease to exist. It may be necessary for the patient to understand and accept that each personality is "more than the job that is done or the memories that are held."
2. Supplying context. At times, providing simple data about what a religious group actually does affirm (as opposed to what was said by the abuser), or providing additional theological background can allow for reinterpretation. As times this process may involve direct contact with a traumatized personality. It may also involve supporting specific conclusions already being considered throughout the personality system.
COMPLICATING MPD DYNAMICS
1. Difficulty in separating emotion and concept. For many reasons, the MPD patient’s feelings have come to serve as a key in dealing with and understanding the world. The perception of reality can be consistently and excessively influenced by the person’s emotional state. For example: "I felt abandoned during the trauma, and therefore the truth is that God abandoned me. I feel guilty now, therefore I am guilty." My way of describing it is to say that the person is "looking at the world through abuse-colored glasses." The emotion and the conclusions that flow from it serve as the compass for the person’s view of reality. The person then looks for other data to support it.
If the patient is able to begin to consider a healthier or more balanced religious identity, that can help support the process of naming and talking about emotions. The patient can use religious ideation to reflect on the meaning of emotions that are felt. For example, "If it were true that I am not condemned by God, what would that mean about the feeling that I am worthless? Could that feeling be just a feeling, not reality at all?"
2. Hearing with four ears. Especially in public situations, clergy usually present religious concepts and challenges to growth in faith presuming denial and resistance to change by the congregation. It is as if the hearer is expected to be wrapped in insulation. To challenge for change, clergy often use overstatement and simplify what they are presenting. Without the usual insulation, the MPD patient hears not just with one ear, but with both. Based on the tendency of the MPD patient to personalize and hear rules and mandates as absolutes, there is a likelihood that what is said will be heard as much more serious and absolute than was originally stated. The person hears with "four ears" rather than with two or one.
3. Fragmented religious experience. The discontinuity of current experience (what patients call "gaps" or periods of amnesia) means that it is difficult to take what is currently said and balance it with other recent statements or learning. For example, a sermon this week about following the 10 Commandments may not be softened by a sermon last week or a sermon next week about God’s mercy and forgiveness. The more discontinuity of experience, the more difficulty in constructing a healthier, coherent pattern of religious ideation.
4. Primitive concepts and conclusions, the existential search for security and stability. In many ways the MPD patient may be locked into a core religious issue that could not be resolved in childhood. Often the same set of perceptions continues to be used in trying the address the religious issue in the present. For example, the question "Why didn’t God rescue me from the abuse?" may be supported by a view of adults as all-powerful and able to act effectively if there was only the desire to do so. "Why doesn’t God rescue me from the emotional pain of the treatment process?" may be supported by a view of adults (including the therapist) as all-powerful and able to spare me from this pain if there was only the desire to do so. There may be a continuing search for a rescuer.
5. Sense of powerlessness. The profound powerlessness experienced during times of abuse can lead to a desperate hunger for whatever sense of control can be grasped in the present. There can be a strong desire for a religious authority who "has all the answers" or who appears very powerful. The MPD patient may as a result be strongly attracted by clergy and churches displaying aspects of cult behavior. A desire to respond to the patient’s desperation may also lead clergy to unconsciously act in uncharacteristic ways, even to the extent of taking on the role of an abuser. That may be expressed by clergy encouraging extreme dependency, manipulating the patient, or even by engaging in sexual abuse. By definition I would consider any sexual activity in these circumstances sexual abuse.
6. Projection and Projective Identification. Difficult emotions, such as anger or rage, can be projected by the MPD patient toward God. To resolve a sense of emotional uncertainty, they may engage in acts that they would see as forcing God to condemn or act with anger toward them. In effect that would "prove" or validate the sense of self as condemned. The over-all image of God may be as a harsh, angry, or vengeful deity, and may have been heavily influenced by the abuser. In some unusual cases, the view of God may be so contaminated and problematic that the best suggestion may be to start to build an image of God from scratch, with some basic, uncontaminated concept to serve as an orientation point.
For example, I might suggest that the person reflect on a positive experience of beauty and peace in nature and use that as a reflection of God. Then add an image of a baby’s laughter, etc. The person can then begin to use a basic, healthy, clear image as a "touchstone" for some of the contaminated concepts.
7. Difficulty with process, ambivalence, ambiguity. Religious uncertainty and questioning can lead to a sense of existential threat. Pressure may be placed on religious figures to speak with inappropriate certainty, undercutting the process of questioning. It is important for clergy to refuse to offer artificial certainty. On the contrary, it may be very helpful for the religious figure to state and quantify the relative certainty. "I am 75% certain that ..." "I believe that X is the best approach, partly because Y would mean that ..."
8. Translation. The patient will often take what is said and translate it into the framework of their experience, distorting it beyond recognition. That translation process can act to block new thinking or reevaluation of past experience. At times it can be very helpful to indirectly introduce cognitive dissonance, rather than offering a direct challenge.
For example, in addressing Satanic beliefs, where there is a strong traumatic connection, conditioned responses, and great fear at the idea of questioning stated beliefs or principles, it may help to introduce discussion of a parallel group. It may help to talk about control dynamics using a Christian cult or the KKK as an example. As those dynamics begin to be understood, they can slowly start to be applied to the control dynamics of the abusing group. In talking about trickery in believing something not true, it may help to examine in depth the techniques of a faith healer who has used fraud. In talking about distortions of perception, it may help to examine illusions used by a stage magician. I might note that it has been important for me as a Catholic priest to acknowledge hypocrisy, injustice, etc. on the part of the Catholic Church. That models the principle that belief does not mean blind acceptance.
RELATIONSHIP WITH THE CHURCH COMMUNITY
For someone with MPD, relationships with any community can be strained, but especially so with a religious community. There is often a reported sense of being on the outside looking in, of not truly belonging. The trauma of the past as well as the existence of "the others within" can be hidden secrets that prevent truly being part of the community. There may be a tendency to view other members of the community as either idealized saints or hypocritical sinners.
The MPD patient may have increased difficulty in maintaining decisions in conscience or their own viewpoint in the face of any felt pressure toward conformity. The strong desire to belong to an identifiable group may lead to a fear of disagreement. Group expectations may be experienced as coercive.
Transference toward the present Church community may influence and confuse relationships. It may be difficult or impossible for the patient’s present Church community to address the dynamic. However, individual members or the community as a whole may unconsciously react, as a process of countertransference or projective identification, and expel or abandon the MPD patient.
A PLAN OF ACTION—MINISTRY TO THE TRAUMATIZED
Any direct involvement or work with someone who is severely traumatized must, in my opinion, be based on clear and consistent involvement.
The parish usually cannot be a counseling center. Even if some urgent or short-term counseling is available, long-term availability is usually not possible. Setting up expectations that can’t be fulfilled is destructive, especially for MPD patients.
Clergy time is usually very limited, but clergy often have a hard time saying "No" clearly and sticking to it. Most clergy would like to be supportive, but the end result of contact with an MPD patient may be a frustrated, resentful minister and a parishioner who feels abandoned.
For clergy or others representing the parish, a realistic danger is the setting up of an unhealthy dependency relationship, or a situation where there is emotional or even sexual abuse down the road. The raw intensity of emotions of an MPD patient is something that clergy can be easily swamped by. Even a feeling of pressure to "come up with an answer" can lead to a situation where harm is being done.
1. Clergy response. It is possible for clergy to increase their awareness of the dynamics of abuse and take that into account in usual parish processes. If a choice is made to go further and be available as a resource or consultant in ongoing therapy, that decision should be carefully made, with careful, ongoing review of the involvement.
There are many things that all clergy could do.
2. Parish response. There are many possibilities that could be considered.
3. Suggestions for worship/public situations. These recommendations would be appropriate standard practices for anyone with a history of trauma. There is a need in parish life for a sense of humor, a naturalness, an easy gentleness. At the same time, many situations can be experienced as radically different than intended. Perhaps at least considering these issues would help modify ministerial style where necessary. Situations that would be especially difficult may be more easily identified.
RELIGIOUS GROWTH AND DEVELOPMENT FOR PERSONS WITH MPD
I believe that it’s critically important to orient religious growth around seeking the truth. Truth must be honored, even if it hurts. I reject the idea of "finding a God that you are comfortable with" as an easy repudiation of God or the initial religious community. The greater challenge is to identify in what ways the image of God has been contaminated and then to work toward a truer image. Isn’t making God into what you want him to be the process that was often used by the abuser?
I’m also uncomfortable with a 12-step process that encourages "surrender to a Higher Power." The process is far more complex than that, and such a surrender may in fact not be a move toward healing but, at least implicitly, an invitation to denial or avoidance of the hard work of "religious decontamination."
I feel that clear decisions based on consciously held values should be encouraged, rather than the more familiar route of "following the path of the least resistance" or acting to avoid feared retaliation or rejection by others. Following conscience can be uniquely difficult when the sense of moral personhood is also fragmented, with different values, beliefs, religious ideation and identification widely different for the different personalities.
The process of religious growth and work on trauma-based religious issues should occur at roughly the same pace as the therapeutic work. Reflection on religious dynamics and understandings can pave the way for additional therapeutic movement. The key should be to not seek change "all at once" but gently, over time, in the same questioning and exploring style that is used for therapy. There should be recognition of the wide variation in dynamics for individual patients, and careful consideration of the traumatic history.