De dónde viene el término «Sistema» en el TID. Referencias

Hay justo ahora en Twitter un hashtag que dice #NoSoyUnSistema. Entre varias cosas mencionadas, hay un grupo de gente que parece molesta por varias cosas que se han creado en el movimiento de visibilidad del TID, particularmente Youtube.

Uno de los argumentos es que la palabra «Sistema» fue creado por un grupo en Tumblr, «romantiza el trastorno», y que las personas con TID «no funcionan como sistemas ni de forma organizada», y alegan que «se está desinformando».

La comunidad de TID en Youtube no pretende romantizar el trastorno, sino alejarlo de los mitos del cine.

El esfuerzo para la visibilidad del TID no es un «juego de rol». Quienes participamos activamente en la comunidad estamos en tratamiento, nos educamos, nos respetamos y nos apoyamos.

Vamos a revisar el uso del término «sistema«.

Nos dimos a la tarea educativa de encontrar en nuestro material (que por supuesto hemos leído) referencias del uso de la palabra sistema en referencia al conjunto de identidades/alters/estados/personalidades/partes disociadas:. Esto encontramos:

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Recognizing that (1) alters vary in their complexity and elaboration, and (2) different persons’ systems or complexes of alters have different styles of operation.
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Traducción:
Reconociendo que (1) los alters varían en su complejidad y elaboración, y (2) los sistemas o complejos de alters de diferentes personas tienen diferentes estilos de operación,

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Yet DID patients often will acknowledge that their personality systems are actively switching and/ or far more active than it would appear on the surface (Loewenstein et al., 1987).

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I am allowing myself to hope that Mariska’s personality system and, therefore, she, will be more readily accessible than in most DID patients.

Paul F. Dell. Dissociation and the Dissociative Disorders (p. 609). Taylor and Francis. Kindle Edition.

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First, thanks to Mazey, the ageless brown-skinned guardian of our system, for all the guidance and love she’s given me in my quest for recovery and wholeness. Countless times Mazey held the system together when | was no longer able.

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While my outside world has been lonely and empty, relationships developed among some of my parts, forming a «system» of alter personalities. Each new painful experience created new parts more real than the people | knew outside of me. Personalities were forced into being — some exploded into my life. Each has a name and specific job, and some have missions. Having a reason for existing is how we cope.

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• Dissociation is a creative way of keeping the unacceptable out of sight. • It is a way for the DID internal system to protect secrets and continually learn to adapt to the environment.

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Also, the dissociative personality system is usually set up to avoid detection.

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Alters who are in place to protect the system are going to be very careful about not letting the therapist get too close initially.

Haddock, Deborah Bray. The Dissociative Identity Disorder Sourcebook (Sourcebooks) . McGraw-Hill Education. Kindle Edition. (p. 83) 2001

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Keep the whole system in mind. When we explore the internal system of parts, we must think of the whole picture and try to include all parts and voices.

Mosquera, Dolores. Working with Voices and Dissociative Parts. A trauma-informed approach

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Al pasar el tiempo, ir acumulando más experiencias negativativas y sentirse rechazadas por el resto del sistema, acaban funcionando como persecutorias. El paciente describe sintomáticamente esto como fenómenos de influencia (siente que una parte de él o algo ajeno a él le impone pensamientos, sentimientos o acciones), alucinaciones o pensamientos obsesivos.

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Si esta introyección corresponde a un abusador, acabará constituyendo una parte persecutoria en el sistema. A veces el paciente llega a estar realmente convencido de que esa parte de su mente es realmente el abusador.

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Se refuerza aquí la función protectora de esta parte que la asusta, tratando de ayudar a la paciente a entender mejor la estructura de su sistema interno.

Anabel González;Dolores Mosquera. Trastorno de identidad disociativo o personalidad múltiple (Psicología) (Spanish Edition) (p. 100)

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System. The structure of relationships within the internal world of an individual who has MPD… It is often helpful for a person with MPD to make a map or diragram of his/her internal personality system

M. Cohen, Barry. Giller, Esther. W. Lynn et al. Multiple Personality Disorder from the Inside Out. (1993) (p. 228)

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…have them help heal the distressed parts, and bring choice and conscious control to the whole of each client’s system.

Shapiro, Robin. Easy Ego State Interventions. Strategies for working with parts. (p. 29) (2016)

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Just as each individual responds to trauma differently, we would expect each client’s structurally dissociated personality system to be unique.

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The «decoding» of parts activity outside the normal life self’s consciousness is an extremely important focus of DID treatment that should never be conducted judgmentally, without empathy for the parts in question. And it helps the client become familiar with his or her own system –

Fisher, Janina. Healing the Fragmented Selves of Trauma Survivors. Overcoming Internal Self-Alienation. (p. 26)

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Mi extraordinario sistema de partes me había ayudado a desarrollarme como persona, a tener amistadoes y a destacarme en la escuela y en los deportes.

Trujillo, Olga R. La Suma de mis partes. Testimonio de una sobreviviente de trastorno de identidad disociativa. (p. 221)

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Again, traumatized inner systems are delicate ecologies. Just like with external ecologies, changes in one aspect can have unforeseen consequences. This is far less likely, however, if you think in terms of systems—then the consequences often can be foreseen and preempted or dealt with from Self.

Of course, this map doesn’t just apply to inner systems. It has been used effectively to understand and work with families and corporations, and I believe it applies to human systems at any level. Systems of parts and people tend to polarize, form protective alliances, and exclude or cut off from each other whenever they are traumatized and lack effective leadership.

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I learned many years ago the importance of respecting protectors and their right to protect the system and to not be pushed out of the way. Burdened inner systems are sensitive environments and we need to approach and visit them accordingly. Your protectors have spent a lifetime trying to keep you (and everyone else) away from your exiles, so they need to be consulted first and convinced that there is a good reason to let you go there. We don’t go to exiles without permission from protectors.

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Parts that are «out» may be entirely unaware of the other parts of the system.

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The first step in this collaboration is to assure the internal system that all parts are welcome and that all of them – even those who are suicidal or destructive – were formed in an attempt the self-system, no matter how much they now seem to threaten it.

Van Der Kolk, Bessel. The Body Keeps the Score. Brain, Mind, and Body in the Healing of Trauma. (p.284-285) (2014)

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Switch is eight years old. He held incredible rage for being abused, but he also felt a powerful allegiance to one of our abusers and turned that rage toward me and some of the others. Switch harmed my body many times. He is not so angry anymore, and he has been accepted by everyone in the system. Switch has his own sheriff’s badge now, which he likes to wear around. He is a member of the core group.

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Arly folded her hands. “It’s a long haul,” she said, “but people do recover from this. In some cases, eventually there’s a full integration of all of the personalities into one, and in other cases, where the personalities prefer to stay separate, they can work toward achieving cooperation so the whole system can function relatively smoothly in the world. Either way, like I said, it’s a long haul.”

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For me, the point of therapy is for our clients to become happy, functional, and relatable people. The point of ego state therapy is to find internal resources, bring them to the front of consciousness, enhance them, have them help heal the distressed parts, and bring choice and conscious control to the whole of each client’s system.

Shapiro, R. (2016). Easy ego state interventions: Strategies for working with parts. W W Norton & Co.

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Una vez que se han identificado las partes disociativas es recomendable que el terapeuta realice lo que se conoce como mapeo del sistema (Putnam, 1989)

Baita, Sandra. Rompecabezas. Una guía introductoria al trauma y la disociación en la infancia. (p.222) (2015)

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In this drawing, Dalma showed her complete internal dissociative system to me. She said, “Nada is really angry, she’s mad at Daddy, she doesn’t want to take a bath with him. Mary is the older one, she’s older like a grandma, she’s 89, Lily is the best, she’s really good, not like Nada, she’s the worst. Daddy used to touch Debora’s private parts in a room, and Dalma saw this, Beatriz too.” As she referred to Dalma in the third person, I assumed that there might be another part talking, so I asked who was the one talking? She skipped the question and kept saying: “Debora said, ‘Please don’t do this anymore,’ and Daddy would say ‘I won’t, I promise, can you forgive me?’ And Debora always forgave him.”

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The most important thing for the clinician to understand is that, without an adequate identification of the personality system (Silberg, 1998), you will only work partially, with only one aspect (feeling, memory, sensation) of the whole experience, and you will not be able to progress into any trauma resolution.

Wieland, S.. (2015). Dissociation in Traumatized Children and Adolescents: Theory and Clinical Interventions: Second Edition. 10.4324/9781315740430.

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Perhaps because we were speaking about a single topic, searching for a coherent conclusion, our deliberations seemed more organized. That was remarkably new in an MPD system that had always been as fragmented and fractious in its conversations as in its personalities.

Oxnam, Robert. B. A Fractured Mind. My life with multiple personality Disorder. (2006)

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Mapping the personality system

The idea of mapping the personality system of MPD patients is not new; both Morton Prince (1909a) and Walter Franklin Prince (1917) published diagrams of their understanding of how alter personalities of their patients fit together. Bennet Braun (1986) has expanded the idea of mapping into a useful therapeutic technique.

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The form of the map also provides information about the personality system’s internal metaphor, which can be used in working with the system.

Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. Guilford Press.

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Como ya hemos indicado anteriormente, la personalidad de todo el mundo es un sistema dinámico complejo que, como todos los sistemas, conlleva continuas acciones y reacciones, en las que partes de dicho sistema interactúan para mejor o para peor.

Boon, Suzette/Steele, Kathy/Van der Hart, Onno. Vivir con disociación traumática (Biblioteca de Psicología) (Spanish Edition) . Dessclée De Brouwer. (p. 56)

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SYSTEM pictures depict an array of individual elements forming and working as a unit that represents the current internal organization of parts-selves.

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The therapist working with MPD must always work within the system of alter personalities to effect change. «System» refers to the interrelation among alter personalities and other parts who inhabit the inner world of the MPD client and who usually function on her behalf. Just as any organization, members may work well together at certain points in time, and not at others.

Cohen, Barry M. Thayer Cox, Carol. Telling Without Talking. Art as a window into the world of multiple personality. (p. 21) (1995)

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Systems can have any number of alter personalities, from two to a great many. Generally, it is believed that the earlier the trauma occurs, the more extreme the trauma is, and the longer time during which it occurs directly bear upon the number of resulting parts. The kind and amount of support one receives at the time of the trauma, as well as afterward, can also make a difference.

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The System Map is like an internal family tree, though it can be drawn out in whatever format, in whatever way is easy for the System to understand. It will contain and illustrate information such as who split off from whom and how you all relate to each other. As you become more aware of your System over time, your System Map may grow as you encounter newly discovered parts.

A.T.W.. Got Parts? An Insider’s Guide to Managing Life Successfully with Dissociative Identity Disorder (New Horizons in Therapy Book 1) . Modern History Press. (2005)

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Although they may be harder to understand, these latter ego states are often the protectors of the system, because protecting the system, which seems ludicrous to an outsider, gives consistency to their inner world.

Hunter, Marlene E. Understanding Dissociative Disorders: A Guide for Family Physicians and Healthcare Workers. (2009) (p. 14)

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The goal is not to achieve a fusion – any results will be transient. Instead, it changes the characteristics of the alter system for a brief period of time, during which the patient may become more accessible to other interventions.

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A Fifth pathway might be termed a «brokered departure». In such cases, an alter’s ceasing to be separate is virtually negotiated within the alter system. Such alters may report or be reported to have joined with one or several alters in a planful way.

Kluft, Richard P, M.D., Fine, Catherine G., Ph.D. Clinical Perspectives on Multiple Personality Disorder. (p. 121) (1993)

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El terapeuta que se acerca a sus primeros casos de TID corre el peligro de pasar a ser un elemento más del sistema de partes del paciente, cronificándolo más que ayudando a su evolución hacia sistemas mentales más adaptativos.

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Todo el sistema interno del paciente ha de asumir la responsabilidad. El modo en que esto es manejado por el individuo está muchas veces conectado con la responsabilidad negada o puesta en otros de las figuras relevantes en la infancia del sujeto.

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Cuando existen barreras muy marcadas entre los estados mentales, este proceso ha de ir acompañado, de modo paralelo, de un trabajo con el sistema interno, como describíamos en el capítulo del trabajo con partes.

González, Anabel. Trastornos Disociativos. Diagnóstico y Tratamiento. Ediciones Pléyades. S.A. (2010) (p. 237)

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Any increase in symtoms, reduction in function, or series of crises for no apparent reason, is a red flag. What is going on? The answer could be: ongoing trauma or conflict in the present; some internal system conflict; host resistance; or the therapy going too fast.

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In order to treat flashbacks in DID, it is essential to understand the system conflicts and dynamics that are driving them.

Ross, Colin A. M.D. Treatment of Dissociative Identity Disorder. Techniques and Strategies for Stabilization. (2018)

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If inner conflicts are minimized, DID alters can learn to cooperate like a well-coordinated soccer team; where all the players work together for a common goal. Each member of a soccer team has a particular position, using a specific skill set. This is directly analogous to a cooperating DID system.

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Most of the alters were just too young for me to employ these techniques. Eventually, I found that the most appropriate approach for Joan was to just talk to the alters, and work with what arose on an ad hoc basis. I let the system decide, in its internally assessed order of urgency, who and what needed to be dealt with during each session.

Yeung, David. Engaging Multiple Personalities. Volume 1. Contextual Case Histories. (2014) Preface.

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In much the same way, dissociative clients can only start to talk about the untellable when the inner system is co-operating and the therapeutic environment is sufficiently contained.

Taylor and Francis. Editors. George F. Rhoades, Jr. PhD. Vedat Sar. MD. Trauma and Dissociation in a Cross-Cultural Perspective (pp. 310-311) (2006)

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Also, since Claire’s letter, Karen is becoming more aware of and familiar with her split-up internal system and I can now talk to her about it.

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Although she feels there are other parts inside her that are more capable of talking to me, I regard Karen 3 as the person I’m talking to and treating. But I really have no basis for regarding her as any more dominant or primary than any other part in her system.

Baer, Richard. Switching Time. A Doctor’s Harrowing Story of Treating a Woman with 17 personalities. (2007)

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The alter stated that she had rung up the service herself to express this and that staff had asked the host and not her to contact them. The participant described the experience as follows:

My perspective on it was that if they want to treat me, they’ve got to treat all the others as well because… if they’re saying… to some of them, “No you can’t talk,” to me that makes the whole situation worse. You’re just fighting against… the whole system. You’re not bringing them all together… I think you’ve gotta talk to the others to make that happen and if you’re only just talking to me, what’s gonna happen when I leave that hospital for treatment?… I kept thinking yeah I can just see it. They’re [alters] gonna get angry, they’re gonna start doing this, that and the other and fighting against it. What’s the point in that? (P2)

Jessica Floris & Susan McPherson (2015) Fighting the Whole System: Dissociative Identity Disorder, Labeling Theory, and Iatrogenic Doubting, Journal of Trauma & Dissociation, 16:4, 476-493, DOI: 10.1080/15299732.2014.990075

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One might ask why a patient who utilizes the mechanisms of splitting develops the characteristics of multiple personality rather than a borderline or narcissistic personality. This question remains problematic. Greaves (1980) attempts an explanation by suggesting that «.. .. alter selves, though woefully incomplete as personality systems, may nevertheless represent a level of ego organization which is higher than that of borderline personality. It is this feature which allows the alter selves to age, acquire experience and assume additional degrees of identity.»

Weiss M, Sutton PJ, Utecht AJ. Multiple personality in a 10-year-old girl. J Am Acad Child Psychiatry. 1985 Jul;24(4):495-501. doi: 10.1016/s0002-7138(09)60571-9. PMID: 4019981.

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Este enfoque permite a los estados de ego tener un verdadero cambio con el terapeuta. Durante el tratamiento, se estimula a cada estado a contar sus propias experiencias dentro del sistema, y se le reconoce su participación.

Hunter. E. Marlene. MD. FCFP(C) Canadá. Manual Médico Para el Personal Cubano de La Salud Sobre Trastornos Disociativos

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System. This is the word we use to refer to all of the different personalities in a person with DID. This includes the one who lives out front in the world, the ones who only come out sometimes, and the ones who never come out and only live inside.

Alderman, Tracy. Ph.D. Marshall, Karen, L.C.S.W. Amongst Ourselves. A Self-Help Guide to Living with Dissociative Identity Disorder. (1998) (p. 13)

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In this textbook he emphasized a treatment that involves intensive interaction with all the alters in a personality system. (Refiriéndose a Frank Putnam)

Hacking, Ian. Rewriting the Soul. Multiple personality and the sciences of memory. (p. 18) (1995)

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Se trata de una forma creativa de mantener aquello que es inaceptable fuera de la conciencia. Ayuda el sistema disociativo (TDI) a proteger sus secretos y adaptarse continuamente al medio ambiente.

Carvalho, Esly. Ph.D. Sanando la Pandilla que Vive Adentro: Como el EMDR puede sanar nuestros roles internos (Spanish Edition) (p. 35). Unknown. Kindle Edition. 2012. 2013

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The alter Chrissy needed to learn boundaries. Based on Christine’s presentation in therapy, I identified her as the primary personality and kept that position throughout our work with her “system.”

Pattillo, Christine. I Am WE: My Life with Multiple Personalities. Christine Pattillo LLC. Kindle Edition. (2014)

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When alters share a degree of mutual awareness of one another, they may understand themselves to have all manner of relationships with one another. For example, certain parts often care for or try to protect scared child parts. In addition, life experiences may be recapitulated in the alter system; for example, an alter based on an abuser may see itself entitled to hurt alters based on the patient’s experiences of being unable to prevent or interrupt victimization by the abuser or abusers.

The alter system frequently replicates the DID patient’s experience of the relationships and circumstances that prevailed in his or her family of origin. An ‘‘inner world’’ is commonly developed in which the alters interact. It is common that some alters active in the inner world may never assume executive control of the patient as the patient interacts with external others and may never manifest themselves in therapy unless they are sought out. Furthermore, events in this inner world constitute a ‘‘third reality’’ to the patient and may be experienced as just as real as events that take place in external reality [27].

Kluft RP. Dealing with alters: a pragmatic clinical perspective. Psychiatr Clin North Am. 2006 Mar;29(1):281-304, xii. doi: 10.1016/j.psc.2005.10.010. PMID: 16530598.

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Again, their system operated democratically despite the tension and hostility among them.

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But Lauren was too frightened to do anything, and her internal system was stalemated. She came to the next session blaming everyone from God on down for her misfortunes. I could hardly blame her.

Mayer, Robert. Through Divided Minds. Probing the mysteries of multiple personalities. -A Doctor’s Story. (1988) (p. 81)

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It may again be that a dissociated system falls into the subconscious, and keeps on repeating itself in the form of independent states, but vaguely connected with the principal personality.

Boris Sidis, M.A. PhD. M.D. (Harvard) and Simon P. Goodhart, Ph.B.. (Yale) M.D. Multiple personality. An Experimental investigation into the nature of human individuality. D. Appleton and Company. 1919 (p. 56)

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Clinicians working with DID patients generally must hold the whole person (i.e., system of alternate identities) responsible for the behavior of any or all of the constituent identities, even in the presence of amnesia or the sense of lack of control or agency over behavior (see Radden, 1996).

Journal of Trauma & Dissociation. International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. 2011

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As part of the emphasis on safety and self-management, the clinician will commonly develop “safety agreements” with the patient’s alternate identity system to provide a structure for the patient to reduce unsafe behaviors.

Journal of Trauma & Dissociation. International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. 2011

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Disclosures and requests for help by one part of the system, without the agreement of other parts, are likely to generate internal civil war. This may be particularly intense if there is an idea that the therapist would favour fusion of personalities or abolition of certain troublesome personalities. This would be equivalent to an external agency taking sides in a conflict within a country.

One point that cannot be emphasised too highly is that for many patients a multiple personality system has been established as a means of surviving. To threaten this system may be experienced as a threat of death. In this way the therapist may be perceived as utterly dangerous, either through malevolence or ignorance. Nevertheless, the fact that the patient is presenting for treatment at all means that in some respects the system created for defence is breaking down, and this creates the motive for therapy.

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Even so, we did work fast and effectively. Introductions were made, fears were laid to rest and integration proceeded smoothly. While our relationship was brief and her final integration unusual (in that I was very new to her life and system), her story in many ways was not unusual at all. At the heart of it was a deep sense of shame. A shame of such monumental proportions that it must be hidden. Secrets of shameful events were guarded and kept under wraps.

Peterson Crawford, Leah. Not Otherwise Specified: a multiple life in one body, 15 year anniversary edition. Edición de Kindle.

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This was not about integration as defined by the mental health professional or in the professional literature. The women were referring to a conscious connection, respect, and cooperation within themselves as it happened within their therapy and then generalized to other relationships. They chose to retain their internal systems, adjusting the internal relationships to maintain adaptive functioning in their lives.

Green, PhD, LCMHC, MA, NCC, DCC,, Elizabeth. Our Voices: Six Women With Multiple Personalities Talk About Life and Relationships in Their Midlife (pp. 44-45). Edición de Kindle.

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Part 3 is about using a whole system approach to the client, seeing parts of them as parts of the whole client that require help to move towards gradual integration. The key to this, the authors propose, is through recognising and embracing resistance in all its forms and working with this, so that the various phobias of inner experience, parts, memories, attachment and loss, and healthy change and risk-taking can be gradually faced.

Treating Trauma-Related Dissociation: A practical, integrative approach (1st edn) (Norton Series on Interpersonal Neurobiology) Kathy Steele, Suzette Boon, Onno Van Der Hart W.W. Norton & Company, 2017). Reviewed by Louise Hamilton & Stuart Mitchell

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Análisis funcional de la fobia a las partes disociativas

El terapeuta debe haber hecho ya un análisis funcional inicial del sistema de la personalidad del paciente y sus diversos subsistemas (partes disociativas; véase el capítulo 11). La selección de las interventions apropiadas requiere un análisis funcional continuo de las relaciones dinámicas entre las partes disociativas dentro de la persona como un todo, de lo que inhibe o activa las partes disociativas, y de lo que ayudará a los sistemas de acción a volverse más coherentes y coordinados. La bibliografía sobre el TDI [trastorno disociativo de la identidad] a veces define este proceso como una “cartografía” del sistema de la personalidad del paciente (Fine, 1999; Kluft, 1999; Sachs & Peterson, 1996), lo que también puede aplicarse a la disociación estructural secundaria.

Van der Hart, O., Nijenhuis, E. R. S., Steele, K., van der Hart, O., & Ruiz, F. C. (2011). El yo atormentado: La disociación estructural y el tratamiento de la traumatización crónica. Desclée De Brouwer.

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According to this perspective, in the treatment of Sandy, all the “alters” were my patient(s). It followed that I would need to have a relationship with all of them, to the degree possible, and treat them as equals within the system. “They” would ultimately determine whether or to what extent integration would occur, not the therapist and the “host” personality. Putnam warns (1989), “Before a therapist performs a partial or final fusion, the therapist should try to determine whether the alters are ready for such a fusion” (p. 306).

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When therapists began working with dissociative persons, the explicit goal was generally integration or fusion, a term that was used to mean fusing all the insiders into one person. This was usually conducted through a ceremony that joined the entire system or major parts, and was artificially induced by therapist-directed hypnosis. It often did not work, or created more problems than it solved.

Definitivamente, no en Tumblr

El lenguaje que decida usar un paciente es importante. Los alters no suelen querer llamarse a sí mismos «alters». Y no es obligatorio llamarse «sistema«. Eso lo entendemos y es importante no forzar a una persona a usar un término con el que no se identifica. Pero el término «sistema» no fue inventado en Tumblr (lanzado en el 2007, encontramos citas de 1919), sino que es usado por los autores más reconocidos de Trauma y Disociación en la actualidad y en el pasado.

Fotos y screenshots de algunos textos citados.

No es necesario usar el término sistema para uno mismo. Pero se usa en la comunidad científica.

La mayoría de personas con TID (sistemas, múltiples, plurales, personas que viven con TID, pacientes de disociación compleja) en esta comunidad pasamos la mayor parte de nuestros días en la defensa del reconocimiento del TID como un trastorno real, un trastorno que dificulta el funcionamiento, que no necesariamente te hace un asesino, que hay esperanza de tener una vida satisfactoria, que existen estudios, que hay gente que te cree y que te apoya.

Creemos en la sana discusión científica y fundamentada, y no condonamos ad hominems o amenazas.

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Otras referencias

• Comunicación
• Alters no-humanos
• Fusión y unificación
• Coconsciencia