Abstract

Introduction

“Did you discuss these things you see and that you hear with your previous therapist?” — Jay Peters.

“Are you nuts? Of course I never told nobody about that. If I’d have told them I saw little fuzzy things going by the doorway, or hear my kids crying when I’m miles away, they’d have thought I was crazy for sure.” — Mary J.

Mary’s evident fear that people would think her crazy if they knew about her hallucinations is, in our experience, common for victims of childhood sexual abuse. Her fear of discovery actually masks and even greater fear — that she is crazy. In fact fear is the wrong word as Mary, and all survivors of severe trauma whom we have worked with, are convinced that they are or are becoming crazy (Ellenson, 1986). They live in a daily terror of either being found out or of “loosing it all the way” (Kluft, 1987).

Reassurance that such hallucinations are a normal part of PTSD and dissociative disorders usually produces a combination of relief and skepticism: relief that somebody knows about their experience yet does not immediately say they are crazy; and skepticism that anybody who doesn’t think they are crazy must be even crazier.

Over the years it has been our impression that people with a trauma history, especially those who regularly employed dissociation, express more fears about being or becoming crazy than do either the “worried well” or the schizophrenic clients whom we see in a variety of settings. This impression is somewhat supported by Kluft’s finding that dissociative clients endorse more Schneiderian first rank symptoms of schizophrenia than do people diagnosed as schizophrenic (1987; see also Allen & Coyne, 1995). In fact, such features as made thoughts, feelings, and acts,; thought insertion and withdrawal,; and internal voices (Kluft, 1991) are so commonly reported that Ross (1989) has proposed that they be reclassified as first rank symptoms of dissociation. This suggestion fits perfectly with our increasing conviction that fears of being or “going crazy” are so strongly correlated with trauma and dissociation that they might be pathognomonic. The current study sought to test this clinical impression.

Method

Design of the Study:

The study reported here was a preliminary, integrated quantitative and qualitative study to address the question: Do people who identify themselves as having some form of dissociative disorder refer to themselves and their experiences as “crazy” more frequently than do either people who identify themselves as schizophrenic or some representative group from the general population, such as single parents? We chose single parents as we wanted a group of people dealing a fairly high level of stress in their lives and therefore ample opportunity to feel as if they too are “going crazy.”

To assess self-reference as “crazy” in these three groups we monitored the messages they sent to specific areas of the Internet. Access to the Internet is, for most people, available through an Internet Service Provider (ISP). One of the services available through most ISPs is access to what are commonly called newsgroups. These are, in many cases, user initiated, maintained, and moderated. At present there are over 11,000 such groups available on the Internet, each focusing on a specific area of interest. The newsgroup is an electronic equivalent of a community bulletin board except in the electronic version there are different bulletin boards for people with different interests. Anyone can read, reply to, or put new messages up on the bulletin board. Busy groups might have hundreds of new messages a day while some of the less popular groups may languish with only one or two messages a day.

For this study three newsgroups were monitored (alt.support.dissociation; alt.support.schizophrenia; and alt.support.single-parent) in which the “alt” signifies that the group is unmoderated. All three of these groups are intended for individuals and their families/friends who identify themselves as dissociative, schizophrenic, or single-parents. Groups such as “alt.support.dissociation” have well codified guidelines for participation which attempt to ensure that the group is, indeed, supportive (Discord, 1997). For the most part messages are, in fact, posted by those for whom the group is intended though there are occasional intrusions of “Trolls”—people who derive satisfaction from disrupting the “traffic” of supportive messages—who post deliberately inflaming messages termed “flames.”

Procedure

Other information collected each day included, for each group, the number of people posting messages that day, the number of messages, the number of lines for all messages, the number of quoted lines, and a running total of the number of people participating in the group.

When the word crazy or a synonym was found, then the context of that hit was examined. The criteria employed were relatively simple: the writer must be referring to a self-assessment or a description of their mental processes as being “crazy.” These criteria served to eliminate hits on such obviously inappropriate entries as “I like nuts on my ice cream.” Also excluded were all the common vernacular uses of crazy such as “I worked like crazy,” “I drive like a maniac,” or “don’t make yourself crazy trying to do everything.” In addition we eliminated uses in which crazy or its synonym referred to others or to social and political institutions, e.g. “The whole world seems to have gone crazy.” In ambiguous cases eliminating the hit was preferred unless a clear self-reference could be established. Finally, we intended to weed out any hits which were written by “Trolls” but found none during the sample time.

After this weeding out process what remains are messages in which the author refers to his/her thoughts, feelings, actions, perceptions or self as “crazy.”

Findings

A summary of the findings of the study is presented in Tables 2 and 3. It is immediately apparent that, compared with the two other groups, the dissociation group had more writers who were more active each day.

Table 2.

Summary Data:

Table 3.

Summary Data:

Table 4.

Summary Data:

Table 5l.

Grouped Absolute Frequency Table:

Limitations of Data

The data which we have presented above are limited by several factors. First, there is no way to ascertain the accuracy of people’s self-identification as belonging to one or another group. We are dealing therefore with self report. One of the hits in the schizophrenia group was, in fact, made by a regular writer in the dissociative group. While no other instances of this kind of cross-over (with hits) occurred, the distinction between groups is not absolute.

Another possibly confounding factor was the relatively short duration of data collection which introduces the possibility of a contagion effect. It is entirely possible for one writer to bring up a theme which then elicits related responses from many other writers. In a large group such as the dissociation newsgroup, comprised of many people who may have been repeatedly psychiatriclly hospitalized (Putnam, 1989), the possibility of contagion is increased because of the number of people reading the messages who can be expected to resonate with such words as “crazy,” “nuts,” and “insane,” words which are culturally attached to psychiatric hospitalization.

This contagion effect was not seen, however, in the instance where a regular member of the dissociation newsgroup posted a message with the word “crazy” in the schizophrenia newsgroup. Over the remaining data collection period there were no entries in the alt.support.schizophrenia group with the word crazy. We also attempted to compensate for possible contagion effect by breaking up the sampling time with several two week intervals between month-long periods of daily data collection. Overall, contagion effect was not seen but further research, specifically designed to account for this possibility is needed.

Yet another possible confound results from the use of written materials. Because we could not “read” the non-verbal communications, we may have taken seriously some self-descriptions as “crazy” which were intended as jokes or which simply reflect common vernacular usage. A related and possibly confounding effect, suggested by one reviewer, is simply that groups naturally develop a self-referential jargon. According to this theory, the dissociation group might refer to themselves as crazy in the same way that hip young African-Americans now refer to each other as “Niger.” This objection, however, negates the psychological understanding that jokes and vernacular usages are not meaningless “noise” but rather reflect unconscious fears and self-identifications.

Discussion

The data collected from this study appear to indicate that people with trauma histories and dissociative disorders refer to themselves in their on-line writing as “crazy” twice as often as people who identify themselves as schizophrenic and ten times as often as people coping with considerable stress in their daily lives. While this very limited study casts no light on the causes of the noted differences, other research, combined with our understanding of the nature of dissociative processes provide us with some clues which, in turn indicate areas for further study.

People with trauma histories may think the are or are going crazy because they universally experience transient visual, auditory, or tactile hallucinations. Gerald Ellenson found a perfect correlation between histories of sexual abuse and clients who report such hallucinations (Ellenson, 1986), a finding which has been confirmed by this and other clinicians familiar with Ellenson's work. Put briefly, trauma survivors, of whom people with dissociative disorders are a subset, may think they are crazy because they experience symptoms which, in our society, are commonly associated with schizophrenia: They have "crazy" symptoms.

This does not explain, however why people with dissociative disorders might describe themselves as "crazy" more than people with schizophrenia. This, we believe, is related to the nature of and internal experience of each disorder. In dissociation it is quite common for the individual to report simultaneous levels of awareness. The rape victim reports the depersonalization as an ongoing process: "Then I floated out of my body and hovered in a corner while he did those terrible things to her." Bandler and Grinder, in their work with phobias, often use up to three levels of dissociation, instructing the person they are working with to dissociate from the trauma, and then, form that position, dissociate again so that you may watch yourself watching yourself… (1979). In these and countless other examples, an observing portion of the ego watches the dissociative process. Watkins and Watkins (1990) have suggested that the "Hidden Observer" first postulated by Hilgard (1986) is, in fact observing in all instances of dissociation. People who employ dissociative defenses are therefore often aware of functioning simultaneously on different levels of consciousness. They are, in essence, aware of the failure of the ego to integrate experience. This takes us back to the reigning definition of dissociation, the failure of the normally integrative function of the ego (American Psychiatric Association, 1994). The failure and post hoc evidence of it (“You looked like you where somewhere else”) is bad enough. Being aware of the failure, like watching, in slow motion, as your car skids off the road, leads people to the conclusion "I'm cracking up." The failure, taken together with the often undisclosed history of hallucinations, may lead the individual to the inescapable conclusion, "No, I'm not cracking up, I'm already there, I'm crazy."

A final factor to be considered is the shaping influence of chronic disconfirmation of the victim’s reality during and subsequent to the abuse. Not only is the immediate reality of pain and loss frequently disconfirmed by the abuser (who attempts to “reframe” them as love and connection) but subsequent denial of the abuse disconfirms the survivors entire reality. This disconfirmation of reality often leads the survivor to question their perceptions and, ultimately, their mental capacity (Davies & Frawley, 1994). They decide they must be crazy, a conclusion which is often directly supported by the abuser and by family members who, if they choose not to believe the survivor, often call him or her “crazy” for “making up such stories.”

Taken together these three forces may potentiate each other, leading the survivor inexorably to the conclusion: “I must be crazy.” This conclusion may then “leak out” in everyday language in self-reference as “crazy.”

Summary

In this study we began with the clinical experience that people with trauma histories and dissociative disorders referred to themselves and their mental processes as “crazy” much more frequently than any other group of people we worked with, even those whom society has called “crazy” for centuries—people with schizophrenia. We sought to confirm this impression by counting the occurrences of the word “crazy” or any of 21 synonyms in the messages which people who identified themselves as either dissociative or schizophrenic posted to respective electronic support groups. Our clinical impression was clearly supported as people in the dissociative group referred to themselves as “crazy” twice as often as did writers in the schizophrenic group.

References