The Myth of Sanity: Divided Consciousness and the Promise of Awareness by Martha Stout

From the Publisher

Why does a gifted psychiatrist suddenly begin to torment his own beloved wife? How can a ninety-pound woman carry a massive air conditioner to the second floor of her home, install it in a window unassisted, and then not remember how it got there? Why would a brilliant feminist law student ask her fiancé to treat her like a helpless little girl? How can an ordinary, violence-fearing businessman once have been a gun-packing vigilante prowling the crime districts for a fight?

A startling new study in human consciousness, The Myth of Sanity is a landmark book about forgotten trauma, dissociated mental states, and multiple personality in everyday life. In its groundbreaking analysis of childhood trauma and dissociation and their far-reaching implications in adult life, it reveals that moderate dissociation is a normal mental reaction to pain and that even the most extreme dissociative reaction-multiple personality-is more common than we think. Through astonishing stories of people whose lives have been shattered by trauma and then remade, The Myth of Sanity shows us how to recognize these altered mental states in friends and family, even in ourselves.

"We only think we're sane, says this Harvard psychologist. . . . The befuddled, normally sane masses can learn a lot from the victims of grave psychological abuse." (The Dallas Morning News)

Publishers Weekly

Stout, a clinical psychiatrist at Massachusetts General Hospital and an instructor at Harvard Medical School, writes here about her experiences working with abuse survivors who exhibit dissociative behavior--blacking out, losing time, even developing "alters" or multiple personalities. Engaging in the fashionable practice of analyzing psychiatric disorders in terms of the culture at large, Stout claims that in our repeated exposure to media violence, we have become a "shell-shocked species." In other words, the everyday experiences of distraction and escape ("spacing out" during a meeting, losing oneself in a movie) are not that different--in terms of physiology and behavior--from an abused individual's experiences of dissociation and hypnotic trance, which she illustrates through fascinating accounts of her patients' lives, such as the boy who witnesses his brother being kicked to death by a sexually abusive uncle and the girl whose mother threatens, during a terrifying game of hide and seek, to cut off her thumbs. Stout describes dissociative experiences in compassionate and moving prose ("Julia did not remember her childhood because she was not present for it"; "Garrett's childhood was too terrifying for any child to survive... he became several children, and these children divvied up the horror, and made it survivable"). However, readers may be surprised to find that, title aside, this engaging book never delivers on its initial promise to show us how dissociative individuals have harnessed a particular ability to live life to its fullest; most of the people here seem pretty happy just to have survived. Agent, Susan Lee Cohen. (Feb.) Copyright 2001 Cahners Business Information.

Library Journal

Such films and books as The Three Faces of Eve and Sybil have made the phenomenon of multiple personality disorder familiar. This condition, which is now known as Dissociative Identity Disorder, is more common and less flamboyant than its portrayals in the media. In its less severe form, argues Stout (psychology, Harvard Medical Sch.), sufferers may just seem absentminded or emotionally distant. Moreover, the kind of childhood trauma that causes such dissociation can be caused by "life events" such as accidents or surgery as well as by ongoing parental abuse. As is often the case with books written by therapists, it is impossible to tell how common such a condition may be, and the reader is left with the suspicion that the author is generalizing from a few patients. However, as this particular title is well written, the topic is of perennial interest, and this is the only discussion of the less-exaggerated forms of the disorder written for the lay reader, this book is recommended for all but the smallest public libraries. Mary Ann Hughes, Neill P.L., Pullman, WA Copyright 2001 Cahners Business Information.

Product Details

• Table of Contents
• Read a Sample Chapter

Table of Contents

Read a Sample Chapter

Chapter One

Old Souls

How does one kill fear, I wonder? How do you shoot a spectre through the heart, slash off its spectral head, take it by the spectral throat?

—Joseph Conrad

We are all a little crazy.

     In listening to my patients tell me thousands of stories about the past, as they try to find some peace in the present, I have learned this beyond the shadow of a doubt. Rather than behaving sanely, rather than being in touch with our present realities, we human beings—all of us, myself included—are too often simply run by losses and hardships long gone by, and by our stockpiled fears. Our collective history, our individual lives, our very minds, bear unmistakable testimony.

     Instead of receding harmlessly into the past, the darkest, most frightening events of childhood and adolescence gain power and authority as we grow older. The memory of these events causes us to depart from ourselves, psychologically speaking, or to separate one part of our awareness from the others. What we conceive of as an unbroken thread of consciousness is instead quite often a train of discontinuous fragments. Our awareness is divided. And much more commonly than we know, even our personalities are fragmented—disorganized team efforts trying to cope with the past—rather than the sane, unified wholes we anticipate in ourselves and in other people.

     Is this our unalterable destiny as human beings, or are there some authentic solutions?

     Inmy capacity as a therapist for trauma survivors, I have spent twenty years listening to people's stories, to the recounting of experiences so nightmarish, so abusive, and so abhorrent that one might well wish never to have known about them. Then it has been my privilege to know these same people as they recovered from their past experiences, and learned how to live in the present. And I believe that their stories contain meaningful lessons in how to leave behind some of our own long-ago terrors. There are possible solutions that come as gifts to the rest of us from the old souls, the exceptional survivors.

     I began my practice by specializing in the treatment of people suffering from medically threatening anorexia and intractable depressive disorders. Also, for better or not, I developed a professional reputation as someone willing to take on individuals who were on the edge, patients whose potential for suicide or other self-destructive behavior had placed them at high risk. Gradually, I began to notice that, too consistently to be ignored, most of the people I was treating were survivors of extreme psychological trauma, and that their symptoms tended to match the phenomenon of post-traumatic stress disorder just as closely as the more traditional diagnoses.

     Sometimes I think of my lifework as overall lessons learned, themes, discoveries. But much more instructively and frequently, I think in terms of the individual human beings whom my profession has brought to me. On a certain level, I feel tied to many of these people with a knot so tight that I readily understand the appeal of notions such as fate, or even karma.

     I believe I was drawn to them for their fire. The honest, purposeful self-examination of a traumatized life creates a heat so exquisite that it burns away the usual appeasements, self-deceptions, and defenses. "What is the meaning of this life?" becomes a very personal question, and demands an answer. Some of the people I have known have burned so fiercely that they have gone all-stop, have quit their jobs, even endured temporary poverty, because answering the question consumed more energy than can reasonably be generated by a solitary individual. There is something electric in the eyes, a little wild.

     But paradoxically—and yet, I think, for all the same reasons—these same people often reveal an irresistible sense of humor, an ironic angle on life that has dispensed with the polite and the guarded, and that tends to get right to the core of things. And so, though it may sound odd, when I am with my patients, I laugh out loud a lot.

     Many trauma patients are detached and objective when they speak of extraordinary events, such as the particulars of failed suicide attempts, that most other people, if they speak of such matters at all, tend to cushion with lengthy introductions and euphemisms. As I listen to the telling of a personal history, more often than overt "symptoms," it is just such Faulkneresque understatement of the sometimes macabre, along with the burning light in the eyes, and the cunning humor, that makes me begin to suspect extreme trauma in the individual's history.

     As a psychologist, and as a human being, I am impressed with the irony that these severely traumatized patients, people who have been through living nightmares, people who might blamelessly choose death, often emerge from successful treatment by constructing lives for themselves that are freer than most ordinary lives from what Sigmund Freud, a century ago, labeled as "everyday misery." They become true keepers of the faith and are the most passionately alive people I know.

     Or maybe it is more necessity than irony. I have been told more than once by the survivors of trauma that it would not be worth the struggle merely to go on surviving. And that is exactly what most of the rest of us do: we do not choose to die, or to live; we go on surviving. We do not choose nonexistence; nor do we choose complete awareness. We slog on, in a kind of foggy cognitive middle-land we call sane, a place where we almost never acknowledge the haze.

     Over the years, what my trauma patients have taught me is that this compromise with reality and its traumas is simply not sanity at all. It is a form of madness, and it befuddles our existence. We lose parts of our thoughts in the present, we sabotage the closeness and comfort in our relationships, and we misplace important pieces of ourselves.

     All of us are exposed to some amount of psychological trauma at some point in our lives, and yet most of us are unaware of the misty spaces in our brains left there by traumatic experience, since for the most part we experience them only indirectly. Seldom do we ponder the traumatic events in our own lives, let alone the frightening hardships and life-or-death struggles that were the daily lot of people as close to us, in terms of time, as our great-grandmothers, or even our grandmothers.

     But we do feel crazy, and a little silly, when from time to time we cannot remember a simple thing we ought to be able to remember. ("Early-onset Alzheimer's," people will joke—neither morbidly nor quite lightheartedly.)

     And we feel our insanity, and sometimes a near-frantic sense of being out of control of our lives, in the misunderstandings and rifts in our most cherished relationships, in the same emotionally muddled arguments that go on for years and years. The conflicts never quite kill the love that we feel, but they never quite end either. And as a society, we feel incompetent, and sinkingly helpless, when we reflect upon the greater-than-half failure rate of marriages in general.

     Too many of us walk on eggshells around our life partners, theoretically the very people whom we should know the best. We do this because we are never certain when that lover or that spouse is going to become aggrieved, or fall silent, or fly into an impenetrable rage at something that happens, or at something we have said, and become a distant stranger, a different person altogether whom, in all honesty, we do not know at all.

     Or we look at our parents as they grow older, and seeing that time is running out, we long to be closer to them, to know them as friends. But when we actually try to think about accomplishing this, our thoughts skitter away from us like frightened deer from an open meadow, and in the next moment our minds are elsewhere—anywhere else—the rising price of gasoline, a memo at work, a spot on the carpet.

     Many of us find it difficult, and sometimes impossible, to stay in one "mode," to be constant and recognizable, even to ourselves. One of the most universal examples of this is the experience of returning "home" to one's parents. After a family visit, the commonest revelation, sometimes private and sometimes voiced aloud to friends, is "I turn into a different person. I can't help it. I just do. All of a sudden I'm thirteen again." We are completely grown up and may even consider ourselves to be rather sophisticated. We understand how we ought to act, know what we want to say to our mothers and our fathers. We have plans. But when we get there, we cannot follow through—because suddenly we are not really there. Needy, out-of-control children have taken over our bodies, and are acting in our stead. And we are helpless to get our "real" selves back until well after we have departed from our "homes" once again.

     Perhaps worst of all, as time passes we often feel that we are growing benumbed, that we have lost something—some element of vitality that used to be there. Without talking about this very much with one another, we grow nostalgic for our own selves. We try to remember the exuberance, and even the joy, we used to feel in things. And we cannot. Mysteriously, and before we realize what is happening, our lives are transfigured from places of imagination and hope into to-do lists, into day after day of just getting through it. Often we are able to envision only a long road of exhausting hurdles, that leads to somewhere we are no longer at all certain we even want to go. Instead of having dreams, we merely protect ourselves. We expend our brief and precious life force in the practice of damage control.

     And all because of traumatic events that occurred in the long-ago past, that ended in the long-ago past, and that, in actuality, threaten us with no present danger whatsoever. How does this happen? How do childhood and adolescent terrors that should have been over years ago manage to live on and make us crazy, and alienated from ourselves, in the present?

     The answer, paradoxically, lies in a perfectly normal function of the mind known as dissociation, which is the universal human reaction to extreme fear or pain. In traumatic situations, dissociation mercifully allows us to disconnect emotional content—the feeling part of our "selves"—from our conscious awareness. Disconnected from our feelings in this way, we stand a better chance of surviving the ordeal, of doing what we have to do, of getting through a critical moment in which our emotions would only be in the way. Dissociation causes a person to view an ongoing traumatic event almost as if she were a spectator, and this separation of emotion from thought and action, the spectator's perspective, may well prevent her from being utterly overwhelmed on the spot.

     A moderate dissociative reaction—after a car crash, for example—is typically expressed as, "I felt as if I were just watching myself go through it. I wasn't even scared."

     Dissociation during trauma is extremely adaptive; it is a survival function. The problem comes later—for long after the ordeal is over, the tendency to be disconnected from our selves may remain. Our old terrors train us to be dissociative, to feel safe by taking little psychological vacations from reality when it is too frightening or painful. But later, these mental vacations may come upon us even when we do not need them, or want them—or recognize them. For no conspicuous reason, we depart from ourselves, and people we care about depart from themselves, and these unrecognized psychological absences play havoc with our lives and our loves.

     Unsurprisingly, survivors of extreme psychological trauma have extreme dissociative reactions, and listening to my trauma patients has allowed me to understand not only dissociation itself, but also the ways in which people may overcome the numbing and unwanted outcomes of dissociative experience. Listening to my patients, I have come to believe in the possibility, for all of us, of staying in touch with reality, of becoming truly sane. If these people can learn to remain present with the reality of their memories, if they can make a commitment to live their lives consciously and meaningfully, so can we.

     For the mental universe of the extreme trauma survivor is so full of violence and violation, natural demons and unnatural acts, that one wonders—I wonder every day—how such people find the courage to decide to go on living. It is a place where trusting someone is not an option, and where the genius of one's own imagination becomes an inescapable stalker. In such a landscape, whenever the inhabitant becomes so bone-weary that she lets down her guard a little, another memory cabinet door swings open to reveal precisely the thing that she cannot endure. This thing is different for each person, but always hovers at the outside limit of terror. Letting down her guard is at once what she most achingly desires and what she most vigilantly avoids. It is a universe of fear and exhaustion—especially exhaustion—and people will try almost anything, however irrational, to make it stop.

     As a therapist for survivors, I routinely witness extremes of human behavior for which neither my personal history nor my formal education in psychology could have prepared me even minimally. Survivors are often what the uncompassionate vocabulary of psychiatric hospitals refers to as "cutters." This means that unrecovered survivors of early trauma often inflict bloody injuries upon themselves—deep cuts and third-degree burns—not necessarily with death as a goal, but rather out of some compelling sense that the injuries themselves are necessary. For the most part, these acts of self-abuse are carried out methodically and repetitively, and with a chilling awareness of the practicalities of injury. Some of my patients learn to bandage themselves as well as any nurse could, and when a trip to the emergency room is required, they have already prepared a socially acceptable answer to "How did this happen to you?" and offer it calmly when asked.

     The doctors believe the story, and no one recognizes the desperate situation of the person into whose arm the stitches are going.

     In a seeming contradiction to self-injury, prior to recovery some trauma survivors study, buy, and stockpile weapons against outside threats. Sometimes a certain special weapon will be concealed and carried with the person, as routinely as someone else might wear a wristwatch. The concealed mace or knife or gun seems to be a defense against a horrible, nameless danger that never materializes but is constantly expected, a testimony to the monstrous threat the individual knew in the past, and was unable to defend herself against. Whether or not a weapon could have prevented the original trauma does not seem to be important. What is important is a kind of material insurance that one is not nakedly helpless like before.

     The busy professional person no one would ever suspect may very well make a confession in therapy, and show me the unused but studiously maintained knife she hides inside her boot.

     The forms of extreme behavior can be dramatic, or they can be obscure and progressive. In my experience, the profoundest cases of anorexia nervosa (self-starvation syndrome) are always trauma survivors, usually survivors of sexual abuse. Like the despairing victims of voodoo, those afflicted with profound anorexia also sometimes die of congestive heart failure, but by a slower mechanism. This was the case with Marcie, a patient who recently entered treatment with me after having technically died twice, and having been twice revived by the physicians.

     This is what happens when the cause is anorexia: in cases of advanced starvation, the body cannot get enough protein to survive. It must begin to feed upon its own internal sources of protein, for example, the muscle tissue of the heart. When the heart has been sufficiently damaged, it can no longer pump blood well enough, and congestive heart failure results.

     My new patient Marcie starved herself to death when she was twenty. She wonders why she did not see bright lights and hear the angels. But more than that, she wonders why the doctors saved her.

     "Do you like my new shoes?" she asks me now. "I got them for four dollars and ninety-eight cents in Harvard Square. I haven't had new shoes in three years."

"Why, Marcie?" I ask.

     "I don't like to have so many things for myself, you know? Some people can have lots of things, but it just makes me nervous, you know? I don't need too many things for me."

"I'm glad you bought the shoes."

"Do you really like them?"

"They're very pretty, Marcie."

     Marcie is my height, five feet five inches tall, but when she first arrived at the hospital in Boston, after her "deaths" in a New York hospital, she weighed sixty-eight pounds, a fetus in fetal position in a psychiatric seclusion room. Today, two years later, she weighs 115 pounds—according to the charts, a reasonable weight. But pale, troubled, looking out from behind her large round glasses, and feeling that she is fifty pounds overweight, she is still more spirit than body.

     No more seclusion room now. Marcie takes the Red Line, and the Green Line. To Harvard Square. To Boston, to see me. To see The Tin Drum.

Why why why why? she asks.

     Why are people like that? Why do people have to be like that? She asks me, over and over. Why? She asks Günter Grass.

Why?

     Oh yes, survivors' hearts and histories are torn and scarred, in all the ways one would expect, and in a multitude of ways one could never imagine. And by now I could own a macabre collection of potential suicide instruments—nooses, pills, hypodermic needles—given up to me by survivors, often quite ceremoniously, as they begin to recover.

     But after recovery, after they have chosen to live, these same people often truly live—passionately, in a way many other people never achieve. Survivors embody extremes of human experience, such that everyday misery is a near-stranger to them. At first, their pain is much worse than our everyday misery, by a factor so large that it would be difficult for most to conceive of it. And then later, after recovery, everyday misery is simply unacceptable. Life must be a passionate, conscious journey, or it is just not worth the survival effort.

     In the context of their own personal experience, and their struggle to come to terms with it, survivors inevitably address certain questions. Does anyone ever truly care about anyone else? Is love just a word? On this planet, is it possible to be in control of anything? Is it all right not to be in control? Does human life, in its pain and vulnerability, contain something that makes it worthwhile? And these questions are not addressed philosophically, from the relatively detached stance the rest of us may enjoy at times, but rather from a position of intense and consumingly personal relevancy every day.

     Eventually, the trauma survivors I see glean their own answers to some of the most fundamental human questions. And the beliefs, strategies, and personal values they come to live by are fascinating, a school for human life. Perhaps most instructive of all is the recovered trauma survivor's intimate relationship with what is for many people the most distant of philosophical concepts: awareness of the truth. That awareness is life-giving, that dissociation and numbness are lethal, is a lesson the recovered survivor has learned down to his or her bones. It is the lesson that sparks the missionary's glint. It restores faith, and makes living a workable choice. And though the turnabout may seem ironic, this lesson is precisely the one that many of us have not learned deeply enough to make genuine living possible. Perhaps, like grandchildren, we can learn it from the old souls, from the survivors.

     I myself understand whatever I do about these things because I have had the rare privilege of listening to the people who are my patients. I listen, for example, to Marcie, she who was twice dead and twice revived by the doctors, she who is now twenty-two years old and also as old as the world. If Marcie chooses to live, it seems to me that what she will have to say about human life is prophecy, fascinating and true as any the race will ever receive.

     Marcie is from Albany, New York, where the fantastical pink granite State Capitol stands at the head of State Street. In Marcie's house in Albany, she was repeatedly beaten and raped by her crazy father and her crazier older brother, until she was old enough to get out.

Marcie's voice is flat when she speaks of Albany.

     I have already heard that her father abused both his children, and that her brother, in his turn, abused Marcie. Rape handed down from father to son. I have already heard that Marcie's helplessly depressed mother would rock in her rocking chair for hours at a time, intoning "Oh no, oh no," over and over to no one in particular. On the day Marcie's father finally abandoned the family, that was what her mother was doing. I have heard that Marcie's brother eventually received a diagnosis of schizophrenia, in an Albany hospital I cannot contact because Marcie cannot remember its name.

     "I remember once I locked myself in my mother's room and called the police. When the police came, my brother went to the door and told them everything was fine. They went away. I climbed out the window and hid for a long, long time. It was dark when I came back. I knew how mad they'd be."

     I look up at the abstract painting that hangs behind Marcie's chair in my office, and in my own mind I repeat Marcie's question—why? And will you decide to stay with us anyway, Marcie? I silently ask her. Will you choose to continue your life, or will you keep trying to end it?

     She looks over at me in my chair, and as if reading my mind she asks, "What do people do with all that time? I mean, people other than me. They must do something. All those nights and weekends for years and years. I can't even imagine what I'm going to do with all that time. Don't people get awfully tired after a while? I mean, won't I get awfully tired? And is there something that makes it okay in the end? Is there something that makes it worth it, being so tired, going through all this?"

     I don't know, Marcie, I think to myself. One day you will walk in here and you will tell me.