wildflowers

Western psychiatry is not a perfect institution. While it does benefit some people, it has a lot of systemic problems embedded within it. Diagnoses often uphold social norms, which isn't always a good thing- consider how racism, sexism, etc. interact with the mental health system, as well as how Western psychiatry is often used as justification to strip basic rights from people because they don't fit those norms well enough.

It's one thing to seek support and receive what you were looking for. Great. I'm glad that you had a good experience. It's another issue entirely when "support" is pushed at the cost of someone's autonomy, independence, or freedom- when support is given like a threat, not an aid.

The concept of mental health is neither absolute nor universal. One person's healthy life is another's living nightmare. Applying your ideas of health to someone else may not actually help them.

You do not have the right to decide for someone else whether their experiences are beneficial for them. You have the right to negotiate a different way of interacting with those experiences if needed (or even to leave someone over it), but that's not the same as deciding that actually, someone is Very Sick and needs to be medicated or sent to therapy whether they want it or not.

Have whatever opinion you want about someone else's mental health, but remember that it's your opinion based on your own life experiences and frameworks, not objective reality. They may see their own experiences very differently from you.

There's a LOT of reasons, I'm going to try to cover them quickly and briefly, but you're welcome to ask additional questions!!

LET'S LOOK AT SOME DISABILITY THEORY!!

First, we need to understand that there's different levels of that statement.

A portion of the clinical community believes that the dysfunction criteria, across the board and with all disorders, both in the ICD and DSM, is "redundant and circular, where the symptoms fulfill the criteria." Basically, they're saying, "symptoms are symptoms because symptoms are inherently disruptive, and therefore the dysfunction criteria is stupid and serves no purpose other than to remind some clinicians not to over diagnose. If you have the symptoms you have the disorder."

I'm kind of on that train, but with a caveat that I don't see discussed often. It's very simple.

A disorder is not a death sentence. It's not a failing on your part. It's simply something that gets in your way of competing equally with others, and the label will give you accommodations to compete at the SAME level as everyone else.

In the same breath, that automatically means "everyone is a little bit X," and it sort of downplays the significance of the label and the struggles of people with that disorder, and it's just kind of up to people to figure out the nuance that I can't put words to.

Hopefully that makes sense.

Not only do some clinicians consider the dysfunction criteria generally useless across the board, when we look at CDDs specifically, it goes even deeper. In western society, it's considered generally impossible to live a normal life with others in your head. Like, we don't even need to look at the criteria, every single case of many is disordered inherently because no agent gets to live their own life based on their own choices.

Which... true, but again, there's nuance there that I can't put words to right now, or maybe ever.

The point is that, on one hand, you're considered disordered whether you like it or not. And this doesn't necessarily need to be a bad thing.

In the opposite direction, you have the extremists of the neurodiversity movement, which believe that no disorder is real, it's just a result of society not being accommodating to natural differences. And so we should abolish psychiatry.

Right.

Looking at specific disorders, we need to actually READ the functional consequences section. Each disorder has one, and it contains the thresholds. Not all disorders experience the same type and level of dysfunction. For example, the dysfunction criteria was also added to catatonia. I genuinely don't think you could make an argument for that NOT being disordered all the time. It was added to other disorders where there genuinely could be an argument. For example:

I was diagnosed with adhd when I was very, very young. My mother hid that from me and my schools. I received no accommodations and didn't find out until it was much too late. In some ways I still struggle and in others, I developed habits that helped me thrive and work around symptoms. Now, while I have some symptoms, I'm not bothered, it's the least of my problems, I'm getting help indirectly, I literally could not care less.

Do I, or do I not, have ADHD? At this point I don't think I would be diagnosed, it's not a problem, but my brain is inherently built like every other ADHD brain (an understatement, this is a hypothetical). The ways that I struggle are personal, and it won't look like anyone else.

In a way, disorders are flexible and subjective, but at the same time, there are objective aspects. There's a complicated interplay happening.

What are the lines, where are the thresholds?

OMG I went off topic. The functional consequences of DID allow for high functioning individuals to maintain a diagnosis even during periods where symptoms seem to receed. The best way to explain this is:

You don't fluctuate in and out of disorderedness, you're always disordered with varying levels of functionality.

The accommodations will be there if you ever need them again (assuming you got diagnosed because you needed help once before). You may never need to use the label again, like with my ADHD. And you're allowed to stop saying you have that disorder if it's not for you anymore. Even DID. I didn't tell my newest doctor about it. I made that choice and I'm allowed to.

So there's so many battling ideas of how to measure dysfunction, and the DSM talks about how complicated it is in the preface.

Speaking of the preface, you start to learn some interesting things about the dysfunction criteria. It was added to basically everything, just as a reminder to doctors to not diagnose everything.

That's it.

The goal is to remind clinicians that they can't just diagnose anything they think is weird, it's got to have problems.

But the DSM goes on to talk about these kinds of problems, saying that it can be a simple as a biological variance or actual dysfunction.

What the hell does that mean?

Very simply, can you be happy while being disordered?

There are many people who experience every single part of a disorder, including struggles, but just keep on keeping on with a smile. Some may not even know they have a struggle, like with some reading comprehension disorders. Look at colour blind people who never realize, or some people with dyslexia. You just find other ways of living and it barely bothers you. Maybe if you knew, though, you might suddenly have problems. Maybe you just don't care.

It's a conversation about how personal dysfunction and distress are, and the many ways, both disruptive and not, that dysfunction can appear.

It's a reminder that we generally suck at judging our own levels of dysfunction and that the opinions of family and friends should play a (reasonable) role in any diagnosis or treatment plan.

It's a reminder that no two cases will EVER look the same and that disorders are not perfect or all encompassing.

It's a reminder that people are allowed to reject a diagnosis. It's a reminder to keep the patient's needs and wants in mind.

But depending on how you look at it... yeah.

And when she goes a bit ’crazy,’ when she starts crying and can’t stop, when she sits and stares into space for an hour because she can’t figure out what to do next or how to do it, when she doesn’t want to go for a drink after work with her colleagues and can’t bear their jollity, when she can’t concentrate at work or remember what it was that she was doing, when she lies awake at night worrying about how to pay the mortgage… when all these things happen, no one actually says that she’s gone mad. Everyone understands that she’s in grief and that it will take time, perhaps a long time if the death was sudden and unexpected, for her to rearrange her life again so that the new normal becomes automatic and comfortable and comprehensible. And even then, for decades afterwards she may contend with the why? questions of sudden tragedy and life not being as sugar-sweet as the John Lewis adverts suggest. But when we have a ‘breakdown,’ when our dissociative coping strategy that has kept our trauma or abuse at bay for years or years suddenly collapses in the lounge and dies on the floor, and we find when we come home from work that it’s not there anymore, people don’t see our resultant behaviour as normal. Even we ourselves think we have just ‘gone mad.’ We don’t have a paradigm for it. And because there’s no corpse in the lounge, no funeral cortège, no life insurance pay-out and a bank statement in a single name, because it’s all intrapsychic and hidden in the undergrowth of our mind, then our outward behaviours do seem ‘crazy.’ When we can’t go to work the next day, and we can’t concentrate, and we keep bursting into tears, and we can’t bear to socialise, and we lie awake at night, and everything seems too much, then we don’t think, ‘This is normal.’ We think, ‘I’m insane.’

I was able to pick up very quickly that antipsychotics were not a long-term solution for me because… even though they did reduce distressing and destabilizing symptoms… but they also flattened my internal world. My internal narrative dulled. Meaning-making became harder. Parts of how I think, imagine, and relate went quiet in a way that wasn’t sustainable or stabilizing. I became very depressed because of it.

That does not mean antipsychotics are bad or that they don’t help people. They do. They temporarily kept me from going off the deep end and hurting myself. They just didn’t help me in a sustainable long-term way. So I stopped taking them. And that decision was made with medical supervision, not on a whim. Sometimes certain meds just don’t work, and sometimes people rather not take medication.

That isn’t a fringe belief that only I or “crazy” people hold. The Hearing Voices Movement holds similar views, has been around since the 1980s, and is internationally recognized. Its core position is that the presence of voices or hallucinations is not automatically the problem. Neither is how someone chooses to label those experiences. The problem is distress, fear, and loss of agency. They support understanding voices instead of immediately fighting them, setting boundaries with internal experiences, reducing fear and adversarial relationships, and prioritizing quality of life over forced normalization.

None of that is “feeding psychosis.” It’s closer to harm reduction, which saves lives.

And medication is a tool, not a moral requirement. For some people it’s lifesaving. For others, the side effects… like emotional blunting, depression, cognitive dulling, loss of internal cohesion (for me, specifically)… outweigh the benefits. Both realities can exist at the same time. Nothing in my post suggested otherwise, and I do not need to hold anyone’s hand through basic nuance that was already implied.

And no, coexistence is not “romanticization.” I hate that stupid buzzword.

Living alongside voices or hallucinations usually involves grounding skills, recognizing triggers, trauma-informed therapy, clear internal boundaries, and actively preventing escalation. Many people who take this approach experience fewer crises, not more, because of these tools.

For example: since changing my approach and reframing my psychotic-like symptoms in a more neutral or positive light, I haven’t had a dangerous or destabilizing episode in about two months. That might not sound like a lot, but I was melting down almost weekly before I started therapy and learning tools to live with both my DID and psychotic-like symptoms. With the help of my psychologist and psychiatrist, we also found that HRT was far more stabilizing for me than trying to manage everything through antipsychotics because my dysphoria and menstrual cycle were the main triggers, and they both lessened with HRT.

Now, the symptoms I experience are mostly neutral. Or, at worst, sometimes a little startling or disorienting. But I’m not in danger, and I’m not distressed. Outwardly, I just appear odd or “crazy” to some people, and there’s nothing wrong with that. I’m just… living with my symptoms. My main problem now is with other people trying to tell me I’m dangerous or need to go back to therapy because I hallucinate or hear things sometimes, or that I’m “anti-recovery” or “self-harming” because I don’t mind living with voices, hallucinations, or a “colorful” internal reality because I’m not in distress or as destabilized anymore.

If it ain’t broke, I’m not gonna fix it just because it makes people uncomfortable. Especially at the cost of my own mental health.

Finally: how people choose to label their internal experiences is their business. Labels are tools, not literal claims about objective reality. Please learn the origins of the term “plural” and what it’s supposed to represent. Policing language does not protect people. You are just trying to enforce a single, rigid recovery narrative that doesn’t help everyone. It might help some people, but it’s not a one shoe fits all situation.

What I will say now instead of just assuming it’s implied is that treatment should be individualized, not moralized. If a treatment reduces symptoms but destroys someone’s ability to function, relate, or recognize themselves, that outcome deserves scrutiny. Functional coexistence is a legitimate treatment goal for some people who hear voices or experience hallucinations.

The only place where this is controversial is online discourse. Just saying.

Anyway, here are some helpful links and resources I’ve used that I think other people might also find beneficial or interesting:

but i dont have an appearance LMAO? i dont know what i would look like as an alter, ive never seen myself, never had anyone tell me, i just kinda rock with the body and just alter my appearance that way (much to everyones dismay LMFAO we have no eyebrows rn)

so i see a lot of systems who DO have appearances, or know what exactly they look like, but i never see anyone who just doesn't know what they look like, or if they even have an appearance outside of the body's appearance

(introjecting here from typing, i just remembered that im originally an oc from like 13 years ago and i can just use that as an appearance LMFAO)

but like for ALL of my alters, we don't have a set appearance. usually we just go off what we're introjected from (bel is belphegor from obey me and gio is giorno from jjba) and they usually vibed with it, but for alters that were more brainmade, we dont got any appearance

To be clear, I don't know my alters, but obviously when you have DID, you are always an alter, so: for example, I might think about what I envision myself to look like, and then at a different time, I might vibe with something else instead.

Stuff like that is what I mean.

I don't think most of us really have like. a set appearance. because we game a lot I noticed many of us have visual traits that we gravitate towards but that doesn't necessarily reflect how we see ourselves so much as what we like to see on a character we can move around in a game. some of us may have OCs based off of us somehow but that's not how we visualize ourselves. in fact I'd argue internally we *don't* visualize ourselves much at all even if we have pretty strong visualization skills. idk alters aren't really how we look, at most we have an "internal voice".

I say all this but I *know* the Big Three of Purple, Green, and Gray have very set appearances but most of the rest of us don't. er, except me. because I started as an imaginary friend. but even then internally when I talk to everyone else it's not like they're visualizing me, it's more like if we project myself out into the real world they can see my imaginary-friend self overlaid onto the real world. if that makes sense.

Present day sometimes I mix up the order of when things happened.. Or im asked abt what happened yesterday and it takes me a few seconds to remember. Last week and the week before that are fuzzy but I could figure it out when thinking about it. earlier in the day feels unreal. there’s someone that messages me on birthdays and knows my name that I don’t rlly know anything abt. But maybe we just didn’t kno each other well in the first place.

I’m just trying to figure out how do u kno if u have amnesia? or if childhood memory is supposed to be like that?

Oh boy, an excuse to write an essay! (Genuinely. We like writing.)

On Amnesia, Flashbacks, and Diagnostic Muddiness

It's typical to have at least some clear childhood memories after the age of 3-5, though some people have better recall than others. I know people who remember only major events through their childhood, and I know people with nearly perfect recall. Both of those are seen as fairly normal.

It's also fairly normal to forget finer details over time. Someone who's 19 will typically remember more of their childhood than someone in their 50s, though again, this varies by quite a bit. Memory can be better or worse even in people without significant memory problems.

I think the observation that's most likely to answer your question is that there's a sense of a story to most people's memories: a series of events attached to feelings, thoughts, and sensory impressions that added up to create meaning. They can trace the person they are now back through their life experiences to see how they got here. Someone might say:

"When I was eight, only one kid came to my birthday party, but she was really nice and we had a great sleepover- we played Truth or Dare, and she dared me to climb onto the roof. It was scary, but I felt free! I think that night was what made me decide I wanted to be closer to her. We wound up becoming best friends until she moved away when I was twelve. It hurt to see her go, but I met you the year after that, and I don't think I'd have had the space for another friend if she hadn't left. So I'm kind of glad it happened, even if I still miss her sometimes."

That's not guesswork. There's a sense of sequence and meaning to what many people can remember about their lives. Even when the exact date is lost, there's an idea of what came before and what comes after. "First I did this. Then, this happened."

The experience of "I have no idea what happened for entire years of my life" can therefore be enough to count as amnesia on its own, especially if you're missing major life events. That's usually not how people experience their childhood memories, and amnesia is defined as memory gaps inconsistent with "normal forgetting".

It's a little more complicated than that, though.

The Recent Past

We don't constantly notice gaps. They only become apparent when we're directly confronted with the missing time, such as when we try to remember what happened or find evidence of it happening- and how often does that happen in day to day life, really?

There are little things in daily life that we do notice: forgetting that we did a laborous task and going to do it, only to find that it's already done (how? when?). Finding drawings and writing that we don't remember the contents of, even if we know when it was made. Failing to find something even though we know where we put it- it isn't there, someone else moved it and didn't share the memory of doing that. Trying to remember what we did that day, only to feel like we're wading through fog to piece it together. Knowing that something happened, but missing all of the details and having no idea when it happened, just a vague sense of something. Some of us struggle with this more than others, and some of us have better shared recall.

Primarily by non specialists. Having a psych degree, even at a Masters or Doctorate level, does not make someone an expert in every single disorder ever. There are many people in the psych field who have only briefly looked at a page or two of text mentioning DID. Their opinions on it don't mean jack shit in comparison to actual specialists.

It's generally not seen as reasonable to go look at everyone in an entire general field of science for information on some very specific thing within that science for other things. You wouldn't go to random nurses in a hospital and expect them to be able to tell you things about every single medical disorder ever and know exactly what the fuck they were talking about when it comes to every single one. You wouldn't go up to a random biologist and expect them to be able to give you details about every species of life in existence. No, if you want accurate information on specific scientific topics, you look for a specialist in that topic rather than going to whatever person in that general field of science you happen to stumble upon first.

Simple example: I need to shower, eat food, and go to grocery store. I'm hungry and don't have energy to cook, so the easiest food option would be to get a deli item at the grocery store. But I want to shower before leaving the house. But I don't have energy to shower without eating first.

It feels very silly to get stuck on such a minor dilemma for as long as I have! But there are times I've spent hours looping through this list, trying and failing to start it anywhere. And the only way out, I find, is to manually override it: to catch it happening and say, fuck it! I can go to the grocery store stinky! It's fine!!

It could be considered a subset of perfectionism, because the override very much involves hitting yourself with the idea that it's ok to do things suboptimally. But it feels like it comes from a slightly different place. As someone who struggles with executive function, I get myself through a lot of tasks by trying to optimize to the smoothest, lowest-friction way through. The task order that minimizes having to do any step more than once, or having to remember too many things at a time. If I can arrange my tasks just right, sometimes I can get one task to cover part of the work of doing another! And if I can put my tasks in an order that feels natural and ideal, I can lower the energy of activation it takes to get moving. And, sometimes, avoid the choice paralysis of not being able to pick a task out of a list of equal priority.

Except that, obviously, sometimes the optimization process throws up glitches of its own. There's the closed loop I described, and there's also another catching point where a task I have the mental energy and wherewithal to do gets stuck behind a task that's too big/intimidating/difficult to tackle. For example: I just sent some emails I've been procrastinating on for over a month, because I need to set up a new email address, and I was telling myself it'd be better to get that set up before I contacted people, because it would save me the hassle of dragging a bunch of conversations over to a new account when I did get it set up. I still haven't made the other email! But I realized that hypothetical future hassle was not worth the delay of not sending those emails for as long as it's going to take to actually get my brain together to figure out a new email service.

Surprisingly, doing something like this often actually makes the difficult task I was stuck on easier! Another thing I struggle with is a flinch reaction from tasks that are both pressingly important, and unapproachable to do. The more I need to do a task immediately, the more stressed and overwhelmed and self-recriminating I get about the fact that I don't know how to even start doing it. It gets so bad I can't even think about it directly - I think about the general shape of it, flinch, and divert my attention so I don't panic.

And when I've got a minor, pressing task stuck behind a big nebulous scary task, it presses the unapproachable task forward, makes it urgent, and that makes it harder to figure out how to do. If I can get around it, and do the actually pressing task in some contrived way that pushes some miscellaneous messy consequences forward, it takes pressure off the big task. And then I can actually think about it, without panicking, which makes it possible to actually work on doing it.

That last point also often applies to asking for help. I have a weird hangup here: I find it excruciatingly difficult to ask for help if I haven't at least *started* the thing I need help with. Which gets into the same dynamic: I have a big unsorted task I can't think about directly without panicking, or the path of steps to doing it that I've managed to figure out starts with one I can't make myself tackle, so I'm stuck doing nothing with no way in. Asking for help means admitting to someone that there is going to be mess, that I can't tackle the problem in the optimal front-to-back way so there's going to be inconvenient problems generated in some of the steps that will have to be dealt with at other steps, and some of that inconvenience might be to people other than me!! But just managing to say this, to admit this upfront, is sometimes enough to cut the gordion knot of not being able to start anywhere.

Using myself as the example, I have DID, and I have my diagnosis.

To have DID, I had to experience repeated childhood trauma, as well as a lack of a support system to help me through that trauma. I developed a system of parts who represent the states of my psyche, the things I had to break apart, hide, or mask with, in order to survive the onslaught I faced. These parts struggled with communication, understanding, and memory; however, now in my adult life and with a lot of fucking work, these parts can communicate well with more understanding and less gaps in memory.

To have a DID diagnosis, I needed:

Two or more distinct personality traits

Amnesia and/or gaps in memory

Distress from either of these two symptoms

And the symptoms needed to NOT:

Be better explained as part of a cultural phenomenon (like mediumship or imagination)

Be better explained by doing drugs or having other disorders

Looking at these, it is not only possible, but probable that an endogenic system without trauma causing their systemhood could be diagnosed with DID. If they have multiple personalities, have amnesia, and are messed up about it, then it’s entirely probable!

This sort of thinking has helped me tremendously with accepting the idea that there are systems out there who have DID without trauma. Because it’s absolutely entirely possible for them to have the diagnosis without trauma.

But for me, I cannot bridge the gap to believe one can experience the actual symptoms — those being the flashbacks, amnesia, dissociation, lack of ability to communicate, attachment issues, triggers, etc — without having experienced repeated childhood trauma (the only exception being if they developed it later from another, similarly diagnosable, trauma-based mental disorder, i.e. C-PTSD). I can’t understand where these symptoms would have come from without that piece.

So… where does this leave me?

“You can develop DID without trauma.” No, not in my opinion.

“You can have DID without trauma.” Debatable, depending on how you’re defining “having.”

“You can be diagnosed with DID without trauma.” Agreed; however, I will be quick to point out that people don’t just randomly experience amnesia, and SOMETHING is causing that, and maybe look into ACEs and what counts as trauma.

And — perhaps most importantly — I cannot be the judge, as an individual online, of if someone ‘truly’ has DID or not. If someone says they have DID, I will take them at their word. If someone says they’re diagnosed with DID but not sure if it’s an accurate diagnosis, I will treat them as they wish to be treated. If someone says they’re a fully endogenic system who developed DID entirely without trauma… Well, I will refer to them as a DID system, if that’s what they want. I just might also have a LOT of questions.

Turning away from the discussion of endogenic plurality however: I also see these benefits.

Separating my identity as a DID system from my diagnosis has allowed me to heal and grow with far less shame. My life is not dictated by a diagnostic manual.