Chapter 10. To Begin With ―Psychoeducation (8)

If we take into consideration that dissociative pathology develops as some part of the patient’s mind are not allowed to express themselves, this chain reaction can be a step forward. Obviously, however, dissociative chain reaction can be a disturbance to the patients’ daily living as they cannot easily control their symptoms. Patients in their workplaces might have a difficulty staying and focusing on their job while experiencing frequent dissociative episodes. They might have trouble with partners who might not know how to deal with their partners’ unusual behaviors. Expressions of dissociative parts should be induced in a safe therapeutic environment under the informed clinicians’ care in order to avoid any negative influence on the patients’ social and occupational life due to inadvertent dissociative chain reaction. I often use a metaphor of volcanic activities. (See also the chapter 15). Untreated dissociative patients are like a volcano with a magma chamber beneath. If left untreated or put under some stress, it might erupt sooner or later. If there is a way to let off the magmatic energy, eruption might be avoided. However, if that procedure is mishandled, it might induce uninvited eruption. When expression of dissociative parts are handled in a clinical settings, its therapeutic benefit as well as problems should be taken into account very carefully.
⑤ 　to let the patients know that “what caused it” is always a complicated question
When we suffer from physical and emotional illnesses, we often ask ourselves why it happens. This is also true of dissociative disorder. Quite often mothers wonder if they did anything wrong, which caused their offspring to have the illness. External stressful events, such as bullying at school, injury, illness, death of close relatives, etc. are often suspected as a cause for the dissociative disorder. Needless to say, history of childhood sexual and physical abuse, which are considered to be the major cause for dissociative disorder in the American textbooks are inquired. However, quite often the cause for dissociative disorder is complex and difficult to tease out. Therapeutic benefit of seeking the cause is questionable in many cases.
For the purpose of psychoeducation, to the question of “what caused this”, I consider that the following answer could be appropriate.