I put together a book

the Fascinating World of Dissociation

Chapter 15. Dissociation and the “Volcanic Model” (6)

It appears that what we can do is very limited as far as dormant volcanoes are concerned (and so are dormant identities of DID patients). However, if a dormant volcano can still erupt in the future with resultant grave disaster, we might have to take some measure to prevent it from happening. So far, our technology is very limited, but some time in the future, we might be able to reduce a pressure inside the volcano in order to delay or abort its eruption. Being aware of the total lack of any specialized knowledge about volcanology, I would venture to imagine: What if some very measured tectonic movements are administered in order to “let off steam” of magmatic pressure little by little ? However, I am also aware that that type manoeuvre should be done with most caution, as it might backfire and trigger larger and unexpected eruption. This tactic of "letting off steam" might be applied more realistically to our treatment of DID patients. We might be able to call out emotional identity sometimes in order to avoid future unexpected appearance and disorderly conducts. However, it might end up stimulating the emotional personality unnecessary.
More concretely, let us imagine a DID patient who has a violent identity who can suddenly pop out and disrupt the social life of the main identity. Fortunately he has been gone for a while, and he might stay dormant indefinitely if undisturbed. However, if the patient has some stressful events on his/her job, it is expected that that violent personality might get stirred up and emerge again. In this case, is it therapeutic and ethical to take preventive measure and deal with him while he is still dormant? It is a very touchy, but important question. There is a Japanese saying “Don't wake a sleeping baby”. If we apply this to the treatment of DID, calling out the violent identity might end up triggering another disruption in the patient's life unnecessarily. However, if experiences of traumatic stress is imminent and the violent identity is most likely activated, or if there is some hint that he is already half-awake, we might need to follow another proverb: “Crying baby should be picked up and cuddled”.
Of course there is no single answer to this question. Clinicians should rely on their experiences and their gut feeling to find the answer at an each juncture of their clinical experiences. Volcanic metaphor (or"baby metaphor"?) does not indicate us any correct answer, except to help us have an image about what might be going on in the patients. The metaphor might also help us refrain from having a following heroic idea: “in order to really treat the patient, we need to get to the bottom of the patient's problem at all cost."

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Chapter 15. Dissociation and the “Volcanic Model” (5)

*　I have to mention here that recently Japan Meteorological Agency announced that they no longer use this classification (http://www.jma.go.jp/jma/kishou/know/faq/faq8.html).　According to them, active volcanoes were defined as ones that have erupted within the past 2000 years and are still showing fumarolic activity. Recently, however, it has been gaining an international consensus that active volcanoes should be defined as those which had eruption within the past 10000 years. As for dormant volcanoes, they should be ones that have some past records of eruptions, but are not currently active. Dead volcanoes are those which do not have any past record of eruption. However, recent volcanology enables us to know more about past activities and it was revealed that some volcanoes have regular eruptions every several 10000s of years. Therefore, classification of dormant and dead volcanoes is not considered valid these days.

Therapeutic principles using volcanic metaphor – how to treat “dormant” patients
Now I would like to use this volcanic metaphor to discuss the way DID patients should be treated, especially those who have emotional or violent identities. Active volcanoes are like DID patients whose very emotional identities are now out and show agitation and disorderly behaviors. Dormant volcanoes are a condition where the activity of emotional identities is put on hold. Dead volcanoes are like a situation where emotional identities are no longer considered to emerge and start acting again. In fact, many DID patients are in this dormant stage. Tectonic movement is a metaphor of the patient’s encounter with the past abuser, or any traumatic stress that patients might experience in their life. If patients can live without these factors, their life would be peaceful without disruptions by their emotional identities. However, if patients are unlucky, they might be involved in some traumatic accidents and emotional identities might resume their activities. Dormant DID patients’ lives are like a bet where they never know whether their emotional identities become active in the future or not.

Chapter 15. Dissociation and the “Volcanic Model” (4)

In this context, I will use volcanic activities as metaphors to discuss dissociative disorders. Patients with dissociative disorders may function well for a while, but once some other identities become active, they might have problems, especially when these identities are violent, emotional, or what structural dissociation theory calls EPs (emotional personalities). As EPs carry traumatic memories, with their activation the individual might get frantic and disorganized, confusing and disturbing people around, and often ending up losing their friends or jobs. To discuss how to deal with these identities, the use of volcanic metaphor can be useful. The reason why volcanic metaphor is used is that it can express suddenness, unpredictability and violent nature of the activation of some identities.
The figure shown here describes an active volcano, a dormant volcano, and a dead volcano.




Figure (####) volcanic metaphor of dissociation

  The left one, an active volcano has current volcanic activities. In the middle dormant volcano, activities are suspended, but there is still at a risk of eruption at any time. The Left one is a dead volcano which activities are not seen for a certain period of time and there is no expectation that it would resume its activities. What is indicated below these images of volcanoes is the tectonic movement. Volcanic activities are often triggered by this movement or something else.
You might realize that this type of classification is not clear-cut at all. For example, if some dormant volcanoes do not show their activities anymore, they were practically dead volcanoes after their last eruptions. On the other hand, what is classified as a dead volcano might erupt if it is stirred up by sudden and unexpected tectonic movement, and therefore it was not really dead. Thus it is very hard to foresee what might be the future of these volcanoes. (By the way, recent volcanology is no longer using this classification. See below*)

Chapter 15. Dissociation and the “Volcanic Model” (3)

When we observe some chaotic movement, we often notice its pattern-like traces, as though it has a certain regularlity and predictability. However, if you look more closely, these traces are slightly different from one another. This pattern-like movement, in fact, has what is called a fluctuation. Think about wind ripples on the sand dune. Or, a wind-whipped flag. They show seemingly a regular shape or movement, i.e., but their width of the grooves of sand, or the traces movement of the flag, fluctuate and are a little different from each other. Even the most regular movement, such as the earth’s orbital path, is slightly different each time it turns around the sun. Are natural phenomena chaotic? They are. In fact, we cannot think of any phenomenon in the nature which is not chaotic. As for earthquakes, they certainly are. If we know that in certain area, it occurs roughly every some years, we predict the next one to some extent, but we never know exactly when. Hurricanes come in a same way. The volcanic activities that we will discuss have the same nature. Complex system is a system where many factors are connected in an intricate manner, and many movements in complex system are known to be chaotic. System as simple as a double pendulum with only two free parts (i.e. two centers of gravity of each pendulum) shows chaotic movement. Let alone natural phenomena with innumerable number of factors involved.
Human central nervous system is also a hyper- complex system. Whatever happens in the brain can have chaotic nature. Epileptic seizure, switch into mania or depression etc. all have some periodicity, but without exact predictably. Dissociative patients’ sudden switch into violent or emotional identity can have a serious influence on the patients’ and their family members’ life, but it is very difficult to foresee and prepare for.

Chapter 15. Dissociation and the “Volcanic Model” (2)

However, we cannot discuss in the middle of the treatment sessions, such as “If you imagine volcanic activities…..” otherwise the patients and their family members would be very puzzled and confused. Therefore, I would like to use this opportunity to demonstrate the usefulness of this model and get the readers prepared for it.
The way dissociative phenomena occur is “chaotic”
Academically speaking, natural phenomena and brain activities are in a sense very similar. Both occur in a complex system and they are basically “chaotic” in the way that they occur.
The term “chaos” generally connotes a condition of great disorder or confusion. However, in science, it has a very specific meaning. It can be defined in many different ways, but here is how I understand: The movement or behavior of systems that follow deterministic laws, but on appearance it is random and unpredictable. “Deterministic” means for example movements that follow the law of classical mechanics, such as Newton's laws of motion. Chaotic motion strictly follows the law, but still appears to be very disorderly and unpredictable.
A good example is what is called double pendulum. It is a pendulum with another pendulum attached to its end. It is a very simple system, looking a little like a nunchaku. But once set in motion with a specific initial condition, its movement is impressively “chaotic” and disorderly: its movement never seems to be in a pattern of repetition. (If you happen to see it, you really understand what I mean. You can find many examples on the internet.)
This chaotic movement of double pendulum is still in a hypothetical space where the movement is determined strictly by the physical law. It is easy to imagine that double pendulum in a real world is much more disorderly and unpredictable, except that it would finally stop and become static due to friction.

Chapter 15. Dissociation and the “Volcanic Model” (1)

In this last chapter, I will discuss what I call the “volcanic model” of dissociative disorder. Recently I often find myself using this model in explaining to the patients and their family members what is happening in the treatment process of dissociative disorder.
Dissociative phenomena, especially flashbacks and switching commonly occur in dissociative patients, and they are predictable to some extent, in terms of when and how they happen. If they happen on average a couple of times in a week, they will happen most certainly within a next month. However, in what day and at what time they occur is very hard to know, unless there are some very clear triggers. In that sense, dissociation is similar to natural phenomena, such as earthquake, hurricane, or volcanic activities.
In our mind, the memory of the Great East Japan Earthquake is still vivid. This incident might have left in the mind of many people the unpredictability of a disaster of this kind. We know that
earthquakes of that size occur semi-periodically, every hundreds of years or so in northern part of Japan. However, there is no way of knowing exactly what year and what month it certainly occurs, at least on the level of modern seismology in our country. In contrast, aferquakes are much easier to predict. They are likely to occur in proximity to the time and the area of the main shock. In the case of the Great East Japan Earthquake, they occurred in the most likelihood off the coast of Sanriku, and the sooner after the main shock, the more likely. However, if we earn predictability about some phenomenon on a certain level, we seek the higher level and eventually run up against unpredictability anyway.
Pathology of dissociation is similar to this. For example several different identities appear frequently for a period of time, and then they may become quiet for a while without any apparent reason. Even if there is some pattern found, such as seasonal, or that of the stress level, it would not allow us to foresee exactly what triggers the appearance of identity A, B, or C, etc., similar to most natural phenomenon.