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"Integration"

By: Patricia D. McClendon, MSSW

Date: December 1994 for B.E.A.M. (Being Energetic About Multiplicity) Newsletter

Question: "Do you happen to know of any books or journals on integration?" - Anonymous

Dear Anonymous,

I only know of one book that deals exclusively with integration. Mending Ourselves: Expressions of Healing and Self-Integration by the Readers of Many Voices and Edited by Lynn W. (Many Voices Press, 1993), is a collection of essays, poetry and art. it is available at the Sidran Press.

Links to relevant books: (This section added on April 11, 1997.)

bulletBecoming One: A Story of Triumph Over Multiple Personality Disorder by Sarah Olson is also available at Amazon.com (20% off cover price). I'm currently reviewing a complimentary copy of this book.
bullet37 to One: Living as an Integrated Multiple by Phoenix J. Hocking (formerly Sandra J. Hocking) available at Amazon.com. I haven't seen this book to review it.
bulletBeyond Integration: One Multiple's Journey by Doris Bryant, Judy Kessler available at Amazon.com.

I don't know of any clinical books or journals that deal exclusively with integration. There are chapters in books and articles in journals that discuss integration. Clinical Perspectives on Multiple Personality Disorder, edited by Richard P. Kluft, M.D. & Catherine G. Fine, Ph.D. (American Psychiatric Press, 1993) has two chapters that discuss integration in great detail with an emphasis on integration as the overall treatment goal. Chapter 6: "Clinical Approaches to the Integration of Personalities" (by Kluft) and Chapter 7: "A Tactical Integrationist Perspective on the Treatment of Multiple Personality Disorder" (by Fine) represent the "current" thinking of the majority of clinicians in this field. This is an evolving field and what works for one multiple or 10,000 multiples will not necessarily work for all multiples. There is some confusion about the terms: unification, integration, and fusion. In this book, Kluft does an excellent job clarifying this confusion in one neat little paragraph:

Unification is an overall, general term and encompasses both fusion and integration. Integration refers to an ongoing process of undoing all aspects of dissociative dividedness that begins long before there is any reduction in the number or distinctness of the personalities, persists through their fusion, and continues at a deeper level after the personalities have blended into one. It denotes an ongoing process in the tradition of psychoanalytic perspectives on structural change. In contrast, fusion refers to the moment in time at which the alters can be considered to have ceded their separateness...(p. 109).

Diagnosis & Treatment of Multiple Personality Disorder, Frank W. Putnam, M.D. (Guilford Press, 1989), is considered the best book on the treatment of multiple personality disorder. Putnam works for the NIMH (National Institute of Mental Health) in Bethesda, Maryland. In his book, Putnam addresses the reality of treatment:

Although there is a general consensus among experienced therapists that integration of the alter personalities is a desirable goal, this simply may be unrealistic with many patients. Kluft (1985d) is the first to acknowledge, "In a given case, it is hard to argue with Caul's pragmatism: `It seems to me that after treatment you want a functional unit, be it a corporation, a partnership, or a one-owner business'" (p.3) It is a mistake to make integration the focus of therapy. Treatment should be aimed at replacing maladaptive behaviors and responses with more appropriate forms of coping. Ideally, integration of the alters will emerge from this process, but even if it does not, the therapy may well be termed a success if the patient has achieved a significant improvement in his or her level of functioning (p.301).

For you trivia buffs, Dr. David Caul was the psychiatrist who treated "Billy" Milligan at Athens Mental Health Center (Athens, Ohio). In 1977, "Billy" was charged with raping three women and was found not guilty by reason of insanity (multiple personality disorder). To my knowledge, "Billy" is still receiving inpatient treatment at Central Ohio Psychiatric Hospital in Columbus, Ohio (see update, below). Dr. Caul developed a technique called Internal Group Therapy, IGT, to help multiples improve internal communication and cooperation. John and Helen Watkins, pioneers in developing Ego-state therapy, were his contemporaries. Dr. Caul made many contributions to the field of dissociation. He died on March 14, 1988.

Unity and Multiplicity: Multilevel Consciousness of Self in Hypnosis, Psychiatric Disorder and Mental Health, John O. Beahrs, M.D. (Brunner/Mazel, 1982), is a book for the more sophisticated reader. Beahrs "assumes that we are not only a unity, but also a composite of many aspects, facets, or parts which each have their own personality and on- going experience simultaneous with and to an extent separate from one another and the overall Self" (book jacket). My understanding of his book is that unification of parts of Self is impossible because we are not unified in the first place. Integration is the desirable goal for treatment. Beahrs uses the analogy of "The Conductor-orchestra" (p. 69), to explain fusion. (This would probably be termed integration today because, after the symphony is over, the members are free to go their own way until the next practice or performance. The music during the symphony, however, could be considered "fused" because each instrument loses its separateness.) Recently, I saw a slogan on a shirt of a teenage boy that read: "Symphony or Destruction" and it bought to my mind Beahrs' analogy. I'll try and summarize what Beahrs meant by his analogy. You need a conductor to conduct the orchestra, violinist to play the viola, and each player plays their instrument. The conductor doesn't play the musical instruments and the players don't conduct the orchestra. Each musician must play their instrument according to the sheet music. No ad lib solos are allowed. This is no place for competition! For the music to be a symphony there needs to be cooperation and communication between the conductor and orchestra players...not a sound is lost and together all the instruments are "greater than the sum of their parts." Otherwise, the music is destroyed...and would probably sound rather chaotic like the "warm ups" right before the orchestra plays. Practice is were the players can finely hone their skills and try something new and different, but the conductor needs to be the one who decides whether or not to allow the players to play their part differently and that would be communicated to the rest of the orchestra by rewriting the sheet music. This is no place for unilateral decisions to be made! The performance of one player affects the entire orchestra! So, integration is a gradual process that is indicated by increasing communication and cooperation between the parts of self with the realization that each part affects the others: a "we" mentality develops, not a "them vs. us ", and not a "them vs. me". There is an "executive" personality (conductor) that is in charge of all the other parts of self (the orchestra). This "executive" personality must be fair and respectful of all the other personalities and work out compromises between the personalities and decide on solutions to problems that are in the best interest of all the personalities.

More trivia... Beahrs was greatly influenced by the Watkinses and Milton H. Erickson (Search Amazon.com for a list of many books and audio cassettes). John ("Jack") Watkins' social analogy of splitting of America into Union and Confederacy is a similar analogy to the conductor-orchestra analogy. Milton H. Erickson believed "that resistance would come from the conscious or the primary SELF...much more than from the unconscious who would all too willingly cooperate if given the chance" (Beahrs, p.122). Erickson is the "father of hypnosis", so to speak. He believed that if the direct approach failed that hypnosis could be used to "by pass" the conscious mind's resistance to therapeutic change. Erickson taught that it was best to use the direct approach first. If that doesn't work then go to the indirect approach. People learn easier when change is presented in a way that they can visualize making the change. Kluft does not advocate indirect Ericksonian techniques because he believes it can be confusing for clients. "...(T)he language used to address the MPD patient must be clear and the sentences should be crisp. Elegance of expression must yield to the need for unequivocal clarity of communication" (Kluft and Fine, 1993, p.37). Erickson was able to help clients that other esteemed therapist were unable to help. Resolving the "confusion" was therapeutic for his clients. His work deserves further attention. Perhaps a balance can be achieved concerning the use of Ericksonian hypnosis.

Some auto/biographies about multiples who experienced integration are: The Family Inside: Working with the Multiple, Bryant, Kessler, & Shirar (Norton, 1992) (Note: This book has stirred some controversy.); Katherine, It's Time: An incredible journey into the world of a multiple personality, Kit Castle & Stefan Bechtel (Harper & Row, 1989); and The Flock/the Autobiography of a Multiple Personality, Joan Frances Casey with Lynn Wilson (Knopf, 1991).

A lovely book for younger alters is the fairy tale The Silver Boat by Ann Adams (Behavioral Science Center, Inc., Publications, 1990) and speaks to the issues of cooperation and integration. The best line in the book is: "You must think of what you want rather than what you fear." The front cover of this book (which was illustrated by Max Elbo) along with the above line was made into a poster suitable for framing. It would be an excellent reminder to face your fears in order to get what you want. See Ann Adams'web site which has large images from her book.

See The Minds of Billy Milligan by Daniel Keyes and Frequently asked questions and an update on Billy Milligan.

The book, The Minds of Billy Milligan is available through Amazon.com or your local used bookstore (now back in print). My old copy is a bright blue foiled paperback edition.

Write to author, Daniel Keyes at mailto:dankeyes@usa.net.

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Last updated on January 13, 2011.

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This photo was taken just days shy of my 49th birthday. Copyright © 1995 - 2013 by "Pat," Patricia D. McClendon, MSSW

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