My name is Sam Vaknin, and last time I checked, I was the author of Malignant Self-Love, Narcissism Revisited, and yes, you got to write a series of books and e-books about personality disorders and other topics. Aren't you bored with this introduction? It puts me to sleep.
I'm also a professor of psychology in several universities, which will remain unnamed for those of you who have a predilection of proclivity for conspiracy theories. I teach in Russia, therefore I am a KGB agent. Never mind, the KGB doesn't exist anymore.
So today, Minnie and I are celebrating. And no, we are not celebrating our anniversary, which is something we will not do on camera. We are celebrating the opening of a new YouTube channel.
Someone sent me a link to a YouTube channel titled Sam Vaknin Antichrist. Antichrist, me, I have arrived. I finally made it. I am the American Jewish success story or the Israeli Jewish success story. Hell, what took you guys so long? I've been freezing my tail here. Right.
It may come as a shock to you, but I do read some of your comments. Don't get your hopes too high. I read some of your comments before I delete them. Generally, it's a pleasure to delete your comments, but sometimes I get stuck on something that looks interesting.
So there was a comment the other day, someone had the temerity, look it up online, temerity. Someone had the temerity to suggest that there is a field or a topic or a theory in psychology of which I'm not aware. Didn't she realize that I'm the perfect genius, that I know absolutely everything, that God consults me when he is not sure or when there's no article in Wikipedia?
I was kidding. Of course she knows all this. And yet, she directed me to a theory, a trauma theory. No need. I was well aware of it. And actually it underlies a part of cold therapy, as we will discuss a bit later.
Minnie keeps telling me that my sense of humor is worse even than her coffee, which is not an easy accomplishment. And that I'm an arrogant prick, luckily for you, as opposed to Minnie, you're faced only with the arrogant bit of this expression, not with a second word. And I promise to never expose you to this unsavory traumatic experience.
And for those of you who consider videos longer than 30 seconds, onerous, those of you can't stand videos longer than 30 seconds, judging by your comments, the vast majority of you. The answer to this video is a resounding yes. Read the title. The answer is yes. And now you can proceed to your favorite pastime, which is cats jumping off hot tin roofs. Also go and get yourself checked for ADHD, attention deficit hyperactivity disorder, and for PTSD having watched my videos.
Okay, my next video will deal with a base rate fallacy. For those of you don't know how to spell base rate, and I'm kidding you're not. There were quite a few comments of people who don't know how to spell, spell base rate fallacy. Base, B-A-S-E, like in bases or army base or Navy base or okay, base rate fallacy, confirmation bias, and cognitive deficits. Of course, cognitive deficits such as grandiosity, underlying narcissism.
So it has a lot to do with a narcissist and his rejection of life and refusal to countenance reality.
Okay, enough with jokes. Let's get to the business of teaching you students.
And as is my habit or my new habit in my recent videos, I start by referring you to literature.
So I suggest that you read everything you can by Dorahy, Van der Hart, Nijenhuis, Kathy Steele, Butler, Crabtree, Brown, and go into some historical writings by Jeanette Brown and also read everything you can by Van der Kolk.
Those of you who've heard of some of these gentlemen realize that today's topic is trauma and the dissociation that trauma induces.
This is a topic that underlies the most modern thinking, most up-to-date bleeding edge thinking on a variety of mental health disorders, among them narcissistic personality disorder and borderline personality disorder.
But today what I want to do, I want to explore one approach to dissociation, which is first becoming a dominant approach.
In 1893, that's a bit before I was born, there were two gentlemen, Breuer and Freud. And of course, having said gentlemen, it's clear that they were Jewish.
So these two gentlemen came up with an article, wrote an article, published an article, and they suggested that individuals with trauma memories go through numbing, detachment, amnesia, and avoidance of triggers and memories.
And they said the very same people who try to avoid triggers the best they can, in a variety of ways, they are triggered the most.
Trauma was the main topic of study. I would even say the cornerstone of early psychoanalysis pre-Jung, when Jung was still a disciple and a fawning and admiring student of Freud.
It was much later that Freud recanted and he realized that he was the victim of high society, rich women with nothing better to do. He was a form of entertainment. They came to him and they told him stories about how they had been abused by their fathers, usually.
And he bought it hook, line and sinker and constructed the whole theory based on their stories and false memories, memories that they came up with in order to gratify and please Freud.
Freud went to the extent of saying that he now disbelieves most of the trauma stories that he had heard from his patients, because had they been true, then he himself must have been sexually abused by his own father.
But that's a vignette side. Let's continue.
The personality is not a monolithic slab of stone. It's not the proverbial rock. In other words, it's not an entity, exactly like the living body. The living body is a colony, a colony of trillions of cells.
And in each one of our cells, there are very, very ancient and primitive organisms which had survived inside ourselves.
These organisms have nothing to do with us. They don't share genetic material with us, mitochondria, for example.
So we are like a giant zoo. Our bodies are like giant zoos with trillions of cells, organisms, the gut flora, for example, billions of bacteria or viruses. I mean, we carry this gigantic zoo with us wherever we go.
The personality and the mind are the same. It's a zoo. It's an amalgamation of very ancient voices, of constructs, of defenses. So different structures comprise the personality experience.
Personality is therefore a process, a process. It's an experience. It's not a thing.
And some personalities experience too little, some personalities experience too much.
This distinction is very, very important. Some people are prone to interface with the world and with other people, much more than other people.
So this important, although apparently trivial insight, underlies the theory of structural dissociation.
Before we go any further, structural dissociation is one of well over 50 trauma-related theories and trauma-related therapies which I had incorporated into cold therapy.
Cold therapy, to remind you, is a treatment modality that I had invented, that I had created for people diagnosed with narcissistic personality disorder or for people with major depression.
And I suggested to re-conceive of narcissism, to re-conceive of narcissistic personality disorder, as essentially a post-traumatic condition.
A post-traumatic condition and therefore requiring trauma therapies. Structural dissociation was an important theoretical foundation of cold therapy. So together with other approaches to trauma and other approaches to re-traumatization, I put these together and also with child psychology and came up with cold therapy.
So what is this theory? What does it say? What does it teach us?
Well, dissociation can be conceived as one of two things. Either it's a deficit, it's a malfunction, it's a glitch in the software. It's when we can't take very painful, very threatening, very harrowing experiences and the thoughts we had during these experiences and the emotions we had felt during these experiences. We can't cope with them and we can't integrate them. We can't make them a part of our self.
So we kind of hive them off. We kind of push them out, push them away. These memories, the cognitions that go with them, the thoughts, the emotions that we had felt, we place them in a container and therefore there is an integrative deficit, dysfunctional integration.
There's another way to look at it and that's the older way, the way of Freud and others. The dissociation is actually a defense. It's when the child usually is faced with extreme abuse, extreme trauma. He has very few active defenses. The defenses he has are very primitive like splitting and they work only so far.
Splitting, for example, is very threatening because if you split mother, an abusive mother, you split her in two. There's a bad mother and a good mother. The bad mother is there. She's very frightening. So even the defense mechanisms, the primitive defense, infantile defense mechanisms of the child, they are not very defensive. They bring the horror of the situation to the front. So children are defenseless.
Dissociation is one defense. It's simply not remembering, forgetting or not being there or thinking of the whole thing is not true. Derealization, depersonalization, amnesia in reverse order.
And so structural dissociation claims, the theory claims that dissociation is an integrative deficit, not so much a defense. And that dissociation has two types of symptoms, psychoform symptoms and somatoform symptoms. And we'll come to it in a few minutes.
What is integration? What is this integration that the theories is analyzing and dissecting so much, structural dissociation theory? What is integration?
Integration, first of all, is an adaptive behavior. It's a behavior that helps you to survive, to cope, to function, to propagate yourself. So it is also an adaptive behavior on the level of the species, not only on the level of the individual.
And it depends on two processes.
The first one is synthesis. Synthesis is when we associate, when we put together, when we combine in a reasonable, coherent, cohesive, rational form, combine all the components of experiences and all the functions into meaningful, coherent mental structures.
And these mental structures are created on the fly. As we have an experience, we immediately create a mental structure to cope with this experience. This mental structure contains the memories, the thoughts, cognitions, the emotions, and the functions associated, the behaviors associated with all this.
And this is the mental structure that we create with each and every experience. This is called episodic mental structure.
And mental structures that amalgamate, aggregate, find common denominators across multiple experiences across time.
So these are the synthesis processes.
And then there's another process, realization.
Remember, we are talking about integration. Integration depends on synthesis, creating mental structures to cope with episodic experiences and with experiences across time, that is, synthesis.
And the second process is called realization.
Realization is when we analyze and when we assimilate experiences, but we do it in two ways, personification and presentification.
Personification is when we own the experience, when we analyze the experience, and then we digest it, we assimilate it, we own it, we say, it is my experience. This experience, to a large extent, defines who is I, who is me, it is myself.
It's a little similar to the concept of constellation in Jung, although there are important differences, but constellation is a form of personification.
And then presentification.
Presentification is when during the process of realization, during the process of living through the experience, during the process of experiencing, we bring the past and the future into the present moment, and we integrate over.
It all makes sense. The moment makes sense precisely because it's a natural flowing extension of the past and it leads inexorably and seamlessly to a future which is also connected to the past in ways which are comprehensible and acceptable and reasonable and not nightmarish.
So presentification is the equivalent of mindfulness and it involves reflexivity. It involves the ability to regard the moment as the most important.
It's the most important because it explicates, it gives meaning to, it organizes and it explains perfectly everything that led to it, the past and everything that will come forth, forward, will come henceforth, the future.
In other words, the present is the interpretative tool and organizing principle of our lives.
And this presentification and personalification, the feeling of self, they together combine realization and you have synthesis and synthesis and realization lead of course to integration.
Because if you feel that your experience is yours and that it's connected to your past and to your future, you're integrated, you're put together, your parts make sense, you make sense.
Depersonalization for example, when you don't feel that you are you, when you feel whatever is happening is happening to someone else, when you even stand outside observing yourself, observing things that are happening to that thing, that entity which looks like you.
Depersonalization, being on autopilot, things are happening to me but it's not really me. I'm removed from the scene, I'm detached mentally.
Well, depersonalization is a failure in personification because it creates semantic memory but not episodic memory. It creates language memory.
You can describe what had happened of course. You were there, you were an observer, you were a spectator, you were documenting the events at least in your memory, in your hippocampus, in your long-term memory.
And yet you didn't experience what was happening. It was not episodic. This is not an episode that had happened to you. It's only semantics, only language.
And I have a whole video dedicated to this. It's a lecture I prepared for my students in one of my universities, it was Southern Federal University in Rostov and Don in Russia. And it's a video lecture that deals with connection between memory, types of memory and identity. And how disruptions in memory create disruptions in identity, identity disturbance or identity diffusion.
So depersonalization is an example of personification failure.
Trauma generally reduces our ability to integrate.
And this depends crucially on who we are.
Some people are very, very, very sensitive to trauma. They have pre-morbid personalities, as we call them.
To start with, they have low integrative capacity, either psychobiologically, you know, they don't have the tools or the properly developed instrument. So it has something to do with genetics or biology, or because they've been exposed in early childhood to traumatic experiences, or because they are highly sensitive people.
It's a tiny fraction of a population which have highly overdeveloped empathy.
No, no, no, not empaths. Empaths are grandiose terms of what I suspect to be covert narcissists.
I'm talking about really, really hyper empathic people, people who have high, who have an abnormal form of empathy. So they would be traumatized all the time.
And the trauma reduces their integrative capacity and leads to recurrent dissociation.
But we must distinguish dissociation from dissociative process.
Dissociative process is anytime we fail to integrate, anytime you fail to integrate.
And this happens a lot in normal day-to-day dissociation. For example, when you listen to my lectures, my boring lectures, your mind wanders, or you fall almost asleep, or you begin to zone out, cut me off, tune out, which proves that you are very healthy. It's the only way to listen to my lectures.
But that is a normal dissociative process. So we should distinguish this from trauma induced dissociation.
Before I go into the theory itself and what it says and what lessons we can learn from the theory when it comes to cluster B personality disorders, which I personally think are post-traumatic states, post-traumatic conditions.
I think all the so-called dramatic or erratic personality disorders and some others, like for example, schizotypal, paranoid, etc. I think many personality disorders are actually post-traumatic conditions and should be totally reconceived in terms of post-trauma.
So this theory is very useful in an attempt to understand the wider context of what today we call, in my view, erroneously, personality disorders.
These are not personality disorders. These are disorders of integration. These are disorders of synthesis, of personification, of presentification. These are procedural disorders. These are disorders of process, all disorders of substance.
But that's another debate.
Before we go to the theory itself and what it says about dissociation, I have to, because I used to be a journalist, so we always bring the two sides. So I have to mention what the skeptics are saying.
The skeptics are saying that trauma is a phantasy.
Dissociation does exist, but it produces phantasies of trauma. The person is asking herself, why am I forgetting things? Why am I dissociating?
Ah, probably I was traumatized. And then when was I traumatized? Well, let me think, did my father ever touch me inappropriately? Let me think real hard. Let me imagine this. Wow, I think he did.
This is called false memory. So dissociation produces false memories and phantasies of trauma. And that is true. It's been documented many times, multiple times.
Therapists who are not skilled and not adept and frankly, narcissistic, have personality problems of their own. This kind of therapist, they tend to induce false memories and phantasies of trauma because they force the patients, their patients to please them, to gratify them and the patient is terrified to lose the therapist. So we tell the therapist anything and then the patient convinces herself that it actually had happened, a process known as confabulation.
So the skeptics say most of the so-called traumas are actually phantasies of traumas, false memories and so on. They say that dissociative disorders are artifactual conditions, artifacts, not really. And they are produced by iatrogenesis. I mean, the therapist creates them in the patient or even by social cultural factors in some societies, some cultures.
When things change, there's a place for redefining some behaviors as trauma.
For example, I grew up in a society where it was perfectly acceptable to physically to beat up children. Children were beaten physically, regularly. And in that society, the physical behavior, the physical communication mode of the parent was actually proof of love.
But of course, as the context change, it's now perceived as physical abuse and even, I would say, traumatic physical abuse.
Trauma is heavily culture-dependent, period-dependent, but I must say, having presented the skeptics point of view, I wholeheartedly, fervently, fervidly, vehemently, and believe me, I know many other words, disagree, because the preponderance and abundance of clinical data and research do not support this view.
There is clear, a linear relationship and proportional correlation and causation between childhood abuse and trauma, as they are defined even socio-culturally, when they are culture or society incongruent.
So everywhere in the world incest is considered abuse. There are things which are universally considered abusive, regardless of the culture or society of the period.
So when we trace back childhood memories of this kind of abuse, we end up having dissociation and many, many of what today we call personality disorders, such as borderline personality.
So without further ado, and to cut a long story even longer, let's delve into the issue of dissociation.
The preeminent scholar of dissociation, Freud and Vriere, was Janet. In 1907, which is when the last dinosaurs still walked the earth and played with me as a kid, in 1907, Janet wrote that dissociation is when there are two or more systems of ideas and functions that constitute personality.
In other words, Janet actually was describing what later in the 60s and 70s used to be called multiple personality disorder. When the personality fragmented, broke down into two discernible selves, full-fledged almost, which could easily be described as a separate personality. That was Janet.
It's a very restrictive view of dissociation, and today we don't hold this view any longer, at least not exclusively.
In other words, we don't think that dissociation is only when you have multiple personality.
And he said that dissociation is the result of inability to integrate owing to physical illness, exhaustion, stressors, stressful situations, and young age, and that it leads to pathological alterations in consciousness, to greater emotivity, to reactive behaviors and beliefs.
Notice the phrase greater emotivity. This is what today we call emotional dysregulation, and it's one of the two hallmarks, together with dysfunctional attachment, one of the two hallmarks of borderline personality disorder.
Janet, decades, many decades before the diagnosis of borderline personality disorder was even imagined, Janet actually was describing borderline personality disorder.
Pathological alterations in consciousness, greater emotivity, reactive behaviors, reactive beliefs, unstable beliefs, what today we call identity disturbance. It's one of the diagnostic criteria of borderline personality disorder.
Not long afterwards, there was a guy called Mitchell in 1922. He suggested that maybe these were not really full-fledged personalities, like Janet said, but they were not far.
And here's what he wrote. He said, when there is dissociation, it leads to fragmentation, to breakdown of the personality, but each of these psychobiological systems that results from the dissociation has its own unique combination of perception, cognition, affect and behavior. Each has its own sense of self, no matter how rudimentary.
Fast forward a few decades, and the American Psychiatric Association in the year 2000, when the Diagnostic and Statistical Manual Edition 4, the previous edition, was published, the APA said the dissociation is a breakdown or disruption in usually integrated function.
All these gentlemen, and some ladies, keep mentioning the word integration. It seems that this is the crucial immutable, invariable foundational problem, deficient, dysfunctional, disrupted breakdown in integrative processes, in integration.
We'll come to it a bit later.
Structural dissociation is a theory of dissociation, but it should be distinguished. We'll deal with it in a minute. We'll dedicate a big part of this video to diving into structural dissociation.
But before I go there, I would like to provide you with some tools to make nuances and finer distinctions than structural dissociation does, although it's a very fine theory.
So, first of all, there is the issue of dissociative self-states, or dissociative personality states, as the DSM used to call it.
We do have situations where we see emerging something that is not a personality in any sense of the word, in any functional, dimensional, categorical sense of the word, definitional sense of the word. It's not a personality, but it is a different self. I would call it pseudo-personality.
When the borderline, for example, faces rejection, humiliation, abandonment, neglect being ignored, stress, severe depression, or when she is under the influence of substances, drinks to excess, does drugs, the borderline switches, moves to another self-state, which is essentially psychopathy. She becomes a secondary psychopath. We'll deal with it a bit later.
But these are distinct self-states. Anyone who has ever been with a borderline, treated a borderline, spent time with a borderline, has witnessed this switching. No one can deny it.
Structural dissociation has difficulty accommodating this switch. They have something called intrusion, which we'll come to a bit later, but it's not the same.
Intrusion is like a negotiated process, a danse macabre, a kind of filling each other out between structures of personalities. It's like a bargaining thing. It's like, I withdraw, you approach, your approach, like approach, avoidance, repetition, compulsion. It's very ballet-like.
That's not what happens in borderline switching. Absolutely not. It's much closer to what you see in people with dissociative identity disorder, multiple personalities, where you see one person disappears and another person appears. Many before, there are smiles and compassion and love and empathy, and the minute after this cold-hearted, stone-faced, goal-oriented, machine-disempathic, aggressive, vindictive, so on.
There's this problem of self-states, which is not fully accounted for in structural dissociation. They did develop something called tertiary structural dissociation, which we'll come to a bit later, but I don't consider this a satisfactory solution.
The second problem with structural dissociation is that it doesn't cope well, doesn't describe well dissociative phenomena and non-dissociated self-states or personality states.
You see, there are situations where people switch between self-states and personality states, and they remember everything. In other words, there's no dissociation. There's just a switching between states.
Structural dissociation says that's nonsense. They call it reification. That doesn't exist.
I'm surprised for all these eminent psychologists. If something exists and you deny it, shockingly, it continues to exist. So denying it is not a good strategy. It's there. There are non-dissociated switching. There is non-dissociated switching between non-dissociated self-states or personality states, and someone needs to give an answer or to incorporate it.
If one wants a total theory of dissociation, one needs to deal with this, and a bit later I will come to a new diagnosis in the Diagnostic and Statistical Manual 5, atypical DID states, atypical states of dissociative identity disorder, multiple personalities.
Like every theory in psychology, there's a metaphysical layer to structural dissociation.
The theory suggests that each one of us is born with a psychobiological series of mechanisms or systems, subsystems. They're inborn, they're self-organizing, they're self-stabilizing, and they're homeostatic. They're like operating systems, like Windows or Android. So they're like operating systems, but they are emotional operating systems, and we're all born with them, and they're there, and we make use of them to cope with experiences and so on.
And these are called action systems. So there are two types of action systems. Remember, these are psychobiological entities, something that every person in the world has, according to the theory.
I regard this as metaphysics. I mean, it's total speculation. Maybe it's right, maybe it's wrong. I don't think it's possible to falsify it. It's not amenable to the scientific method, in my view. So it's not science. It's pseudoscience. But if it makes their day, not against it, you know.
Anyhow, since this is what they're saying, I have to share it with you.
They said that there are action systems. There are two types.
The first type of action system, it's an operating system. The first type of action system, it guides daily living, daily life, and has a dimension which has to do with the survival of the species.
So this is the system that drives us to have children. Total failure, in my case. Probably I don't have it. This is the system that drives us to have sex. No comment here.
So this is the system thatus to behave, to act in daily life self-efficaciously, so as to guarantee favorable outcomes, so as to allow us to propagate our genes within the gene pool of the species. In other words, to guarantee the survival of the species.
Then there is a second action system. So this will be an evolutionary action system.
There's a second action system, and that is what is known as the four Fs. The fight, flight, freeze, and fawn.
This is a physical defense action system, and it's reactive exclusively to threat. Whenever there's a perceived threat, this action system springs into action.
Now, if you put these two together, if you put the daily life action system and the physical defense and the threat action system, put the two of them together, together they operate in social circumstances.
When someone, where you socialize, or where you work or act within social systems, because they constitute, when you put them together, they constitute a social defense against abandonment and rejection.
So it would stand to reason that in people with borderline personality disorder, both these systems, or maybe when these systems work together, they go haywire.
Because what happens in borderline personality disorder, when there is a perceived risk of abandonment or rejection, or when there is actual abandonment or rejection, the individual decompensates and acts out, becomes reckless, self-destructive, self-defeating.
In other words, the individual begins to become suicidal, begins to destroy himself and everyone around him.
So in borderline, the confluence, the combination of these two action systems, which usually operate in social circumstances and interpersonal relationships, this confluence has a glitch. It goes haywire.
And the borderline, when these two systems collude, combine, cooperate, to work within society, and they go bad, they go haywire, the borderline goes haywire, becomes self-destructive and other destructive, loses empathy, for example, becomes reckless, becomes defiant, becomes impulsive, aggressive, even violent.
So this is the first function of the combination of these two action systems.
And there is, when you put the two of them together, what you also get is what is called the interoceptive defense. Interoceptive defense is the defenses we have against mental content, voices, memories, you know, mental content, this is very, very upsetting, very egodystonic, paralyzing in it.
Now we all have these defense, interoceptive defense, but in dissociated people, in people with borderline personality disorder, in my view narcissistic personality disorder, the interoceptive defense again goes haywire.
It protects against mental content. Yes. But it protects too effectively, too efficiently, so as to slice the mental content off, to cut it off, to give no access.
And that is why, for example, the narcissist cannot access his emotions. This is a very, the interoceptive defense is like all the infantile defense mechanisms put together.
Primitive defenses, like splitting, combined with some sophisticated defenses, like passive aggression, and together they are the interoceptive defense.
Again, in normal people, it's very useful. In dissociative and personally disordered people, it creates dysfunction because you have no access to big parts of your memory, so you have to confabulate, of your identity, so you have no identity, there's identity diffusion and disturbance, of you have no access to your emotions, so you're emotionally disregulated, like the borderline, or emotionally dead, like the narcissist and psychopath.
The interoceptive defense can go too far, like everything else.
The source of this theory, I mean, this theory is very old, actually.
The founding father theory is an army doctor, a British army doctor. His name was Charles Samuel Myers.
And in 1940, he found himself treating acutely traumatized war veterans, already from Dunkirk and other battle theaters, combat theaters in Europe. So he was treating badly, badly traumatized war veterans.
And he came up with the idea of action systems and so on.
He suggested that when someone is traumatized, his personality actually breaks in two.
One part he called the A&P, the apparently normal part. So he said, when you're traumatized, you break, and there's a part that is called apparently normal. And there's another part, EP, and that's the emotional part.
This is a reaction to trauma. It doesn't happen in daily life, only when you're exposed to trauma.
Myers called the A&P and the EP the apparently normal part and the emotional part. He called them personalities. But today we realize these are not personalities, so we call them parts.
Action system number one, the action system that is in charge of daily life is connected to the A&P, to the apparently normal part.
Action system number two, the action system that has to do with physical defense on the thread is connected to the emotional part, to the EP.
Now, let's delve a bit deeper into these two structures that materialize suddenly out of thin air in reaction to trauma.
What is the EP, the emotional part?
The emotional part contains vivid trauma recall. In other words, you've been exposed to trauma. The trauma could be pinpointed, can be a single event, a car accident, a plane crash. You've been to war, it wore, so your body being blown apart. A divorce even, a pinpointed divorce, a cheating being cheated on, the death of a loved one. All these creates post-traumatic stress disorder.
And so the EP, the emotional part contains a vivid recollection of all this, but not in the sense that you sit back and say, wow, I remember the car crash. It was really terrible.
No, but you experience the car crash again. And if this is really extreme, you can't tell reality apart from your flashback. You are in the flashback. You feel that you are in the car again, having the accident. You're absolutely oblivious to your environment, your wifetalks to you, you don't listen, which is a normal thing. Okay, forget that. Your dog barks. Your, is the television explodes? Nothing. You're in the car. You're having the accident all over again. You're in the plane, you're crashing. Or you recall the exact minute that the twin towers collapsed or the very second where you have learned that your wife has cheated on you. These are all traumas.
And flashbacks are stored in a container. And this container is the EP, the emotional part.
The emotional part contains not only the memory, but all the emotions that went with the memory.
And these are known as vehement negative emotions, vehement negative emotionality includes fear, horror, helplessness, anger, guilt, shame, anticipatory anxiety. So all these are stored with a vivid flashback of the traumatic event.
And either you experience these emotions, or you are so afraid to experience them that you develop the exact opposite. Leastlessness, non-responsiveness, and submissiveness. Submissiveness in the sense that you become a zombie. You become a robot. You react in slow motion.
And if you are pushed beyond this, you begin to derealize and depersonalize. You feel that you are not in reality. What's happening is not real. And you feel that it's not you, but it's happening to someone else who looks like you very much. And you're just mildly amused spectator.
And so all these are the residents, the denizens of the emotional part, the flashbacks, responses, and they usually affect the body, not the body, but how you perceive your body. So they bring about body dysmorphia. You begin to perceive your body, body wrongly, or parts of your body wrongly. And they create a separate sense of self.
This is extreme event related pinpointed trauma.
What we had discovered later, much later in the early nineties, through the agency of Judith Herman, is that repeated exposure to such events creates a much more complex EP, complex emotional part. We'll talk about it a bit later. And this is of course, complex trauma or CPTSD, complex post-traumatic stress disorder.
Now there's a big disagreement between some of the proponents of this theory and Herman and so on. And again, we'll touch upon it a bit later, but there is a general agreement that there are two types of traumatic dissociative reaction to an event like trauma and to prolonged, anticipatory, long-term repetitive, predictable trauma.
Now the emotional part had been described by numerous scholars and each one gave his own favorite name to the emotional part.
Laufer called the emotional part the war self. Wong called it the survivor mode. Tober, who conducted amazing studies of Holocaust survivors, called it the child part of the Holocaust survivor compound personality. Golinkina and Ryle called it the zombie part in trauma related borderline personality disorder. Putnam called it the alter, alters, alternative personalities in DID, dissociative identity disorder, or used to be called multiple personalities. And Bruin called it identities associated with situationally accessible trauma related memories.
No one has ever accused Bruin of being catchy. And all these include abuser rage, victim rage, and passivity. Rage of the abuser is internalized actually. And there is a rage of victim for having been victimized, but the clash between the two creates passivity.
This is the EP emotional part.
What about the apparently normal part, the ANP.
The main role of the ANP is to cut off the EP. The main job of the ANP is to make sure the EP never gets access to consciousness, never interrupts and intrudes on the conscious functioning, conscious memory, conscious identity, conscious everything of the person.
So the ANP represses traumatic memories. This structure avoids triggers and it avoids triggering the trauma, avoids flashbacks, avoids remembering the trauma, avoids re-traumatizing, avoids re-experiencing the trauma, avoids going there, you know, tries its best, the ANP tries its best to dissociate the trauma and the emotions attendant on the trauma, in short, the EP.
So the ANP does this using a variety of mechanisms and techniques and strategies and tools. Amnesia, of course, is the most dominant dissociative amnesia. But there's many others. There are many others. For example, sensory anesthesia, restricted emotions, numbness, depersonalization, many.
Again, the ANP had been previously described and renamed by many others. Laufer called it the adaptive self. Wong called it the normal personality functioning mode. Tober, who studied Holocaust survivors, called it the adult part of the Holocaust survivor compound personality. Golinkina called it the coping part in the borderline. It's been called the host personality or the moderator personality in the DID. And Bruin, you remember, the guy who can never say anything in less than 46 words, Bruin called it identities associated with verbally accessible memories of general autobiographical experience and of some elements of traumatic events.
And yes, I'm kidding you're not.
Now, there is a war. It's a conflict zone in the traumatized person's mind. There's an ongoing war, belligerence and conflict with many, many attendant dissonances between the ANP whose job is to suppress the AP and the AP whose job is insurgency, insurrection and acts of terrorism.
The AP is like the colonies and the ANP is like the colonial power. Keep it away from the media. Don't let anyone at home know what we're doing here, concentration camps, killing women and children. It's not for the delicate conscious of people at home, back home.
So there's the ANP and the AP and they're fighting all the time. And the EP interferes with the ANP intrudes, obstructs, undermines, attacks, tries to, like intrusion detection system, tries to find the vulnerabilities, the access points, you know, installs malware behind the front lines, sends spies.
The EP is in constant war with the ANP because it is a container for trauma-related memories and overwhelming and disorganized emotions.
And aside, many so-called and self-styled empaths, actually, what they describe is not empathy at all. It's this defenselessness, this lack of skin, this being overwhelmed by disorganized emotions and emotional fragments related to trauma.
Trauma is like a hand grenade, you know. It splinters everything. It fragments everything. It's a mess. It's very easy to confuse this emotional dysregulation with empathy.
But it's not. Empathy actually never goes with emotional dysregulation. Emotional dysregulation leads to the exact opposite of empathy, disempathy.
But that's for another video.
So the EP is this hand grenade. It contains these broken memories, damaged goods, total chaos and disorganization. And it wants to intrude on the ANP because it's repressed and suppressed and has this pent-up energy.
Freud said that when you repress something, when you repress a memory, you repress the memory and the energy of the memory. And this energy works in the unconscious until it erupts.
Now, in psychoanalysis, we manage the eruption. The eruption is managed and structured and controlled. And this is called ab reaction.
But in classic traumatized person who is not attending therapy, in daily life, there is this battle going on and the EP has a lot of energy. It's like an improvised explosive device. It's like a nuclear bomb, to be more precise. It has a lot of energy and it threatens the precarious balance that the ANP had succeeded to create.
Now, the ANP in itself is a pathological structure. It is sick and weak. It's a last ditch defense against recalling the horrors of the trauma.
And so this battle, if the EP wins, if the EP disrupts the ANP, the emotional part, if it comes to the surface, if there is uncontrolled ab reaction, if it reaches consciousness, it's the end.
It leads to absolute demolition of impulse control, impulsive behaviors, defiance, recklessness, anywhere from insecurity to drug abuse, maladaptive reactance.
Reactance is an element of psychopathy.
So it leads to a switching. If it's in a borderline, for example, it switches the borderline to a psychopath. If it's in a psychopath, it switches the psychopath to malignant narcissist. If it happens to a narcissist, it switches the narcissist to a borderline.
This is the switching mechanism.
The victory, the triumph of the EP over the ANP leads immediately via collapse and mortification to switching between the three states overt, collapsed, and covert.
And each of these three states is the exact equivalent, the parallel of what today we call personality disorders.
The collapsed state of the psychopath, the covert state of the psychopath, is actually grandiose borderline or narcissist. The covert state of the narcissist is very, very close to borderline.
You're beginning to see that these are simply mirror images.
If you look from the left, you see borderline. But if you look from the right, you see a collapsed state of a narcissist.
If you look from the right, you see a psychopath. But if you look from the left, you see a collapsed state of a borderline. That's a psychopath, secondary psychopath.
So it gives rise to a unifying theory where actually we say, okay, if trauma management fails, whenever trauma management fails via collapse and mortification, there is switching between alternative parts.
And each of these parts is actually what today we call erroneously a personality disorder.
So again, when the borderline collapses, she switches to a part, to an EP, to a part, or to another ANP, which is a secondary psychopath, which is today what we call secondary psychopath.
This is a proliferation of entities, because what we are doing, we are like the three blindwise men who were brought to inspect an elephant. One of them hugged his leg, one of them touched his trunk, one of them touched his tail.
And of course, they had three totally different descriptions of the animal, because they were blind. But it was the same elephant.
And there's only a single elephant, dissociation and trauma related structure.
And in this sense, I agree with the structure. And within this structure, depending on the results of the war between the ANP and the EP, we have collapsed states, and we have covert states.
The collapse is brought on by this war, and part of this war, or another name for this war, is mortification. Now this is a mortification.
And so when the war, one day, EP, when the trauma, when the traumatic element wins the war, there is switching from overt to collapse, from collapse to covert.
And each of these states is what today we call personality disorder.
The ANP, of course, is conditioned to be afraid of the EP. The EP is a serious threat to the survival of the individual, and more broadly, in evolutionary terms, survival of a species.
So the ANP is very afraid of the EP, of the emotional part. And it reacts to the emotional part's attempts to intrude. It reacts to the attacks by the emotional part.
The emotional part is like a virus, I mean computer virus, or actually like a real virus as well. It tries to infiltrate the system and then replicate.
So the ANP's job is to prevent this from happening. And it uses everything, every tool and weapon in its arsenal to prevent the EP from taking over.
It alters consciousness, it lowers consciousness, or even goes unconscious. It encourages behaviors which lower consciousness, for example, substance abuse, alcohol abuse, addictions, compulsions, self-mutilation.
Self-mutilation in such situation is in order to silence the inner voice of the EP, to silence the memory of the trauma.
And the ANP is so terrified of the EP and its recurrent incursions, its recurrent insurgency, its terrorist attacks. So the ANP is so terrified of this that it develops phobias, multiple phobias.
It's very much like the response of the United States after 9-11. We react with phobias to such intrusion.
So the ANP develops phobias.
Anyhow, it's a weakened pathological structure. It's splinter of the original personality which was fragmented and fractured by the explosion of the original trauma.
So it's weak to start with. It becomes paranoid. It begins to develop persecutory ideation and persecutory internalized persecutory objects. So it creates phobias. It begins to be afraid of thinking, of emoting. So it develops obsessive-compulsive internalized rituals. Don't think about this word. Don't think about this word.
Or externalized obsessive-compulsive rituals. Wash your hands ten times a minute.
So afraid of mental action. It begins to be afraid of the dissociative parts. It begins to deny and repress and suppress and fight and battle. Not only the trauma, the original trauma, but anything remotely that has remotely to do with it.
So it develops aversion to triggers. It becomes terrified of attachment and intimacy, of losing attachment. So attachment loss, phobia of attachment loss. Because attachment and intimacy can present a panoply, a plethora, a compendium of triggers.
When you're in a relationship and it's intimate, your chances to be triggered are much higher.
So the ANP teaches the trauma victim to avoid attachment, avoid intimacy, avoid loss, avoid normal life, avoid any change.
And there is a pernicious, very sick process called evaluative conditioning.
Evaluative conditioning is when we associate neutral stimuli, totally irrelevant stimuli, like good morning, or would you like coffee, or looking at this glass, or I don't know, a displant, totally neutral stimuli, associating neutral stimuli with negative or positive outcomesand with negative or positive feelings. This is called evaluative conditioning.
Why is it bad? Why is it pernicious? Why is it totally destructive and self-defeating?
Because neutral stimuli are neutral. If you evaluate them improperly, you're likely to react improperly.
If you evaluate them negatively, you're likely to be re-traumatized, suffer, be in pain, be in fear, withdraw from life. If you evaluate neutral stimuli positively, you're likely to end up with very bad people in reckless situations and be sexually assaulted.
So it's bad to misinterpret the value, the value sign of a stimulus. Stimulus is neutral, should be neutral, not motivated to action.
So when a neutral stimulus was previously connected, previously associated with a negative stimulus, the neutral stimulus acquires negative overtones. And when a neutral stimulus has been associated with a positive stimulus in the past, it acquires positive overtones.
And this is evaluative conditioning, total distortion, total distortion of the world.
And so evaluative conditioning is used by the ANP in the battle against the EP.
The ANP says, let's avoid all negative outcomes. Let's avoid all negative feelings. And let's avoid all the stimuli that had ever been associated, however remotely, tangentially and indirectly with negativity.
So this process is called constriction, constriction of life, constriction of the world. Your life become narrower, narrower, narrower, narrower, focused until it's a single point on the screen and gone.
An individual can have one ANP and one ANP, and this is called primary dissociation, primary structural dissociation.
An individual can have one ANP and two or more EPs, emotional parts. There will be secondary structural dissociation.
Or an individual can have multiple ANPs and multiple EPs, and there will be a tertiary structural dissociation. And this is actually DID, dissociative identity disorder.
Both ANP and EP, according to the theory, have a rudimentary sense of self. There is an I behind each one of them.
The EP, if it could talk, it would say, I feel bad. I feel afraid. I feel angry. I feel ashamed. I feel guilty.
And the ANP, if it could talk, would have said, you know, I am terrified of the EP. I must suppress this memory. I cannot go through this again. If I go through this again, I will disintegrate and die, etc.
Both of them have like a narrative voice, which is very close to Jung's constellated self or to Freud's perhaps ego, maybe ego plus superego, because there's an element of inner critic there.
And both of them have exclusive access to some memories. In other words, the EP has access to memories that the ANP doesn't have access to, because the ANP doesn't want the access.
The ANP doesn't want to be seen dead with these memories. He doesn't want to remember them. He doesn't want to store them. He doesn't want to classify them. He doesn't want to work with them. He doesn't want to use them. He wants to forget them.
So there are memories that only the EP accesses because the ANP gave up on them. And of course, the other way, their memories that the ANP is using, but would not be conducive to maintaining the fresh memory of the trauma, the flashbacks.
So the EP is avoiding these memories.
Again, I refer you to my lecture about identity and memory on this channel. It's a lecture if I give to my students.
So dissociative parts vary in many, many ways in the degree of intrusion in the avoidance of trauma-related cues, in affect regulation, in affect regulation, in psychological defenses, in capacity for insight, in response to stimuli, body movements, behaviors, cognitive schemes, attention, attachment styles, sense of self, self-destructiveness, promiscuity, suicidality, flexibility and adaptability in daily life, structural division, autonomy, number of substructures, subjective experience, overt manifestations, dissociative symptoms, all these.
So you can't just say EP is this, ANP is this. It so crucially depends on the personal history of the individual, on the exact type of the trauma, on previous reactions to trauma, on coping mechanisms, etc.
Consider, for example, dissociative symptoms. There are negative symptoms and positive symptoms. Negative symptoms have to do with loss, loss of something.
So you have amnesia, numbness, impaired thinking, loss of skills, loss of needs, wishes, fantasies, loss of motor functions, loss of motor skills, loss of sensation. All these are losses. Some people have this, some people have that.
You have positive dissociative symptoms when mental content or functions of one part intrude on another part.
So this is very, very close to psychotic disorder, to schizophrenia. These people, for example, hear voices.
The wall is so big that the EP uses everything to intrude and to break through the defenses, like the siege, the famous sieges of the Middle Ages, where you had to break through the fortress, fortress walls, you know, with catapults and whatever you had.
So the EP is using voices, using psychosis to break through the ANP. Non-volitional behaviors, tics, pains with no reason. You have psychoform and somatoform dissociative symptoms.
Somatoform dissociative symptoms is what Freud used to call convergent symptoms.
And so we should narrow it a bit. Dissociative symptom is a dissociative symptom only if there's a clear evidence that it comes from some dissociative part of the personality.
And also if the symptom is found in one or some parts of the personality, but never in all of them.
So if you have a promiscuous woman and she is always promiscuous, even when she switches as a borderline, for example, she switches between, you know, dissociative parts, she switches from borderline to secondary psychopath or to narcissist from overt to covert and from covert to collapse. I mean, with all these switches in all these situations, she's always promiscuous. So that promiscuity is not a dissociative symptom.
But if she becomes promiscuous only when she switches from borderline to psychopath or only when she switches from overt to covert, that would strongly indicate that it's a dissociative symptom.
ANP and E.P. are not totally divorced, of course. They're in the same skull, using the same brain for those of you who have brains. They share a lack of full realization of the trauma, of course.
What ANP knows, E.P. doesn't know. What E.P. knows, ANP doesn't want to know.
And so there's a kind of Chinese wall between firewalls. They don't talk too often, meaningfully at least. They're like very old married couples.
So they don't realize the trauma fully. If they were put together, integrated, fused, you would have a clear processing, full fledged processing of the trauma, which is what we do in therapy.
But as it is, the trauma is segregated. Both of them have obstructive-adaptive deficits. Both of them are not very adaptive. They don't help the person much.
Too much energy is going into separating, segregating, avoiding, fighting, numbing. So they're not very adaptive. And they both lead to significant dissociative symptoms.
Structural dissociation is a permanent pathological state. It requires treatment to fuse the parts. And it requires social support and restorative experiences after the trauma.
As we discovered that having a social safety network, just a little affection and comfort, having some restorative experiences, good experiences after trauma, they buffer. They even reverse post-traumatic effects even better than therapy.
We actually re-traumatize the patient. We cause damage.
One, we reify the parts. We tend to treat each part that appears after the switching as though we are talking to another person. We don't really communicate across the parts, but we communicate with each part separately, thereby encouraging the emergence of multiple personality disorder. That's why many skeptics say that multiple personality disorder is a heterogenic thing. It's induced by the therapist.
The second mistake is that we put undue emphasis on differences between dissociative parts, rather than on the commonalities.
The third mistake is that we put a premature focus on traumatic memories.
But in cold therapy, these mistakes are the strong points. These mistakes are the main techniques, because we want to break the narcissist.
We want the narcissist to re-experience this trauma in the form of a flashback. We want the narcissist to go through that horrible, harrowing, torturous, destructive, terrifying period in his life and to go through it really, not semantically, but episodically, to experience the episode, to live through it.
It's the only hope for destroying, for getting rid of the false self.
So these mistakes in classic therapy of classic trauma victims, like women with borderline, in treating narcissists, via cold therapy, I took these mistakes and I made them the foundation stones of cold therapy.
When the ANP is full functioning and dominant, PTSD is delayed, of course. It's the main job of the ANP to keep PTSD at bay.
Dissociative symptoms are late, but there's a price. The ANP consumes a lot of energy and prohibits, prescribes, it's prescriptive, it prevents, it inhibits certain behaviors. So functioning is reduced. When the ANP is successful, functioning is reduced.
And even people who delay the PTSD by having a successful ANP, they are much less functional than people who don't have PTSD at all.
I have many disagreements with the theory, but one of them is that I believe the ANP fluctuates. I believe there are periods of high functioning ANP and periods of low functioning ANP and these would tend to explain the collapse.
I think when the ANP wanes, when it wanes, there's a collapse. And when it waxes, there's restoration of the overt phase. And when it wanes, the collapse leads to a covert state.
So the ANP goes down, there is a collapse via mortification, there is a covert state, and then the overt state.
Even the theory itself, structural dissociation, they recognize that in some situation there is what they call submission. Submission, vanishing. It's actually the freeze, fall, and flight parts. Freeze, fall, and flight, coupled with submission, coupled with vanishing. What do we have? Covert state.
Even structural dissociation describes actually the covert state, but just doesn't call it covert.
When the ANP is less than successful, when it has low energy or low consciousness or low self-efficacy, when the ANP is not working that well and the EPs is intruding on the turf, invading, in that stage this leads to covert behaviors and would explain, for example, why passive aggression comes to the fore as a defense. This is associated with EPs.
Collapse and mortification are traumatic, and they evoke past childhood traumas.
The child has been told that he's bad and unworthy, and the collapse and the mortification force regression into that phase where the word, the logos, the word of the godlike creatures, mom and dad, they're godlike creatures. They're infallible. They're omnipotent. They are seven meters high, tall. These creatures are telling you that you're bad, unworthy, failure. You take it. You absolutely believe it. It's very, very traumatic because it's terrifying.
Maybe if you're bad and unworthy, they will dump you in the nearest garbage bin. Maybe they'll get rid of you. Maybe they'llnot feed you. Maybe they'll kill you. Maybe they will bring another child to take your place. It's a terrifying statement, and so the collapse and mortification force the narcissist or the borderline or even the psychopath, the histrionic, force them back, regress them to that part of their childhood where they were mortally, mortally terrified for their own survival.
Now, CPTSD, complex trauma, borderline personality disorder, and a now defunct category called disorders of extreme stress, not otherwise specified. All of them were considered a part of secondary structural dissociation.
I would like to focus for a few minutes on a new diagnosis in the latest edition of the DSM, DSM-5 published in 2013, and it's called other specified dissociative disorder, subtype one. This is the epitome of the secondary structural dissociation.
OSDD-1 is very similar to DID, and so it's not 100% secondary, but as opposed to DID, there's no amnesia. So the person switches between personalities, which are not personalities, switches between parts, switches between traumatic parts, you know, but remembers everything. The parts are not fully differentiated.
And so both the AMP and the EPremember everything, this access to memory is amazing, because theoretically, OSDD-1 should have only one AMP and multiple EP, but this is sometimes not the case. You could have an EP or series of EPs in with OSDD-1.
But of course, these EPs will be not as developed as in full fledged DID, but still, you know, quite a few of them and very powerful, very well developed and so on. And they will be traumatic containers.
But the nature of the interaction between the AMP and the EP parts will resemble uncannily the way these parts interact in borderline personality disorder, and in complex trauma in CPTSD. The differentiation is incomplete.
These alternate personalitiesare not fully developed. They don't have a full fledged idea of self or selfhood. They're not totally separated in the sense they don't recognize each other. They don't share the same memory pool in OSDD-1. They do.
So OSDD-1 is like BPD or CPTSD or steroids. The EPs of OSDD-1 handle some aspects of daily life.
For example, you can have EPs that are very playful, like children, or they are very curious, explore the world, grandiose even. And indeed, most of these EPs self described as children, and they, when they're in a safe environment, or when they are triggered, sometimes they switch, and you can see the child appears, and sometimes they don't switch. It's something called passive influence. They kind of flow.
There's a gradual incremental change. They sometimes have arguments, these parts. They deny each other, or they deny each other's memories, or they deny the form of the body that they're occupying.
And the AMP itself is infected with emotional lability, dysregulation, and shame, and blame, and hatred, and I mean, it's a big mess. You know, it is a big mess.
And OSDD seems to me the kind of primordial state, primordial dissociative state, that once more developed becomes borderline personality disorder and CPTSD.
CPTSD symptoms sound almost to the letter, like the symptoms of borderline personality disorder. The two foundational characteristics of borderline personality disorder, insecure attachment, and emotional dysregulation, exist in CPTSD and in BPD.
And in the next edition of the ICD, edition 11, the international classification of diseases, CPTSD is going to be a recognized diagnosis, and it's going to include as diagnostic criteria, insecure attachment, and emotional dysregulation, which raises the question, why the proliferation of entities? Why do we need CPTSD or complex trauma in BPD if they share 90% of all the diagnostic characteristics?
If CPTSD is founded on insecure attachment and emotional dysregulation, then it's not only a trauma reaction. It's what we would call today a personality disorder.
But of course, we can reverse the argument. Maybe a personality disorder is a trauma reaction. Maybe we're getting it backwards.
We say, wait a minute, CPTSD sounds like a personality disorder. Maybe it's not a trauma reaction.
But wait a minute, maybe it's the opposite. Borderline sounds like CPTSD, so maybe it's not a personality disorder. Maybe it's a trauma reaction.
In both cases, there are traumas of childhood, subtle, severe, nuanced, real, ambient. There's no borderline personality disorder without some kind of trauma.
The trauma doesn't have to be overt. It doesn't have to be physical beating or incest, sexual abuse. Trauma can be ambient, can be parental expectations, can be conditional love, can be what we call lack of parental attunement.
The famous pediatrician turned psychologist, Winnicott, he called it being dropped by the mind of the mother. He said, the mother should be good enough, you know, and if she's not good enough, if she drops the child in the mind, that's trauma.
Judith Herman, Dr. Christine McLean, Gallup and a zillion other scholars argue repeatedly that CPTSD is misdiagnosed as borderline personality disorder. And the borderline personality disorder should be abolished as a separate diagnostic and clinical entity.
I go even further. All personality disorders should be abolished. There should be a single personality disorder and it should be moved, moved in the DSM to the post-traumatic conditions section. It should be a form of CPTSD.
CPTSD, dissociative CPTSD, I mean, when CPTSD is coupled with dissociation, it leads to what today we call personality disorders. Personality disorders are the dissociative states of trauma.
As Herman says, the data on this point are beyond contention. 50 to 60% of psychiatric inpatients and 40 to 60% of outpatients report childhood histories of physical or sexual abuse or both in borderline and in CPTSD.
What happens with narcissistic personality disorder, borderline personality disorder, there is childhood trauma in one way or another.
There are 100 ways to abuse a child. Many of them are not overt and these subtle, ambient, underground ways are even worse, more pernicious.
So there's an abuse. There is trauma and some people with pre-morbid personalities react to this trauma by dissociating.
They create an ANP and EP, whatever model you want to use, I don't care. They dissociate. Dissociation by definition is a fragmentation and fracturing of personality.
Presto, you have narcissistic personality disorder, two personalities. You have borderline personality disorder, effectively multiple personalities and switching. You have the psychopath, secondary, primary. You have overt states, covert states, collapse states.
This all fits perfectly. All we have to do is stop being obstinate, look at the data and accept that at the root cause of all this is trauma and dissociation separately and sometimes co-jointly.