Article in journal “free associations”, Vol 10, part 4, No 56, Autumn 2003, Karnac Books
Valerie Sinason is a child psychotherapist and adult psychoanalyst who is well known for her pioneering work with learning disabled patients. For the last decade she has also been at the forefront of the growing awareness and understanding of ritual abuse and the ways that psychoanalytic psychotherapy can be used to treat its victims. Sinason has played a key role in developing the current understanding of the psychodynamics of this abuse. This controversial work has also focussed on establishing the traumatic aetiology of dissociative identity disorder (DID) and has highlighted its link with ritual abuse. In 1998 she founded the Clinic for Dissociative Studies, which has seen more DID patients than any other single treatment centre in the United Kingdom. This interview took place on 16 April 2003, sitting in the garden of the clinic in north London.
Graeme Galton: You're perhaps best known for your learning disability work, and it's now 24 years since you saw your first learning-disabled patient and I was wondering what feelings you have about your pioneering work in that field?
VS: It feels very strange because that's the field that I thought would be my only field for the rest of my life. So I have a sense of loss, despite the fact I'm still deeply involved in it, both with working one day a week at St George's Hospital and also working with learning-disabled clients who have been ritually abused or have dissociative disorders. I also have an incredible sense of pleasure that things which were seen as impossible or mad, that amount of time ago, are now really deeply accepted and established. The Government's White Paper on valuing people is now saying what we were saying 25 years ago, things that we were really seen as mad or pollyanna-ish for even considering, at best. So I have a sense of one part that is complete, in terms of the need to make something get properly into the mainstream social arena and not be marginalized.
There is sadness over the fact that although access for treatment is accepted, in principle, and it's understood that having a disability does not diminish your feelings or fantasies or thinking about it and about life, the lot of an individual with a learning disability is, in itself, not that much improved. The outer covering might be better and somebody might be in appropriate clothes for their age. They might actually have teeth, instead of having them pulled out because it was such an effort taking people to the dentist and bothering about the communication when they couldn't say where the pain was. There were hospitals that, out of what they thought was kindness, removed peoples' teeth. Of course, that led to them looking different, as well.
Now you're more likely to see well-dressed people, where their appearance doesn't carry a great signpost, `I have a learning disability'. But the emotional experience of that difference is not likely to have improved much. I'm thinking, for example, of a man who, in his institution, had no freedom to do anything over clothes. He now has a room in a house where he can choose what he wears, what he eats, what he drinks. On one level, that's a huge difference, yet his biggest longing is to be in a quiet house. As a quiet man, he has lived in noisy hospitals through his childhood and his adult life, and is now living with loud, disturbed people. His longing for himself is no nearer being realized than it was 20 years ago, even though other aspects of his life have improved.
GG: You said that learning disability was the field where you expected to work for the rest of your professional life, and I'm interested in knowing what it was that led you, in that case, into the work with ritual abuse and dissociative identity disorder.
VS: The irony is, of course, that it was through a learning disabled woman, otherwise I may never have got there. It was a Swedish psychologist, Anders Svensson, ringing me at the Tavistock Clinic because of his terror at the kind of things a woman in Sweden, with a severe learning disability, was saying. He asked me to send what I'd written about abuse and disability - this is 12 years ago - and I did and he said, `That doesn't help. Have you anything on more sadistic abuse?' I sent something else. He said that didn't help. I then sent something unpublished concerning torture and he said that was closer. I felt a twinge of narcissistic injury that nothing I'd written approached anything near the subject, as well as curiosity. What could this be? He asked if he could ring me at home and I worried whether there was something really disturbed about him. There was something so palpable about his terror that I arranged for him to ring me at home.
He was working with a woman with a severe disability whom he had been asked to see because she had suddenly started self-injuring and no one understood why. She was able to show him she had been hurt and there were marks on her and so, because it was Sweden, and not England, the police were called immediately. But no DNA was taken - we still have not got to a point where that's automatic - but it was accepted she had been raped and hurt. At the same time, there was also a highly publicized recent murder of a child in Sweden that had not been solved. Anders and I began a period of, ironically, nine months, where both of us, in our unpaid time, gave an hour a week for joint discussion. For Anders it was more. He would tape the patient, send me the tape - so I could hear her intonation in Swedish, to get a sense of the emotions - and an English translation, and then phone me for an hour's supervision.
Every week the narrative of the patient would go a bit further. We put some examples in a joint chapter in the book I edited, Treating Survivors of Satanist Abuse (Sinason, 1994). For instance, the patient would say to Anders, `Mummy's cold and hard and smells'. Anders sounding shocked, `But your mother's dead'. The patient crying, `I don't know, I don't know'. In the luxury of the supervision position, I could say, `Whenever a patient says, ``I don`t know'', they do know but they don't know you can bear it. And it could be a bereavement psychosis, we don't know what it is, but you pre-empted her response by saying, ``But your mother's dead'', sounding so shocked yourself'. The next week Anders would go back, `You said your mother was cold and hard'. Then she could carry on, `Yes, but they said if I lie on Mummy, now she's dead, they won't hurt her any more, now she's dead'. Each bit where Anders could not bear it, and I supported him, the patient was then able to tell something a bit more that was even worse. I felt sick and petrified every week and I had no means, at that point, of understanding the difference between being struck dumb and confidentiality. In other words, I used confidentiality as a defence against hiding the fact that I was terrorized, even living in another country, by the traumatic secondary counter-transference. And I didn't realize.
Over the nine months, the patient, who had not had access to videos, could not read, did not come from a family that had any particular belief system that would account for these narratives, was talking about night staff taking her to all sorts of places, to churches, to cemeteries. And the way in which she tried to make sense of these events added to our sense of the authenticity, like, `Why take your clothes off in the moonlight? You can't get brown. It's not hot at night'. So we could hear, with the level of disability, her trying to make sense of it. All of this carried on with us hearing about people with cloaks, who spoke in a funny language. Just nearing the nine months, there was a moment where the patient said, `They gave me shit to eat'. Anders said, `They gave you horrible food'. The patient cried and said, `I don't know'. Again I said, `Anders, you pre-empted her. It might be horrible food but you didn't let her stay with what shit means to her'. He went back and said, `You said they gave you shit to eat'. She said, `Yes, on a plate, and dog shit too, and it made me sick and it made the little girl sick and we spat it out'.
And that was it. Somehow, at that moment, the phrase `little girl', and the outside reality terror of the unsolved murder, brought in a child protection aspect to both of us that we could no longer dissociate from, as so many of us do when we're hearing things from an adult. Anders suddenly felt totally different, so did I. I said, `Anders, this sounds like ritual abuse'. He snapped at me, `Of course it is, but we don't have it in Sweden'. I said, `Well, we don't have it England, either'. And the moment we'd had that conversation, all her psychotic symptoms went, her self-injury went and she started improving dramatically. It was so painful, that we had been representing her denial in our combined terror. Also, something about it being named meant that I was more aware of the toll this call took on me. Richard Davies, who is now director of the Portman Clinic, ran a child protection course with me at 10:30 am every Wednesday and on this morning, just after this, he came in and said, `What's going on? Every week I see you, you look sick and you've just had a call from Sweden'. So something happened for him, to free him to notice. And I just burst into tears. He then pointed out the difference between confidentiality and being struck dumb.
He said it was really important that Anders should come to England and present at the Portman Clinic, which Anders did. He got a huge amount of support, including from my late analyst, Mervin Glasser. He went back and found a team he could trust, all of whom got threatening phone calls. It's probably been three generations of police teams that have since gone through it and all faced the same secondary traumatisation as we did. But the woman is safe. In Sweden, if you think any patient can be in danger, it's law that a safe place has to be found for them. I wish that happened here. The laws on innocence are stronger in Sweden, too. So, despite the fact the police have considered her narrative extremely correct, there has been no arrest and it's still presumably carrying on.
Then, at the end of a conference in Scotland for psychiatrists, talking about abuse and disability, I mentioned in the last sentence, `And if you think ritual abuse is a strange thing that's been invented in America, I've seen one case in Sweden and I know that's real. And I've met the woman and I've met the police'. The next day I got two referrals at the Tavistock, by health service professionals, saying they were desperate to talk about a case. I saw them the next day. As soon as the first one started walking towards me from reception, limping, I just knew instantly in my counter-transference that she was limping from torture and it was her. So the first non-disabled adult I saw, other than parents of people with a disability or parents of a child in therapy, was a health service professional, a highly intelligent woman who had gone through exactly the same thing.
As a child therapist, I'd been given sanction by the Tavistock to work with adults with disabilities. Although I hadn't had any dedicated adult training at that point, you do work with parents as a child therapist, and obviously there's something about the analysis and the rigour of that training that equips you for a whole range of things. But I wasn't an adult therapist. Now I am. I thought there's no way the Child and Family Department would give permission for me to work with a non-disabled adult. Who did I trust in the Adult Department? I rang Rob Hale, who came to see her with me and could see she was real, that it was authentic, immediately. We thought she would switch to him, but she trusted me because I'd spoken in public about it and she would not make the change. So Rob had to cover me, as a child therapist, and we worked with her together, and that was how this other work began, and one of the key reasons why I went on to do an adult training. So one severely learning-disabled woman in Sweden really totally changed my life.
GG: And that led to you treating a number of ritually abused patients at the Tavistock.
VS: Yes, Rob Hale was still in the Adult Department at the Tavistock and I was in the Child and Family Department. People suddenly started phoning and writing in. It's amazing how it gets about that somebody who can hear this exists, not that that means it's true every time, or that there isn't distortion and fantasy as well, but that there was something involving ritual that was even more terrible and frightening. In a way, calendar abuse was happening, so the actual days of the week and seasons were being used as agents of terror. If you think of families or schools where punishments were ritualised, so it's a way of adults disowning responsibility for hurting children, `It's not me, it's Friday at 4 o'clock' or, `This is punishment time'. It's a brilliant way of keeping people in terror longer, that's not just personal. So ritual abuse, as something that puts in a structure, a format, a date, a time, a procedure - whatever the belief system, or without a belief system - a ritual used for a negative, has an extra devastating impact. It so happened that, with the majority of the people coming, the nature of the ritual was either from a satanist belief system, or it was paedophiles using a satanist gloss to frighten their victims more. But, as Hereward Harrison of ChildLine pointed out, we don't care what the belief system was, whether it was true or not, the fact is the children believed it. Some of them grew up with it as a belief, having got it from the adults.
In the kind of ritual abuse we were seeing, to say what the crimes are is terrifying to people because they are not part of common knowledge. For the record, since the subject gets so charged, the crimes I'm talking about are cannibalism, induced abortions for the purpose of murder and cannibalism, necrophilia, bestiality, anal, vaginal and oral abuse, and murder. Those crimes are in addition to the severe kinds of grievous bodily harm and everything else that people know about: eating shit, drinking blood, drinking urine, they make people feel sick, eating spiders, being put in coffins for long hours with spiders and snakes. They are all things that stir up archetypes, which is why they are used, of course. Those kind of crimes are pretty unbearable ones to hear about. You are hearing about those all the time. What do you do ethically?
GG: Those are awful crimes. How many ritually abused patients did you see with Rob Hale?
VS: It was 51 that we saw altogether. I think about half of those were seen by Rob, where a psychiatric interview was needed, and then we combined later with the research project. Although he was a consultant in the Adult Department, it was the point where job definitions were getting tighter and it wasn't in his job description. But he was able to do it in his own unpaid time, and ditto me. So we did a couple of years of dealing with this work with no financial support for the time it took. As we saw more and more people, it became clear to us that these people, mostly women, were being doubly traumatized because the health service professionals they went to didn't know this existed. Even where professionals thought there was something here, they were frightened to respond in case it got them into trouble. So, similarly with the police.
A couple of years later, Rob was made director of the Portman Clinic, and all these practices involved crimes, which fitted into the remit of the Portman, so Rob was able to do this within his own paid-work time. We were also given £22,000 by the Department of Health and that paid for my sessional time and for a research assistant. The people started coming in and we were particularly wanting to look out for Munchausen syndrome. We had in mind Arnon Bentovim's research where people with Munchausen often have been abused and the distortion often comes where there was not something to deal with the pain when it first happened and it then gets displaced. We were also very aware, and I had the book on memory (Sinason, 1998) either out or being collected, that traumatized people are going to have more distortions, but that basic traumatic memory is encoded differently. We were looking at those issues before they were generally part of psychotherapists' training.
GG: What did you learn together from seeing these patients?
VS: What we learned from that study of the 51 people was profoundly disturbing: that there was no mental illness that could account for their narrative. Out of 51 people, there were only a couple where we both had serious doubts about parts of the narrative and with those it's still open to question because we did not get the police research support we wanted. Fundamentalist religious belief systems did not account for it. I think we were expecting that, by the laws of chance, there would be somebody who was so brought up with a cruel Satan in their local church, that they would go looking for a concrete one, or rather they already had a concrete one. But in our sample, only two people had actually gone to a fundamentalist church and they had only gone to that church because no one else would hear them. They did not like what happened in the church, the quite brutal exorcisms they both respectively got and the way they were seen as evil.
We sent our preliminary findings to the Department of Health, which were: no fundamentalist religion, it's not psychosis, and it's not recovered memory (they had their memories on coming to us) and the fact there was no training on dissociation for most professionals, and there were no refuges. They had all been informed and this was a very difficult ethical clinical issue that Rob and I had to hold over what was safe to put in the public sphere and in what way.
Then Rob and I were asked to go on a radio programme, and, at the last moment, Rob said he wouldn't. He suddenly got worried about the implications. We had got permission from the Department of Health because it was only to say those agreed bullet points, and I really wanted those in the public sphere because it would stop those urban myths, and Rob was now clear he wouldn't take part. I wanted to then withdraw as well, because with the splits we struggled with together, I didn't need to be the one publicly massacred. But then the producers of the programme said they would go ahead anyway because they had tape recorded things earlier. They had already tape recorded me and they had tape recorded other people. Then Rob was worried it could be worse if I was not on. So he wanted me to represent us. Then of course, the publicity could make a split: Rob Hale was not part of it, here was Valerie Sinason saying these mad things. Rob and I do laugh about this now.
Now he was director of the Portman and, meanwhile, the research money had come to its end. Rob realized he did not think the subject suitable for the Portman and the Portman Clinic did not want the subject. Had the Portman been able to include it in their clinical criteria, it would have stayed there. There would have been plenty of support and I really felt that should have been the home for it.
GG: As a result of which you set up the Clinic for Dissociative Studies.
VS: As a result of which, the contracts for the patients were still there, and Rob said, `I'll get the permission of the Trust to transfer it to you privately', because I would not drop the patients. He did arrange this, which was a big thing for him to have done. Then I discussed how I should go about it with Arnon Bentovim, who helped to explain the process of becoming an independent provider clinic and getting a consulting room and getting clinic insurance - which is different from personal insurance - getting an assessment body and sorting things out.
That really was incredibly painful for me. It was the point of the learning disability service at the Tavistock not becoming . . . not going through the path I had hoped, although, thank heavens, there now is an all-age service, so the work seeded. I'm a pretty institutional person. I was brought up loving institutions and it was a huge bereavement and, even though the Portman was a newer home, it was a small place, about three-quarters of the staff were personal friends as well, and the secretaries were wonderful. I really liked the environment and I really felt that was the place. I had never, ever wanted private patients and I had never wanted the administrative bother of starting up something of my own and it could not be private practice, it had to be a clinic structure. So I then started up the clinic and many more people began coming in for referrals.
GG: The clinic is called the Clinic for Dissociative Studies, could you tell me about dissociative identity disorder and its relationship with ritual abuse.
VS: Yes, dissociative identity disorder means two or more personalities or states of mind that have recurring control of the body, each with their own unique way of perceiving the world. They are separate entities. This isn't due to alcohol intoxication, drugs or epileptic seizures. That's within the DSM-IV criteria.
Just as I had never come across ritual abuse until the Swedish case, I had never come across multiple personality disorder, as it used to be called. I had seen The Three Faces of Eve, and been very moved by it, like thousands of people. But it was not part of any other thinking. It came up where somebody coming for one of the Portman assessment meetings, did not turn up in the session time. Someone else had phoned to cancel the session with a totally different name. Then, when the session was totally over, the first person rang up to say they did not know where they were and they had missed their session. That was my first confusing, bewildering encounter.
So what kind of experiences lead somebody to need to operate in that way? The research from America, where, as with everything to do with abuse and trauma, they seem to be about ten years ahead, was that this was linked to trauma. More specifically, trauma linked to attachment figures, in that the child under five cannot conceive of a parent or key caretaker who is sadistic, mad or in a temporary state of not managing. The child has to think the parent is good because their survival depends on it, so they have to find another way of coping. The normal kind of fight-flight mechanisms, that for a teenager can lead to running away, or fighting . . . if you're little you can't run away outside. No one would be able to look after you, you couldn't look after yourself and therefore flight inside is the only mode of survival. So it seems to be a very creative kind of use of the imagination for the purpose of survival.
Think of stages of dissociation that we all know, not just the autopilot - how did we get somewhere when we've lost our memory of how we got there - but where there is something that frightens us. For example, a memory of school playground bullying where we seem to be slowed down somehow and yet your hearing and sight are very sharp and you have a sense of everything being in slow motion for protection. That's a sort of stage along the way. Then supposing it's you being kicked. There is then the sense of you being outside looking at that little you being kicked because it's not bearable to be there. This is the experience where people have all sorts of out-of-body memories looking down on themselves. If it's an attachment figure, and it goes on and on, then there is a point where it can't be me because my name's Mary and I'm eight, so that little girl there, she's not eight, she's five and she hasn't got parents. The next time abuse reaches a certain pitch, then that new one takes over and is fleshed out with fragments of the original personality to empower her. She then uses the creativity of the host to develop herself.
Some newspapers have mentioned claims that amazingly high numbers of people have been mridered in these rituals. Now I’m realising, through the DID work, that where people have experienced an inside person being killed, where there is no corpse to show, that still was a person, a death.
GG: Inside people being other personalities . . .
VS: Other personalities that are perceptually seen as another person. So the external figures could have been very different. We have certainly found the alleged murder of an outside person very small - well, `very small', what an awful thing to say, it's like talking about `ordinary abuse'. In terms of the kind of excited, `thousands of microwaved babies' bonkers ideas, there were something like, I suppose, an average of three murders that any individual aged 40, say, was mentioning, outside of induced abortions.
Those were murders of people on the periphery of society. Fifty bodies are found in the Thames every year that are never identified. There is an illusion we live in a society where every death is looked at. People need reminding that many of those murdered by Fred West were not even on a missing person's list. There was not even someone who cared about them enough to know they were missing. There is the idea that everyone would know if a baby was born. Who? Someone sharing a flat with somebody? You know, what do urban people know of large rural areas? Think of all the babies who were left in Ireland and other places where abortions were not allowed. Yet there remains this idea that everybody would know if someone else had had a baby and they would know if it was killed or not. Equally, a baby could be kept hidden, and maybe that's where my disability background helps - where people fear the sight of a disabled child will mean their other children won't be accepted, or won't be married, because other people will worry about the genetic inheritance. So they keep the disabled child in a room. Just like the Queen Mother's cousin, who had a learning disability, was kept away. Or just like the other prince, Prince John, with his epilepsy and mild learning disability - kept away, wiped out. Learning-disability people know how people can be kept hidden.
GG: I know you have found that ritual abuse is often part of a family network, so there are powerful attachment issues involved.
VS: Whilst you can have dissociative identity disorder from extreme emotional abuse on its own, and we really underestimate emotional abuse, the commonest group seen in America are where there's physical and sexual abuse too. We've been calling it an attachment disorder. There is controversy over this, but those of us who think that's useful language do so because concentration camp survivors, who've gone through extreme torture, do not develop DID. Vietnam vets have not developed DID. Yes, they can have amnesic states, fugues, dissociation, flashbacks, but DID seems to be where you cannot bear the nature of who the person is that's hurting you. So it's primarily for evolutionary purposes, the child's need for an adult for their survival.
Tragically, in the sample we've seen, but also in a lot of the American samples, ritual abuse of whatever kind, abuse in which there are regularities and repetitions of place, time, meaning, sometimes with a religious belief system, whether satanist or other, but where there are those repetitions around dates, and it involves family members too, is par excellence a breeding ground for DID. One of the problems there's been is that initially there was awareness of incest, families abusing their own children, then there was awareness of stranger danger, paedophilia. What has not caught on adequately and where the most serious, chronic abuse goes on, is where the two combine and you have got paedophilia in the family with outside people brought in and it is not just one parent, it is multiple perpetrators that are interconnected. Our theoretical difficulty in putting incest and paedophilia together is part of the reason why we find this hard to see.
GG: So that contributes to the powerful societal impulse to deny that this abuse could be going on. In this context, can you tell me about the work of the clinic at present?
VS: What I knew from the start, with a controversial subject, is something wonderful that Pearl King said, who is my supervisor and a past President of the British Psychoanalytical Society. She said that for people to be really free, to see what they are seeing clinically, they either have to be old and retired so they do not care what anyone else thinks, or they are newly qualified - unless they are relieved to be free of just one orthodoxy so they expand into it themselves. Therefore, I wanted patrons for the clinic who would be supporters for it. So I would know that if there was the twisted reporting that this subject creates in the media, where any time my name comes up you suddenly get lies from past distortions that get regurgitated, that there were patrons who would not freak out and who would understand that it came with the territory.
Pearl King, Sir Richard Bowlby and Peter Fonagy are the patrons. I see Peter Fonagy as a real renaissance figure over straddling research, the public view of treatment and the meaning of trauma on children's experiences. I also wanted an assessment team who were used to subjects which were controversial, were profoundly experienced and solid. So Arnon Bentovim, who helped to create the clinic, does the psychiatric assessment. As a lay therapist, I need a psychiatrist I trust. Rob Hale also does some psychiatric assessments of patients we have shared, which is really nice, over review. And I really trust him over that. For psychology assessments, there is Phil Mollon, who is one of the leading researchers on dissociation, memory and trauma. There is also Tony Lee, who is in the development research unit at the Tavistock, working with Professor Hobson, who sees the severely learning-disabled patients who are multiple personality. Sir Richard Bowlby has done some of the videoing, because we are seeing it all as attachment trauma, and he was a medical photographer and he has been able to do that in a most courteous way, understanding the situation, not being thrown by it. My husband, David Leevers, has also been doing a lot of the videoing and, again, somehow does not experience a secondary traumatisation and can be very pragmatic about it in a similar kind of way to Richard Bowlby. Howard Steele is doing the attachment research interviews, in that we're taking that very seriously. Brett Kahr has been working with couples affected by DID.
There's a kind of growing clinic faculty. Shahnawaz Al Haque is working with traumatized learning-disabled patients who come through the clinic, and particularly those with a Muslim background, and he's looking at the meaning of dissociation and possession and satanism within that belief system. He's also a part-time imam. Liz Lloyd, who is a psychotherapist who works at Respond with learning-disabled patients, as well as with others, who has also taken on patients and has a particular speciality of understanding body communication and the way mental pain is expressed through the body. There are also Al Corbett, former director of Respond, and Jane Kitsen from CAPP. So I have been building up a team of people, providing different responses to the client group, including even, and this does need mentioning, body therapists - people who can deal with incredible pain in the body, and that includes cranial osteopaths. One of the beauties, after the pain of separation from what I'd seen as the institution I really loved, there is the pleasure in providing treatments that would not be possible within many clinics and seeing the relief given to patients when certain support can be provided that would not be provided in other ways.
GG: What about the onward referral of DID patients from the clinic?
VS: One of the most important issues has been creating links with other therapists across the country, building up a proper referral and treatment network. Also creating links with RAINS, Ritual Abuse Information and Network Support, and LASA, The League Against Sadistic Abuse, and making links with the survivors' associations too. Given the limited number of people a small clinic can deal with personally, one-to-one, and to avoid a horrendous unethical situation of long waiting lists, we've been negotiating and meeting with different therapy trainings to see who can take these topics onboard. The training that has been most helpful, not just from individuals but from the actual core training itself, has been CAPP, The Centre for Attachment-based Psychoanalytic Psychotherapy. We've done joint training days with CAPP, and we have a direct referral system, whereby people can apply directly to CAPP for subsidized treatment, as well as get a CAPP therapist linked to supervision from the clinic. That's a very important new development. There have been people from Regent's College, such as yourself, thanks to the impact of one of our faculty consultants, Brett Kahr and his ability to take on the subject. There have also been trainees and staff from Arbours. Whilst there have been individuals from the Institute of Psychoanalysis who are playing a major part in carrying out this work and offering support and assessment, it's not there in terms of the training body.
As with learning disability, and treatment of learning disabled patients, we've found that there is a very important historical process: until the training body will accept these cases as training cases, so that the senior practitioners are getting an understanding of the problems through supervising, you do not get the safety for a junior or trainee therapist to take on this work. The fear around the subject of abuse is such that you need the authority of the training behind you.
GG: There's a lot we don't know about how dissociative identity disorder works, is the clinic also doing formal research?
VS: We've got an amazing privileged database in terms of people that have gone through the worst experiences imaginable, allowing us access to their histories, the medical problems they have, the daily problems they have, and being interested in our joint working on this. There are a whole list of research topics on a waiting list, some of which are awaiting people's Masters degrees and PhDs. Hopefully somebody reading this might come and say, `I'd like to do a PhD on this. Would I have permission from clinic members to take this up?' What we have been looking at, amongst other things, is: How did it begin? Where does DID come from, what kind of experiences? What level of amnesia is there between states? What is the status of memory? What happens as people integrate? What is integration, or, as John Southgate and Jane Kitsen from CAPP call it, multigration? What are the different levels of pain from this experience? What is the difference between being programmed by others and developing DID as your own creative survival mechanism? What are the long-term physical problems from torture that result in patients going from one place to another for all the different bodily ailments because there is a lack of holistic responses, with very few people taking onboard the level of physical damage as a result of trauma? What is the meaning and impact of diagnosis? What are the ethical issues? So the list of research needing to be done is huge.
GG: I know that some of the patients being seen by the clinic are still being ritually abused. And this must raise important ethical issues for you as a clinician. Have you been able to get any support regarding these ethical issues from the psychotherapy or psychoanalytic professional bodies?
VS: No. We have written to them all and had acknowledgements, but had no response. Of course, how can there be if there is not enough of a body of us who have written in? I'm about to be sending off again, not just by myself, but also with other therapists from different trainings, a shared letter to say, `We are at risk, and the patients are at risk, in the absence of guidance in the ethical code'. Patients are at risk from their therapists' bodies not having a certainty around this. You see, if you have a total certainty that outside reality doesn't count, that it's inner work, it's easy.
GG: And it's the belief that outside reality doesn't count which has been the traditional view.
VS: Which has been the traditional view, yes. Although, again, where is the idea coming from that that's traditional? Freud and Anna Freud were key liaisers with police officers and barristers. Freud worked on a free association test he hoped would reveal guilt in criminal courts and wanted to do that. You find, on the whole, that Anna Freud cared a lot about child abuse and treatment of children. But then clones come in and fossilize what original pioneers did. So, yes it's traditional, but the word traditional needs close looking at. If someone is saying, `Well, I'm pregnant and the baby's going to be taken away and killed tonight'. Then what are you supposed to do? Or someone has witnessed a murder and you have told the police, which we have. You know, `Halloween is coming up. This person wants you to follow them and is saying there will be a murder'. `No'. The provision and resource needed when this is considered an unreal subject means it would only be a police officer who really had such a high moral sense who would push for something to happen. Since all the cases could turn into Fred West cases, then what's our position? `You didn't tell the police enough'. `You didn't tell the public enough'. Well, we have actually told, but that's no consolation.
GG: How difficult. Where would you like to take the work of the clinic next?
VS: I would really like to be doing ordinary analytic work. I would really like it if social work, refuges, volunteer systems, the law, the police had taken this subject onboard, so that clinicians, myself and all the others who I meet with, were not carrying a ludicrous multiple burden. I trained as a therapist. Being a therapist and a writer are the two things I care about. I'm not good at the sort of language and sort of memory and the kind of focussed thinking needed to fight for legal change in that way. I wanted to work with the huge inner worlds which are informed by the outer world. That's what I would like, plus writing. I don't like the lack of private time. This is not to be disrespectful to the brave people ringing in, but it's part of the outrageous position that they are in, that a bit of it gets to me as well. In the absence of a refuge, in the absence of help lines that understand this topic, I'm either living an immoral life or I do not have adequate private time.
GG: On that point, I'd be very interested to know what sort of personal impact this work has had on you.
VS: It's been huge. Family and friends might tragically even be able to document it better than me, in that it changed my life. We can often talk about, and truthfully, about learning from the patient and how understanding something profound, from privileged access to another, changes us. But this is on a totally different level. I'd say it tested every friendship, every relationship, in different ways along this 12-year period.
I would say, initially, there was the issue of how people dealt with my secondary traumatisation, where I could not think, speak, anything else in any moment of private time. So everybody close to me will have suffered from not having the me that they knew. I could not have done this work with young children. Then there was the fear it brought to those close to me that their lives could be in danger, before we understood properly how these mafias operated, where the patient's terror that everyone they cared about would be hurt, which they had been brought up to believe, made them feel any therapist they went to, and any family of that therapist, and any friends of that therapist, would be hurt. Whilst we could do our best to contain the fear of the patient in the session - and look, I'm using the dissociative `we' instead of `I' at this moment - I could feel, am I doing something that's going to bring danger to those close to me? There were people who could not bear it and we stopped seeing each other. There would be parties where I would just nab somebody, talking about this subject, not realizing I was in a traumatized state. And, I'd say for one year after the first English case, I was looking under the car expecting a car bomb, I was expecting the phone to be tapped, I was treating every call to any friend as if someone was listening, which was affecting how I communicated. I was torn over any conference I was in that was publicized, did that mean abusers were going to be there? Would that threaten patients I saw? It was endless. It took a year before I thought there was an ordinary world which existed as well as this. Then there was a period of getting to grips with the subject, researching it, feeling I had a grasp of the basic themes that were repeated in different ways in everyone.
Then the next jolt came, which was when the dissociation that was noticeable in a significant minority in the Portman sample, suddenly started increasing in the groups coming to the clinic. While I stayed, if you like, distant, therapeutically distant, looking at it, intrigued by it, concerned for it, it didn't affect me personally in the way the original understanding of ritual abuse had. But once I started getting closer, particular patients were telling me my trained neutrality was an affront to all they had gone through, because if I could be trained to be like that, then I could be trained to be like their abusers or like them. It was clear that a person-centred, relational approach was the only possible approach, because nothing was safe for them. Then for me there was kind of re-traumatisation again, where private time got more and more eroded.
I'm at a curious other point now which is linked to ageing, and again it's something I owe a lot of thanks to Pearl King for. She is one of the few people to write about the impact of the ageing process - and it's because of her that people over 40 can train as analysts, or be seen over 40. This means actually noting changes in what you can manage and tiredness. So, when the menopause suddenly appeared, and I realized to my shock, as someone who's got a lot of energy and liked best working till one in the morning, and doing a lot of e-mailing and writing and phoning in the 11 o'clock to one period, suddenly I would be ready to go to bed at ten. So I'd be losing 14 to 18 hours a week, and despite all the good effort I'd put into nurturing myself, suddenly I had less time, so therefore the amount of private time work takes up is larger but this is not to do with me not having an adequate filter, it's biology that has altered it. So there's working out that as a transitional stage.
GG: I'm aware, too, that you used to write a lot of poetry, and have two published collections of poems, but you have not been doing as much creative writing lately as you used to.
VS: Yes, there's a kind of writing which comes from working through something to do with sadness. And there's different kinds of writing that come from happiness but a profound awareness of the pain of human existence. I think there's something about my life that is very happy and is very settled, and the poetry-me goes into my clinical work. And the prose writing comes out more and it's the prose writing I'm looking forward to more time for. I really want to write novels, as well. I think some of the things I've had access to would not be believed in a clinical paper. In all the clinical writing on ritual abuse and dissociation we are trying to help people start at the beginning: What is the first session like? What does it mean? Not what happens after years, which people won't be able to hear.
So, if you like, I am wiser now. Before, I would be the ancient mariner stopping the wedding guest, with the albatross, saying, `You've got to listen to this'. Inflicting trauma on colleagues who did not want to hear it. Now I can accept if you cannot hear it, you cannot hear it, there's reasons for it. People have to be given what they can manage, but the law and access to services have to be done. The subject is still in its infancy - infancy isn't the right word - it's frozen, because it's awful. The client is the evil messenger and so is any therapist or professional who says this matters.
GG: That's a powerful note to end on. Thank you very much.
VS: Thank you.
Sinason, V. (ed.) (1994) Treating Survivors of Satanist Abuse, London: Routledge.
Sinason, V. (ed.) (1998) Memory in Dispute, London: Karnac Books.
Sinason, V. (ed.) (2002) Attachment, Trauma and Multiplicity: Working with Dissociative Identity Disorder, Hove, East Sussex: Brunner- Routledge.