Critical issues in the dissociative disorders field: six perspectives from religiously sensitive practitioners.

This article is a compilation of responses to six questions concerning critical issues in the contemporary psychological and spiritual treatment of dissociative identity disorder (DID--formerly multiple personality disorder). The panel of respondents, most of whom are well known in the dissociative disorders field, is comprised of Elizabeth Bowman, M.D., Harry Carlson, M.Div., Christine Comstock, Ph.D., James G. Friesen, Ph.D., Jerry Mungadze, Ph.D., Christopher H. Rosik, Ph.D., and Carl Wilfrid, M.Div. An overview of the responses indicated that the panelists varied sharply in their willingness to consider exorcism as a therapeutic option. Even those who were willing to consider exorcism differed in their understanding of the clinical threshold that needs to be met before initiating such a spiritual intervention. Clinical neutrality and caution regarding the veracity of specific traumatic memory content was commonly urged. The church community was seen as an important potential resource for healing, despite its historically mixed record in ministering to DID sufferers. Perspectives on the future of the dissociative disorders field ranged from guarded optimism to overt pessimism. These responses highlight the divergence of opinion that can exist over controversial issues and suggests the need for continued dialogue between and among clergy and religiously oriented therapists.

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The phenomenon of dissociation and its clinical manifestations, especially Dissociative Identity Disorder (DID), have gained increased scientific attention and scrutiny in the past two decades. Many contentious professional debates can be found in the literature that involve some aspects of DID theory or treatment. However, there have been few forums for professionals with religious sensitivities to share and contrast their views on issues within the field of particular interest to the faith community. (1)

The intent of this article is to create such a forum by soliciting responses to several questions from seven professionals who each have extensive experience in treating dissociative disorders (DD). The panel consists of one psychiatrist (Elizabeth Bowman), four psychologists (Christine Comstock, James Friesen, Jerry Mungadze, and Christopher Rosik), and two clergy (Harry Carlson and Carl Wilfrid). These panelists respond to questions concerning exorcism, false memories, the role of the church, the positive and negative effects of religious faith, changes in the treatment of DID during the past two decades, and predictions about the future of the dissociative disorders field. As the reader will observe below, although there is a general consensus of opinion in some areas, meaningful differences in perspective also exist and shape the specific therapeutic approach these practitioners take to the religious and spiritual aspects of DID treatment.

What is the role of exorcism in the treatment of DID?

Bowman: DID is not a spiritual disorder, but a mental disorder that calls for psychological treatment. Exorcism is a spiritual treatment that does not belong in the treatment of psychiatric disorders, DID included. Persons who advocate exorcism for DID patients view them as ill with both a psychological and a spiritual illness (i.e., DID and possession); thus, they believe they are making accurate differential diagnoses and applying appropriate treatments for both conditions. Exorcisms in DID treatment are performed by well meaning practitioners, but I believe they are the result of misunderstanding the psychodynamics of DID, mis-diagnosing dissociative phenomena as spiritual possession, and failure to recognize transference and counrertransference pressures. The majority of outcome reports on exorcisms in DID patients show negative or short-lived clinical consequences (Bowman, 1993; Bull, Ellason, & Ross, 1998; Fraser, 1993; Pfeifer, 1994). In the United States, exorcisms are also extremely risky legally, so I advise secular and religious therapists avoid them.

Exorcisms usually involve DID patients who are treated by conservative Protestants. This clustering of demon possession with dissociated identity and with therapists who believe in demon possession should raise thoughtful questions. Are DID patients really more susceptible to demon possession than other human beings, or are dissociative ego states being perceived as demons? Why do so many of the DID patients of some theologically conservative therapists but none of the patients of theologically different therapists seem to need exorcism? Enthusiasm for exorcism seems to be associated with considerable interest in reports of satanic ritual abuse (SRA) (Friesen, 1992), raising the question of the therapist's role in the production of these reports. The historical reality of SRA reports have been called into sharp question (Fraser, 1997); therefore, reports of possession during satanic rituals need to be re-visited or given other explanations (e.g., fantasy prone personality; Wilson & Barber, 1983).

Addressing exorcism in the treatment of DID is difficult because exorcism and possession in DID straddle two clashing world views-the scientific and the spiritual. Still, Christianity asks us to think critically about spiritual matters (1 John 4:1). It is impossible to scientifically test for the presence of demons in DID patients, so I am skeptical that practitioners can reliably distinguish demons and alters in DID patients. Claims to distinguish demons from alter egos are based on the subjective conclusions of secular and religious observers, each rooted in different worldviews. Few studies exist of actual outcomes after exorcisms (Bowman, 1993; Bull, Ellason, & Ross, 1998; Fraser, 1993; Pfeifer, 1994). Lists of purported characteristics of demon possession are entirely composed of phenomena that colleagues and I have seen in quite human DID alter egos (Friesen, 1991). Angry alter personalities often exhibit behaviors that appear identical to traditional descriptions of possession: evil-appearing glares, a ngry voices, self-hatred, self-harm, aversion to God and religion, and other symptoms.

The apparent disappearance of supposed demonic phenomena after exorcism is not retrospective proof of possession. In highly hypnotizable people (e.g., some DID patients), hypnotists can induce and relieve paralysis, anesthesia, and other physical conversion symptoms with hypnotic suggestion. Alter personalities, who were seemingly exorcised, have reported that they have hidden for years afterwards. This could explain symptom disappearance. The exorcism ritual may function as behavioral therapy, which temporarily extinguishes the behaviors of malevolent alters (Bowman, 1993; Fraser, 1993).

These rituals may also function as religiously acceptable metaphors that allow patients to relinquish childhood identifications with the evil in their abusers. Non-religious hypnotic interventions can accomplish the same thing without the spiritual risks of labeling the patient as evil. One of my colleagues helped DID patients bundle up ego-alien identifications with abusers and hypnotically mailed them off to eternity with no return address. These techniques give patients power to relinquish ego-alien introjects without calling them demonic.

Possession is recognized as a culturally sanctioned dissociative trance state in many cultures. When nor culturally sanctioned, possession is part of the diagnosis of Dissociative Trance Disorder in the DSM-IV section of criteria sets for further study (APA, 1994, pp. 727-729). Given the long association of possession with dissociative trance states, I suspect that lists of the characteristics of demon possession have been drafted from unrecognized Grade V hypnotizable persons and undiagnosed DID patients seen over millennia. Thus, it is understandable that modern DID patients appear to fill the criteria for demon possession.

Practitioners considering exorcism should first read Wilson and Barber's (1983) treatise on highly hypnotizable persons (i.e., Grade 5 hypnotizability) and their ability to abreact fantasy that they cannot distinguish from reality. These "fantasy-prone personalities" can evoke physiologic stigmata based on fantasy alone, just like those described in demon possession. Since Christianity asks people to handle truth carefully, Christian therapists need to educate themselves about the abilities of highly hypnotizable people before concluding they are demon possessed.

Recommendations for Practitioners. If you are thinking about considering an exorcism, do not act until you have obtained consultation and three to six months of close supervision from an experienced, well-trained psychodynamically oriented psychotherapist. Also, consult your malpractice carrier, your employer, and your lawyer. Protestants: you do not have a monopoly on spiritual wisdom; listen to the advice of a Catholic priest or bishop with experience in discerning demon possession and the need for exorcism. Finally, ask your patient to be seen by an experienced dynamically trained consultant for a second opinion about diagnosis and treatment.

In supervision, carefully consider the psychodynamic formulation of your patient and her object relations, and transference and countertransference pressures. Consider whether projective identification (i.e., you feeling the patient's unconscious disavowed feelings), identification (yours and the patient's) with aggressors, or your own frustration with therapeutic impasse are motivating you to label part of this patient as demonic. Is exorcism a fantasy to rescue both you and the patient? Consider if you are "acting in" (e.g., enacting the patient's disavowed view of herself as evil and in need of banishment, or enacting her desire to have a powerful parent rescue her)? Consider the narcissistic trap of unconscious temptation to feel like a powerful hero (i.e., a spiritual warrior)? Would you feel as gratified if someone other than you did the exorcism? Feelings of powerlessness and attendant rescue fantasies are a common countertransference when dealing with trauma patients. Read literature on countertransfe rence in treating trauma and borderline personality disorder (Herman, 1992; Wilson, Lindy, & Raphael, 1994), and on managing treatment boundaries (Hundert & Appelbaum, 1995), avoiding dual roles (pastor/exorcist and therapist), or misusing power and position (Peterson, 1992).

Consider if there are hypnotic alternatives to exorcism that would allow the patient to dispose of her ego-alien identification with the evil done to her without labeling herself demonic. How might your patient feel if the exorcism does not "work"? Many negative spiritual and psychological outcomes from exorcisms of DID patients are rooted in shunning of patients by churches or in the patient's view of herself as evil and untreatable after symptoms return. What will be the consequences for the patient who now understands herself as demon possessed?

Therapists in the United States, including pastors and pastoral counselors, who perform exorcisms on DID patients should be prepared to defend themselves against malpractice lawsuits, professional ethics charges, or loss of licensure. Abusive exorcisms that injured or killed patients have resulted in criminal charges. Theology aside, performing exorcisms on therapy patients is forensic suicide. Acquaint yourself with literature on recovered memory and risk management before proceeding (Gutheil & Simon, 1998).

In short, my advice to therapists considering exorcism with any patient (especially a DID patient) is to slow down, educate yourself, get supervision and consultation, and think very carefully about your motivations and unconscious pressures in the treatment relationship. If you have even the tiniest doubt about an exorcism, do not become involved with recommending or executing one.

Carlson/Wilfrid: This is an incisive and perhaps key question. It can be very tempting for those treating individuals suffering with MPD/DID to "get it over with in a hurry." In addition, many patients also are eager to "do something magic or quick." This can be damaging to the patient who may either feign integration to please the therapist or become more anxious because "nothing happened."

Is the entity a demon or an alter personality? It is crucial to know what we are dealing with. A Biblical admonition: "Do not believe every spirit, but test the spirits" (I John 4:1). Even Jesus, when he meets a demon, confronts him by asking, "'What is your name?' ... 'My name is Legion'" (Mark 5:1-17). Who are you? What is your purpose? Clergy, above all, need to be very cautious before assuming an entity is a "demon." The New Testament refers to both "demon-possession" and "demon-oppression" (Acts 10:38).

Some years ago, a woman came seeking an exorcism. Two previous exorcisms "did not take." While speaking with her it became clear that she did not have a demon, but she was oppressed by a very angry alter personality. Exorcism is for demons, not alter personalities!

A word of caution for clergy and others who tend to look for demons: Test every spirit! Really ask questions! Be empathetic, but listen to the personality coming out. Ask questions with sensitivity. Remember, persons with MPD/DID know when you are not being honest, and they are always testing your integrity.

Test every spirit means every entity, including the Inner Self Helper (ISH). On one occasion, a patient related that an evil (therefore fake) ISH was providing me wrong information. We developed a "cue" (Jesus is Lord) to assure proof. Shortly after this, the person stated the fake ISH was still there, so we changed the cue to "Jesus is my Lord," which the fake ISH could not say (cf. James 2:19).

Do not get involved in this kind of counseling if you cannot devote the time to continue. It is tempting for all of us to try shortcuts, and sometimes exorcism can be a potentially false and dangerous attempt at a shortcut. In Mark 9:14-29, Jesus cast out a demon that had been troubling a man "since childhood." Quite interesting! The disciples were unable to cast it out, and Jesus says, "This kind can be cast out only by prayer." This suggests a more lengthy kind of process. The passage also states that the disciples were unable to do the exorcism in the usual way. Jesus does but it hints at a different kind of approach in dealing with certain demons.

Comstock: Exorcism casts out something that does not belong. Dissociation is the separation of a personality into parts that do belong. Therefore, exorcism is not an appropriate treatment for dissociation. Clinical findings do not demonstrate any long term benefits from exorcism, whereas even a spirit could benefit from therapy. I focus on interpreting the person's feelings about the part or pattern that they want exorcised in the clinical manner, asking about past experiences, other people's reactions, meanings, feelings, and the issue resolves in the usual way.

Friesen: When it comes to the word "exorcism," some strange images of dark, unfathomable struggles come to mind. Hollywood has had a field day with this word. This is not how God works, at least not in my office. He simply expels evil spirits when called on to do so. If there is a struggle, it is a human struggle, due to unhealed wounds and unresolved conflicts within people. When healing and resolution are in place, the devil is easily defeated. As people get closer to God, their spiritual battles become more effective. "Submit yourselves, then, to God. Resist the devil, and he will flee from you. Come near to God and he will come near to you. Wash your hands, you sinners, and purify your hearts, you double-minded. Grieve, mourn and wail. Change your laughter to mourning and your joy to gloom. Humble yourselves before the Lord, and he will lift you up" (James 4:7-9). James is calling all of us to a deeper walk with God, and dealing with difficult feelings, including grief, mourning, and gloom, will be part o f it. As we get more into alignment with God, it becomes easier for us to resist the devil.

In I Peter 5:8-9 we are all told to be on the alert because of the devil's destructiveness. "Be self-controlled and alert. Your enemy the devil prowls around like a roaring lion looking for someone to devour. Resist him, standing firm in the faith ..." Many people with DID have experienced religious abuse (i.e., the misuse of power by authority figures in a religious context) and spiritual abuse (e.g., curses, hexes, family sins, exposure to the worship of Satan, and other attacks in the spirit world). The devil prowls, looking for weakness in each of us. Those who have suffered religious and spiritual abuse are particularly vulnerable to the devil's attacks-reminding them of their abuse, falsely blaming them for the abuse, and falsely concluding for them that God will not help them. We all need to be spiritually clean so that these kinds of lies from the evil one will not take root in us. It is particularly important for people with DID to get spiritually refreshed and cleaned as part of their healing, so th at the evil one will nor be able to attack them at the point of their woundedness.

Religious strength and protection are vital for those whose wounds are deep. In the apostle Paul's call for Christians to use God's armor (Ephesians 6: 10-18), he stresses that people are not our enemies, but that our struggle is against the rulers, the authorities, the powers of this dark world, and the spiritual forces of evil in the heavenly realms. It is incumbent upon us all to maintain strength as we fight against the devil.

Here are a few practical points for exorcism in particular, and for spiritual warfare in general:

1. Do not treat people as though they are demons. Despite people's good intentions, spiritual warfare often turns into religious abuse. The person carrying out spiritual warfare sees the dissociative person go from one personality to another, and falsely believes that a demon has just taken over. Then the abuse starts--talking to that part of the person as though it were a demon, and commanding it to go in the name of Jesus! What a horrible mistake. Not only does the personality just put in charge get treated very badly, but it also loses a chance to get some help. I have lost count of the number of people who told me that this happened to them. It is a terrible affront to God, it is a serious wound inflicted on the person who is supposed to be getting spiritual help, and it becomes very hard for the person to trust other Christians after that.

2. Do not carry out any spiritual intervention unless there is agreement with the client. To start casting out without the agreement of the one being prayed for is to ignite a storm in that person. If the person being prayed for does not indicate agreement, there can be no expelling. There will only be conflict.

3. Teach people how to exercise their power in the spiritual arena, including teaching dissociated parts to pray and to expel unwanted spirits.

4. When an attempted expulsion is not successful, it is not the client's fault. There may be a lie, a vow, a family spirit, or a religious spirit still attached to a wounded personality, and sometimes these need to be dealt with before the evil spirit can be expelled. Another development can go this way: The expulsion may be successful, but an evil spirit gets reattached sometime later. In order to prevent this, the lie, vow, family spirit, or religious spirit needs to be dealt with when the evil spirit is expelled.

5. Expelling spirits and bringing in God must go together. Remember what Jesus said about expelling spirits and unoccupied houses (Matthew 12:43-45). Expelling spirits is not what this teaching is about--it is about leaving a house unoccupied! Unless God is there, any person is wide open to being demonized. The crucial tasks are finding the wounds and conflicts that are blocking the person from turning to God, and then getting His light into the whole house (Luke 11:34-36).

Mungadze: There has been research proving that exorcism is harmful to DID clients. There has been research also proving that some exorcism has been beneficial to DID clients. In my own experience treating many DID clients who had been through exorcism, the majority of them had very bad experiences with exorcism, whereas a few had good experiences. The differences seems to be based on who led the exorcism. Those who had exorcisms done by people without clinical training in DID treatment had bad experiences and those who had exorcism performed by clinical professionals trained in the treatment of DID had good experiences. This leads me to conclude that exorcism has a role in the treatment of some DID clients, whose clinical picture shows the need for it. Exorcism should never be the initial step in DID treatment. It should not be a primary form of therapy for the DID client. It should be remembered that DID is a psychological disorder and not a spiritual condition. Spiritual issues that arise in treatment, such as demonization, should be seen in light of the total clinical picture

Rosik: Conclusions regarding the role of exorcism or deliverance prayer in DID treatment are, at present, likely to be greatly influenced by the therapist's worldview (Rosik, 2000a). In my judgment, it is premature to rule out at least a potential role for such intervention on the basis of the existing literature. The relevant scholarship on this topic is sparse and difficult to generalize due to such factors as variant definitions of exorcism and biases inherent in convenience samples (Begelman, 1993; Bowman, 1993; Bull, Ellason, & Ross, 1998; Fraser, 1993; Rosik, 1993, 1997). This also implies that exorcism as a therapeutic intervention should be approached very cautiously (Rosik, in press). It should only be considered with patients whose belief system recognizes exorcism as a valid ritual. As a prerequisite, the therapist should have (a) extensive knowledge of and rapport with the patient's alter personality system, (b) attempted standard psychological interventions that were unsuccessful, (c) inquired as to the phenomenological experience of the alters, and (d) obtained informed consent from most, if not all, of the alters. When attempted, the exorcism should be noncoercive and, wherever possible, patient led. Involving a supportive member of the clergy known to the patient can also be helpful. Finally, it needs to be mentioned that the employment of exorcism in the therapy of DID has a dangerous potential to evoke countertransference grandiosity on the part of Christian counselors. Ultimately, we cannot be certain whether successful exorcism expels evil spirits, therapeutically rearranges ego states, or both. Hence, I would not recommend therapists utilize exorcism unless they can approach it with a relatively matter-of-fact demeanor that conveys the intervention is simply another tool in the clinical armamentarium.

How do you address the issue of false memories in the therapy of DID?

Bowman: I use two approaches: educating my patients and maintaining therapeutic neutrality. Soon after trauma memories (recovered or continuous) are reported in therapy, I begin to teach patients about memory and the need for both of us to be cautious about its accuracy. I continue to educate about scientific findings on memory throughout treatment (Bowman, 1996a, 1996b). The primary educational messages are:

1. The memories of all people contain mixtures of accurate and inaccurate details.

2. External corroboration is the only certain way to know a memory's accuracy.

3. Spontaneously recovered abuse memories have been corroborated as often as continuous memories of abuse, but may contain mixtures of accurate and inaccurate details.

4. Do not mistake dreams or flashbacks for memories. Dreams are symbolic material. Flashbacks of documented events can contain inaccuracies.

5. Memories recovered during hypnosis may be accurate but may be more easily distorted by expectations or subtle suggestions.

6. Memories of ordinary childhood abuse have been highly corroborated (75%-90%), but memories of ritual abuse are rarely corroborated (0%-20%) and are likely not literal historical events.

In responding to continuous and recovered abuse memories, I give patients the responsibility to decide about their own memory accuracy. I decline to make statements of belief about uncorroborated memories, stating that "I wasn't there and I can't know for sure exactly what happened." I distinguish believing in them as people from believing in the accuracy of their memory processes. I avoid intentionally using hypnosis for memory recovery. I ask patients to consider literal and symbolic explanations for memories. I do not suggest that dissociative patients who lack abuse memories have been abused. I never suggest the identity of an abuser. And, I maintain neutrality as patients struggle with ambivalence about their memory accuracy.

Comstock: I know that memory is not perfectly reliable and I know that my patient knows that also. Two people can remember (or experience) the very same incident differently and a person's memory or understanding of an event will change over time. Therapist and patient will probably share an experience during treatment that will demonstrate this very point. I think of memories as a mix of some totally accurate portions and some distorted portions. The important clinical meaning of a memory is to communicate a similarity between the patient's feelings from the past and the present. Memories can point out which part of the present day life feels like the past and therefore, which part needs to be unblocked, reprocessed, relearned, changed, or grown beyond.

Friesen: First, I validate to the person about how hard it is to trust those images, and the bits and pieces of information that are trying to take shape in their minds. Next I educate them that intrusions into their conscious awareness are parts of them seeking healing, and I encourage them to help the dissociated parts. Then I make a very strong point-the memory cannot be evaluated until all of it is available to look at. We need to look at the primary material--the memory itself--before we can make sense of it, so I tell them to do what they can to look at the whole episode. Finally, I ask them to read my book, The Truth About False Memory Syndrome (Friesen, 1996), which emphasizes that a memory always comes from somewhere, and always has a factual basis. As we examine the memory we will be able to tell how much of it is real.

After a person has had a re-living experience in my presence, I explain to them how a "flashback" is different from other memories. Initially, it was too painful to process so it was dissociated by the amygdala, and it was recorded in bits and pieces in the right hemisphere of the brain, which does not have the ability to use words nor keep a story line. It is stored in bits and pieces because that is the way the right hemisphere works. At some point, often when something reminds them about one of the bits and pieces of the memory, it starts being processed for the first time ever! The episode that was too painful to process is now being processed, and whatever is over in the right hemisphere is now transferred, through the hippocampus, to the left hemisphere, where it finally gets words and a story line. The thing that is distinctive about a dissociated memory is that when the bits and pieces are getting lined up and put into a story form, the re-living goes into motion. While the event is emerging, each new piece of the episode becomes a surprise, in that the person had no idea what was going to come up next, and there is a pace established to the re-living that is often about the pace of the original event. This seems like a "making something up process" to some people-they conclude that the re-living is the mind making stuff up, but it is really the mind finding out what actually happened! Only after the bits and pieces are finished processing is it possible to make sense of the event. Until that time it will certainly seem unlike other memories, which did not get dissociated, and may therefore feel false. After the memory is processed, we will he able to see how it fits into the person's life.

Mungadze: In my opinion, based on all the research on memory, the brain and DID therapy, the best way to address the issue of false memories is to do good therapy that focuses on helping clients heal from whatever type of trauma they may have experienced. The therapy should not be reinforcing or discounting the client's account of the events recalled, but rather facilitate the client's objective evaluation of their memories.

Rosik: It is important, both clinically and legally, to address the current scientific knowledge regarding memory with patients. When the topic presents itself in therapy, I will usually discuss with the patient how research has shown that memory is reconstructive (as opposed to reproductive) in nature and that memories may be accurate, inaccurate, or some combination thereof. I do not believe it is the therapist's role to decide for patients if their memories are false or true. If they push the matter, I generally offer a statement such as, "I believe you have been through something traumatic. My intention is to assist you as you determine what this might have been." This usually deflates the resistance and builds alliance while keeping patients responsible for developing their own narrative truth.

3. What should be the role of the church in caring for individual suffering from dissociative disorders?

Bowman: The Bible provides no special commission for care of the mentally ill. Thus, the church's role with DID sufferers should be no different than with any other person, with or without a mental illness: to love and accept those persons, connect them to God, and provide spiritual support and teaching. The church should be guided by scripture in responding to DID sufferers: Do not be critical or judgmental by labeling mentally ill persons as sinful (Matthew 7:1; James 2:13). Treat the Dissociative Disorder (DD) sufferer as neither more special nor more sinful than any other Christian (James 2:1-9).

Encourage them to stay in therapy with a competent therapist, whether religious or secular. Do not instill distrust (paranoia) of all non-religious therapists because they may be the only competent community resources for treating DID.

The church should help DD sufferers and other abuse survivors directly and indirectly. Directly, the church should provide supportive congregational and pastoral relationships that convey acceptance of DID or PTSD as simply another type of human suffering (Bowman & Amos, 1993; Whitaker, 1994). Provide the usual social supports given to hospitalized persons (e.g., prayers, cards, visits, phone calls). The church should avoid sinning against DID or other mentally ill persons by quickly labeling frightening or mysterious symptoms as demon possession. The church should provide experiences where DID sufferers can serve congregants and be affirmed for their gifts.

Indirectly, the church should diminish stigma by mentioning mental illness in public prayers for ill persons and by teaching congregants about the difference between mental illness and spiritual malaise. Preach hope, healing, and God's love, but minimize messages that induce guilt for feeling depressed, angry, or for being less than perfect. Publicly name the abuse of children or abuse of parental power as sin. DID patients have often been abused by males, so provide female as well as male metaphors and images of God (Matthew 23:37; Mollenkott, 1983). The church should avoid contributing to a climate that dis-empowers women and children and separates them from direct communication with God. For example, avoid idolatrous chain-of-command theologies or theologies that render mothers less able to object to abuse by fathers. Also, use female and male examples in sermons to illustrate spiritual and personal strength and virtue.

The church's role is not: (a) to be a therapist or provide therapy; (b) to gratify incessant demands for attention or tolerate child-like behavior in public; (c) to treat the DD sufferer as special/different from other Christians; (d) to take a position on the DID person's memories; (e) to censure the person's anger or depression, or label them as evil or demon possessed. Erroneous judgments on those matters are very damaging. Such judgments may represent hubris and are God's job, not yours.

Carlson/Wilfrid: Faith Lutheran Church in Chico, California, has for three years held an annual workshop for sufferers and their significant others, families, and therapists, too. This came about because some members in the church have close family members who have been in therapy for DID. These workshops help families make connections and get some information out. Therapists, multiples, significant others, and helpers talk to the group about what this is like.

Out of this has grown an ongoing support group which has now spawned a second support group in a nearby city. There are probably not many churches that are doing this kind of thing. This happened because the pastor was working with DID and some key lay people had personal involvement. Support for people on their journey is so important. Having someone who is available as a wise and patient supporter can be of great help to patients and families alike.

Another role for the church is as a source of information. The church can host a workshop where pastors and therapists would be helpful in providing insights on counseling and other important matters. Many pastors have had dissociative people come to them, and while their counsel may not have been harmful, some knowledge could have been helpful.

As for the specific role of the pastor in caring for dissociative parishioners, a couple of important aspects of such a role come to mind. First, the pastor must be a developer of trust. Trust is the key ingredient in the establishment of a fruitful therapy. This can take some time, and this trust will be tested! Promises are covenant language. This is the way God works. God came to Abraham and said, "I will bless you, and you will become a blessing." This is a big theological theme: God is a God of covenant! Pastors should understand the need for making promises in terms of building relationships and building trust in these people if they are going to work with them at all. Most DID sufferers have a difficult time with relationships in general, and many have experienced rejection or abuse in church. A church needs to be a safe place from rejection and safe from additional psychological or sexual abuse.

Second, the pastor should be a person of love ([alpha][gamma][alpha][pi][eta]: agape). Love therapy is unconditional love. He or she must respect even the darker, nasty, angry, SOB kind of alter personalities that are in the person. This is the most important gift a pastor can offer. Most of the dark, nasty, suicidal, self-destructive alter personalities really have a soft inside; they want to be loved. They do respond to love and respect. No one has ever listened to these alter personalities or taken them seriously in their fear and brokenness. Unconditional love is certainly a Christian therapeutic approach. But it takes a long time for these alter personalities to trust, and it takes a long time to come to understand them. (Another reason that exorcism is at least premature: just trying to get rid of the alter personalities. That is the way everybody treats bad kids--trying to get rid of them.) How do we give them the benefit of some respect, and come to understand how they were formed, why they were forme d, what they have done, and what their concerns were?

And, let us not forget the positive alter personalities. These are often so weak, and fearful, intimidated, and polite. They are the rescuers; they are the alter personalities that bring balance, and they need to be included, strengthened, and encouraged for the healing and integration process.

Comstock: The church can provide the patient with real community in an atmosphere of love as well as spiritual support and guidance. The church can allow the patient to learn to participate in social and individual activities focused on the positive, unconditional, unceasing love of God even though there are tragedies and human betrayals. The church can teach the patient how to pray, how to see the miracles and graces in human relationships, and, also importantly, can help to fill the days. The church can allow the person to lose some of his or her sense of isolation and self-absorption as he or she develops additional social skills, relationships, and confidence.

Friesen: When the Bible says, "Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress" (James 1:27), the principle being underlined is this: Orphans and widows are examples of people who have no family. We are to be the family of God to them, and to treat them as though they were in our family. It looks to me like this principle is not understood very well in churches today, and therefore, the DID people who need a family often do not find one. In many cases, it comes down to this harsh reality: Therapy is of no value to them unless they get established in a family first. Therapy is a waste of time and effort unless their family needs are taken care of first. For a fuller examination of this problem please read The Life Model: Living From the Heart Jesus Gave You (Friesen, Wilder, Bierling, Koepcke, & Poole, 1999).

Mungadze: People suffering from dissociative disorders usually have acute needs, including needs that are best met by the church. These needs include: needing to be treated as every one else, having fellowship with others, being understood, and given spiritual support. I think that the church can meet these needs without care taking and without making them feel they are a project. It is important that the church give these DID clients privacy concerning their disorder. In order to do this, the church should not have information about their counseling.

Rosik: I have long contended that the church has an important role to play in the care of persons suffering with dissociative identity disorders (Rosik, 1992a, 1992b). For Christian DID clients, whose biological families are often extremely dysfunctional, their spiritual family often assumes a preeminent role in their lives. In addition, with the rise of managed care and the accompanying financial barriers to longer-term psychotherapeutic treatment, I believe in many cases the church will function as the primary agent of healing (Rosik, 2000b). This is because psychotherapy, while necessary, is not sufficient as it does not provide the supportive community so beneficial to the healing process. Quasi-communities such as those previously developed in long-term day treatment programs or inpatient units are no longer financially viable. In my experience, DID patients do not generally appear to benefit from homogeneous group therapy or support groups run by paraprofessionals, nor does such participation tend to br ing patients into contact with emotionally healthy individuals. As noted above, many of these individuals cannot turn to their own family of origin for the experience of safe human connectedness. Thus, the church is perhaps the last community in our increasingly individualistic society that has the human and financial resources to assist the DID sufferer over the long haul.

In specific terms, churches can care for these patients by fulfilling the biblical mandates to listen to and pray for them (James 5:16), encourage and involve them in the life of the church (Heb. 10:24, 25), and emphasize the theological teaching that has typically been missing in their lives regarding their value to God and God's love for them (Is. 43:4; Luke 12:7, 22:4; John 3:16). One caveat for pastors: There is a difference between supporting and enabling DID sufferers. Do not do things for these individuals that you would not do for any other parishioner. Too often I have witnessed well meaning clergy become gradually overwhelmed and burned out by DID patients whose inner turmoil led to an increasing violation of reasonable interpersonal boundaries. Remember, it is always easier to loosen a boundary with these patients than to tighten it later. So do not make boundary exceptions or unduly gratify demands without serious reflection, prayer, and consultation.

4. In what ways do religious faith and spiritual experience promote healing in DID? How might they undermine it?

Bowman: While spiritual experience is generally an unqualified asset for DID patients, religious faith can either promote or undermine healing. Religious faith, whether Christian or other, has been demonstrated in research to be associated with better mental and physical health (e.g., lower rates of depression, suicide, cancer hypertension, anxiety, substance abuse, antisocial behavior, etc.; Larson & Larson, 1991). In DID patients, religious faith can provide a clear structure for right and wrong that strengthens the conscience to help them resist the strong destructive impulses (e.g., suicide, self-mutilation, homicidal urges) that are often contained in angry alter personalities. Religious faith provides a sense of meaning in seemingly endless suffering during treatment.

Religion provides better parental images than those available to DID patients who were abused by parents. For Christian patients, faith provides a positive male image (Jesus) with which to identify. For Catholic patients, benevolent female images (St. Mary and other saints) are also available. Most important, spirituality and religion offer cathexis (connection) to a powerful helper (God) who, unlike real-life parents and friends, does not hurt or abandon these patients. The constant experience of God (although rare for most DID patients) is a powerful asset for enduring psychological pain during treatment.

Religious faith opens access to a potentially supportive faith community (e.g., church, mosque, synagogue) and to the wealth of social support that accompanies it. Religious faith provides DID patients with people who pray with them and for them, and who may provide the DID patient with their first glimpse of normal loving relationships. Healthy religious communities function as surrogate families to ease the loneliness of DID patients whose biological families are unsafe.

Unhealthy systems of religious faith can undermine healing. These systems are oriented toward inducing guilt, emphasizing strict behavioral rules and human sinfulness, and tacitly censuring lack of perfection or human expressions of anger. In these systems, the DID patient's difficulties with low self-esteem can worsen. The most destructive religious systems are those that label mental illness as sin or demon possession, causing the already suffering DID patient to feel intrinsically evil and guilty for having his or her symptoms. Religious systems can also undermine healing by promoting an atmosphere in which the power or actions of parents (especially fathers) cannot be questioned without great guilt. Further, some religious systems prolong the passive disempowered stance of many DID patients by excluding women from leadership and censuring them for assertive behaviors.

Carlson/Wilnfrid: It probably begins with the trust level between the pastor/therapist and the individual. It is hard to impose religious faith and positive spiritual experience in the midst of fear and guilt. The individual usually feels a great sense of betrayal by everyone. This includes God, because of unanswered prayers, as well as family and friends who were either abusive or indifferent.

Healing is a long process. The patient's pastor/therapist needs to have patience, patience, patience; time, time, time; love, love, love. The individual has a deep desire inside to be hopeful, wants to be part of life, wants to be included, and wants to trust! Being with others in worship and Bible study can be beneficial, but the healing can be a slow process. Trust in others can be slow and difficult. And it can be tested often.

Sometimes there is a tendency for religious communities to think too much in terms of black and white. You are either good or bad. That is what these patients are stuck in--too much black and white thinking. "I'm either good or I'm bad. This person is either trustworthy or not." Religious people tend to be that way, and this could undermine healing.

Also, "You have to love all your enemies. You have to forgive all your abusers." Baloney! Spiritually, that is most difficult for a healthy person to do. And these people are far from healthy. To lay something like that on them would be absolutely stupid--it would drive them back into despair and back into their guilt. The religious community needs to be very wise and mature in this matter.

Comstock: Religious faith and spiritual experiences change lives. They can be the steady points of reference from which DID patients can heal and to which DID patients can return for strength, purpose, and comfort. On the other hand, some interpretations of biblical scriptures can be used against the patient to punish, humiliate, or frighten the patient. Reports of spiritual experiences can be used to "prove" how deluded, psychotic, or sick the person is. Spiritual experiences can be overwhelming for a person when the enormity of a personal prayer or meditation experience is more than the person's emotional resources can presently bear. The church or other spiritually inclined people can help to frame the experiences in the larger context of God.

Friesen: Psychology is a good thing. It helps me know what to pray for. It does little good to find psychological wounds and simply re-live them. That can be re-traumatizing. We do better to find the wound, re-process it in a supportive situation, and ask for the Lord's healing in prayer. That helps a lot. Healing wounds is essential for these people, and healing is God's domain. We need to turn to Him.

Spiritual experience undermines people's progress when Christians are simplistic. That is, when Christians falsely believe that they know how to solve other people's problems. When they say that a person who is hurting should do this or that--whether it is praying in a particular way or tithing or submitting to authority or even in renouncing spiritual curses and vows--that will be destructive. There is no formula for "getting better" found in the Bible, and there is no promise in it that people are going to feel good. There is no quick cure. The Bible is full of stories where people find that God's way is best, even through suffering, but it is not what the person expected from God! There are times when it is very discouraging for DID clients to see other Christians getting over their problems, but DID clients have wounds that do not get healed very quickly. They do not need to do this or that. They need (a) to belong to a family that is safe and encouraging, (b) to strive for maturity, which is something we all must strive for, and (c) to seek God's healing for their wounds. They need God, they need His family, and they need a lifetime to become the people that God intended them to be.

Mungadze: Good, vibrant, religious faith and a biblically based spiritual experience can be the most effective pathway to healing DID clients, especially those with SRA, provided the client is ready for incorporating their faith into their healing. Faith can help DID clients have hope when things look very bleak. Faith can also provide DID clients a solid basis by which they can dispute their distortions about God, self, and others. Religious faith sometimes can undermine healing in DID clients, especially when it is forced upon them by other people or when the host personality forces it upon those alters who are not ready to embrace it. Religious faith can also undermine healing when it is used as a way of denying the truth and over spiritualizing trauma and pain.

Rosik: I have written extensively on this topic (Rosik, 2000b) and so will not repeat my thoughts here. Suffice it to say that in terms of interfacing with the patient's psychodynamics, genuine Christian faith and spiritual experience serves to lessen defenses while increasing self-awareness and self-acceptance. Theologically, this means growth in the experience of being deeply and securely loved by God, leading to the promotion of humility before God as well as an active empathy for others. Religious and spiritual espousals not resulting in these characteristics fall, in my view, under the rubric of "having a form of godliness but denying its power" (I Tim. 3:5).

5. How has our understanding of the treatment of DID changed over the past twenty years?

Bowman: The field of DID treatment is maturing. As a field, it has passed a stage of countertransference fascination with DID as a special or exotic condition. Consequently, secular therapists are more careful to maintain firm boundaries and avoid dual roles in DID treatment (Hundert & Appelbaum, 1995; Peterson, 1992).

Treatment is no longer seat-of-the-pants untested frontier transmitted by oral tradition. Treatment guidelines (2) for adults have been published by the International Society for the Study of Dissociation (ISSD, 2000a) and child/adolescent guidelines (ISSD, 2000b). As more therapists treat DID, DID treatment is no longer viewed as unique, but is seen as a technical modification of the three-stage treatment of psychological trauma and chronic severe PTSD. Accordingly, more emphasis is being placed on stabilizing DID patients and building ego strength before moving to address trauma. Currently, less emphasis is given to abreaction of trauma and more to the pacing of treatment to avoid crises. More care is being taken to preserve functioning during the prolonged treatment of DID and to modify underlying pathological personality structures.

The field went through a media-influenced stage of uncritical acceptance of SRA reports, but these reports have diminished in light of corroboration studies that fail to support them as historical accounts. As there is less fascination with SPA, the frequency of patient reports of it appears to be decreasing except in a few geographic areas and treatment centers.

The most important change has been increased caution about memory veracity, in response to lawsuits filed by accused abusers. Hypnosis continues to be used in treatment, but is now out of favor as a means of enhancing recovery from traumatic memories. Therapists are more careful to monitor suggestiveness and are more cautious about uncritical endorsement of the veracity of recovered memories. Confrontation of abusers is no longer encouraged, since it has led to lawsuits and has doubtful efficacy in promoting healing. Awareness of possible memory contamination on inpatient units and in trauma group therapy has risen. This awareness, combined with the advent of the managed care industry, has diminished enthusiasm for inpatient dissociative disorder units. Inpatient abreactions in restraints are now viewed with caution as a possible sign of inadequate pacing of treatment.

Novel techniques such as Eye Movement Desensitization and Reprocessing (EMDR) that speed processing of trauma are beginning to gain acceptance. Research advances are now helping therapists recognize factitious presentations of DID.

Carlson/Wilfrid: Hopefully, we are wiser, more patient and empathic; less confused and fearful. The human mind is a wondrous creation; a wonderful gift. How fortunate we are to see the miracle of the Mind!

Comstock: In the 1980's, clinicians focused on gathering information about patients and about treatment. In part, we re-enacted Freud's journey. We first believed our patient's memories to be accurate, we attributed their present symptoms to past events, and we saw memory work as being curative. We then rediscovered that neither our patients memories nor their perceptions are necessarily accurate. With a more integrative understanding of the dissociative process, we now see one person, a coherent, although not consistent, complex individual with a variety of resources, responses, needs, feelings, and ideas. We know that patients' reports of internal separateness are feeling and not the physical reality. We no longer create maps, or take histories and names of each part as if it were a separate person. We focus less on the past and more on a personally rewarding present day life for the patient.

Friesen: We know enough right now to provide good treatment for DID clients. Of course, we are still learning, but here is the point. This is no longer a new field, and there should be no hesitation to use what we already know. The problem is that there are too few clinicians providing treatment. It is necessary for clinicians to specialize in working with this disorder, largely because the work is different from treating many other disorders. One problem is that clinicians are having a hard time finding training so that they can learn how to carry out interventions that work with DID clients, like uncovering dissociated memories, encouraging cooperation between dissociated personalities, and integrating them. There needs to be mote attention given to teaching what we already know about treating DID clients.

Mungadze: The most significant changes in the understanding of the treatment of DID have resulted from the research of PTSD, memory, and the brain. Currently the focus in treatment has moved from processing memories to behavior management and cognitive restructuring. In the past, therapists were quick to accept client memories as fact, but today therapists are careful to stay neutral and perhaps even help the client confront apparent distortion in hard-to-believe situations. In the past, some therapists may have spent a lot of time and energy trying to figure out intricate systems of personalities in their clients, whereas today the focus is more on resolving significant conflicts, the traumas underneath them, and helping the host to manage his or her system of alters.

Rosik: The dissociative disorders field has undergone significant evolution since I first began treating these patients in the late 1980s. DID remains controversial in some quarters, but it can no longer simply be considered a "fad" diagnosis. Contributing foremost to the evolution of our understanding of DID is the rapidly growing trauma research literature that is shaping theory and practice. Simplistic abreactive models of treatment have given way to more complex paradigms that include greater emphasis on psychodynamic issues as they manifest in the patient's present psychosocial functioning (Kluft, 1999). A more nuanced perspective on patient memories has also replaced earlier, uncritical approaches that treated traumatic recollections as disconnected from the developmental, social, and neurobiological contexts within which they occur. This does not signal a return to undue skepticism of patient accounts. Rather, these factors should serve to help place the responsibility for determining a patient's histo rical narrative where it belongs--with the patient. While Christian counselors are ahead of the curve in terms of recognizing the value of spiritual and religious issues in DID treatment, I fear that too many are not adjusting their approach to this disorder to reflect such important developments in the broader field. This could potentially increase legal liability, create unnecessary religious disillusionment in patients, and lead to the reinforcement of negative stereotyping of Christian counselors within the profession.

What do you foresee in the future of the dissociative disorders field?

Bowman: Critics of recovered memories are beginning to fade in prominence and this will slowly continue as mental health clinicians are now beginning to respond to these attacks in an organized manner. The burgeoning of research on memory, dissociation, and PTSD will continue to elucidate the nature of traumatic memory and dissociation. The recovered memory controversy will leave the dissociative disorders field permanently more cautious about memory veracity, but with a new wealth of research that will place it in a more scientifically sound position than it was before the controversy.

Increased concern with pacing of treatment and with memory veracity will continue and treatment of DID will become more mainstream. More therapists are now being trained to recognize DID, so the current trend toward more therapists treating it will continue. DID is being increasingly recognized on other continents; this trend will continue. The DD field in other countries is beginning to see some backlash by advocates for accused parents, but the DD field outside the US will benefit from American experience with memory and likely will not suffer the massive lawsuits seen in the USA.

Brain (PET and SPECT) scanning will further elucidate the neurological basis of dissociative amnesia and personality switching, and may enlighten us about the biological basis of dissociative amnesia. Research on DID will become more allied with physiologic research on PTSD and dynamic understanding of borderline personality disorder. EMDR or other novel techniques likely will come into more use.

The development of the dissociative disorders field will be wed to the acceptance of trauma as a major paradigm in the etiology of mental illness. Overall, the dissociative disorders field will unify more with the trauma/PTSD field and dissociative disorders will become even more mainstream than they are now. It is difficult to predict the role of spirituality in the future of the DD field except to say that it will mirror the increased awareness of the importance of spirituality in mainstream mental health and medical care.

Carlson/Wilfrid: Historically, the church is where many troubled people have come, and in the future, they will continue to come for help. How positive it could be if there were workshops, etc., where members of the religious community can dialogue with people in the fields of psychiatry, psychology, medicine, and where counselors, therapists, and recovering patients and families could participate.

Comstock: Knowledge about dissociation will be increasingly integrated into other fields and will be seen as a component of many disorders such as impulse disorders, eating disorders, borderline personality disorder, and posttraumatic stress disorder. I think the emphasis will shift from seeing dissociation as an end result or symptom to seeing dissociation as a coping process used when the ego cannot contain the feelings engendered by the event. As research results and outcome data support some forms of treatment and not others, we will be better able to help each patient understand and control his or her dissociative responses.

Friesen: To quote someone, "The more things change, the more they stay the same." I am a veteran in this field, and my hope for widespread improvement in the treatment of DID clients has been practically snuffed out altogether. There are so many DID people who need help who are not getting it because there are too few clinicians trained to treat them! Jesus was right when He had compassion on the crowds he saw. They were "harassed and helpless, like sheep without a shepherd. Then [Jesus] said to his disciples, 'The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field'" (Matt. 9:36-38).

It looks to me as though the general public will continue to avoid pain and, therefore, people who have suffered severe abuse will not get the attention they need in order to recover. People would rather question their stories than listen to them. The prevailing attitude of the general public is very similar to how the general public feels about poverty-struck countries--"We don't want to think about it!" The popular method of handling reports of severe abuse is to shoot the messenger. It also looks to me as though most Christian clinicians are not willing to pay the price to get trained to treat DID clients, nor to risk being sued for helping people whose presenting problems are controversial. Perhaps there is a little more acceptance of working with DID clients today than there was 20 years ago, but not much. There seems to be little room for treating DID clients in the caseloads of most clinicians, and there seems to be little energy in most churches for helping people who have been seriously wounded. I se e that the future will be about the same as the present. There are some really good DID clinicians who are helping many people. The vast majority of therapists do not know how to treat DID clients, and probably will not learn how to do so. The harvest is plentiful but the workers are few. Ask the Lord to send out workers into this harvest field.

Mungadze: I foresee some good and perhaps bad things on the horizon in the treatment of dissociative disorders. Starting with the positive side, very good research on the treatment of DID, memory, and trauma keeps coming and confronting the false memory syndrome foundation's ideas that used to threaten the treatment of DID. Our treatment is getting better and there are more and more DID clients getting well. On the negative side, managed care continues to force some clinicians to document their treatment goals and procedures to fit their cost needs. If this continues, managed care will determine treatment instead of skilled, experienced clinicians that specialize in DID. Managed care will also influence what some doctors and clinicians conclude as diagnoses for their DID clients in fear of managed care's bias against the disorder. Some dissociative disorder specialty programs are already changing their names to trauma programs to avoid the dreaded DID term. This is sad because once again leadership in this fi eld needs to remain in the hands of the treating clinician rather than the managed care reviewer.

Rosik: Treating dissociative disorders is not for the faint of heart! It is easy to be intimidated by experiences of patient rage, reports of therapists being litigated, and colleagues questioning your diagnostic acumen. As a result, many therapists who in years past treated DID because it seemed fascinating and garnered some professional notoriety have stopped treating these patients. Now that the societal climate surrounding DID treatment no longer promotes much secondary gain for therapists, those who remain in the trenches must have a sense of calling. For the Christian in this field, I believe the ingredients of such a calling are twofold, involving (a) a deep and mature faith in God and (b) an unyielding commitment to professional practice.

The field of dissociative disorders is here to stay. However, it is still in a period of relative adolescence and I anticipate we will witness as many new developments in the next decade as we have seen in the past one. Some of this evolution will stem from developments occurring within the field (i.e., new research data and clinical models) while some will be dictated by trends in the culture (i.e., those involving judicial decisions and health care funding). Prepare yourself for further adventure!

Finally, I also believe Christian theological and anthropological insights need to be represented in the future of this field. Jesus' own incarnational mandate (Is. 61:1-3; Luke 4:16-20) speaks to so many of the emotional and spiritual needs of DID patients: proclaiming freedom, releasing from darkness, binding up the brokenhearted, bringing comfort and gladness to the mourning, and enabling praise where once was only despair. Christian counselors, animated by God's Spirit and informed by modern scholarship, are clearly acting within this tradition when they treat persons suffering with DID. We, like the Lord before us, desire healing and wholeness for these individuals so that "they will be called oaks of righteousness, a planting of the Lord for the display of his splendor" (Is. 61:3b).

CONCLUSION

The responses solicited from this panel reflect some areas of general consensus and other issues where significantly divergent perspectives exist. The respondents appeared to agree on the need for caution when dealing with traumatic memories and the need for patients to determine for themselves the historical veracity of their recollections. Counter-transference concerns were frequently noted in the use of exorcism, with a suggestion of motives that included rescue fantasies (Bowman), seeking a short cut to difficult developmental tasks (Carlson/Wilfrid), ego gratification (Bowman, Rosik), and the avoidance of pain and suffering (Friesen). There was consensus on the beneficial impact of faith communities where positive social support is offered and a theological emphasis on God's love is provided. All panelists believed that the church has also been a place where religious and spiritual abuse can occur with potentially devastating consequences for DID parishioners. Finally, there was general agreement that th e DD field has seen significant evolution away from a treatment model that focuses primarily on abreaction of traumatic memories toward a greater clinical emphasis on ego-strengthening and the maintenance of adequate functioning in the present.

Despite these areas of concurrence, some topics evidenced continued sharp differences in understanding and approach. Perspectives on the utilization of exorcism varied widely, ranging from a strict prohibition (Bowman, Comstock) to an endorsement of its regular tactical application (Friesen), with others seeming to affirm its potential usefulness while maintaining that it should occur infrequently (Mungadze, Rosik). The veridicality of memories of satanic ritual abuse also appeared to be viewed quite differently, with Bowman suggesting that these recollections are almost always unreliable, whereas Friesen appears willing to grant them historicity as the patient develops a sense of this. Finally, in evaluating the future of the DD field, some respondents (Bowman, Comstock, Rosik) reported guarded optimism that the field is gaining greater acceptance and a more firm scientific foundation, whereas others (Friesen, Mungadze) expressed a mixed to pessimistic viewpoint due in part to managed care and a dearth of co unselors with specialized training.

It is quite possible that some of these differences in perspective can be explained by the dissimilar patient populations with which these panelists probably work. Many patients will seek out or be referred to therapists and clergy whose approach matches their own general worldview and specific theological expectations. This potential effect of selection bias is intensified when the practitioner has published literature in the field that can also serve as a vehicle for patient self-referral, as is the case for most of the respondents. Thus, the panelists' sentiments may diverge where they encounter clinical responses or therapeutic concerns that are more reflective of the unique subpopulation of patients to which they are exposed.

This article has intended to provide a venue for dialogue and understanding among a panel of religiously sensitive therapists and clergy, all of whom share a common concern for the well-being of those within the community of faith who struggle with DID and other dissociative and post-traumatic disorders. As our scientific and theological comprehension of this field continues to expand, it is sincerely hoped that many more opportunities for such professional interchange will occur.

(1.) Three significant exceptions to this rule arc a 1992 special issue of the Journal of Psychology and Theology (Vol. 20, No. 2) which focused on satanic ritual abuse, a 1993 issue of the now defunct journal Dissociation (Vol. 6, No. 4) examining possession and exorcism, and a 2000 special issue of the Journal of Psychology and Christianity (Vo. 19, No. 2) on Dissociative Identity Disorder.

(2.) These guidelines arc available electronically at: http:\\www.issd.org\isdguide.htm.

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AUTHOR NOTES

BOWMAN, ELIZABETH, M.D., is Clinical Professor of Neurology and former Professor of Psychiatry at Indiana University School of Medicine and a Past President of she International Society for the Study of Dissociation. She received her M.D. from Indiana University and a Master of Sacred Theology degree from Christian Theological Seminary in Indianapolis, Indiana. She has professional interests in dissociative disorders, conversion seizures, and in religion and psychiatry.

Rev. Harry Carlson, retired Lutheran pastor, lives in Rio Linda, California. He received his M.Div. in 1953 from Wartburg Theological Seminary, Dubuque, Iowa. He has served for several years on the Sacramento County Mental Health and Alcohol/Drug Advisory Boards. He met and has consulted with Dr. Ralph Allison since 1979.

Christine M. Comstock received her Ph.D. in Clinical Psychology from The Fielding Institute. She specializes in treating survivors of abuse and has a research interest in the Rorsehach Ink Blot Test. She has published and presented extensively in the fields of child abuse, dissociation, and hypnosis, is a fellow of the International Society for the Study of Dissociation, and has won several awards for her work in the field of dissociation.

James G. Friesen, Ph.D., is a psychologist who has been working with dissociative disorders for 14 years. He is the author of four books, including Uncovering the Mystery of MPD, abest seller in the Christian community. He has spoken at more than 80 conferences worldwide.

Jerry Mungadze, Ph.D., specializes in the treatment of dissociative disorders. He is the founder and director of the Mungadze Association's nationally renowened outpatient and inpatient hospital unit in the Dallas/Fort Worth area. He is also an adjunct professor at Dallas Baptist University in Dallas, Texas, and much of his time is spent traveling both nationally and internationally presenting seminars, workshops, lectures, and case consultations.

Christopher H. Rosik received his Ph.D. in clinical psychology from the Graduate School of Psychology at Fuller Theological Seminary. He is currently a clinical psychologist working at the Link Care Center in Fresno, California. His professional interests include dissociative disorders, bereavement, and psychotherapy of missionaries and ministers.

Rev. Carl Wilfrid is Senior Pastor of Lutheran Church of the Good Shepherd in Reno, Nevada. He previously pastored Faith Lutheran Church in Chico, California. He received his M.Div. in 1969 from Luther Theological Seminary, Sr. Paul, Minnesota. He also received his S.T.M. in Pastoral Counseling from New York Theological Seminary in 1973. He has worked with several DID sufferers, some for an extended period of time.

Correspondence concerning this article should be addressed to Christopher H. Rosik, Ph.D., Link Care Center, 1734 West Shaw Avenue, Fresno, California 93711. Electronic mail may be sent via Internet to [e-mail].