“i’m Done with Suffering”: A Case for Palliative Care in Complex Dissociative Disorders

Abstract
Treatment of complex trauma and dissociative disorders often focuses on identifying and minimizing harm-inducing behaviors, improving the client’s ability to tolerate difficult emotions, processing past traumatic events, and (eventually) helping the client build a life worth living. However, what if, despite the client’s and clinician’s best efforts, the client experiences only minimal (or no) symptom improvement? How do we help clients who have cycled through repeated inpatient hospitalizations, tried numerous psychotropic medications, and engaged in many specialized interventions but who, despite best efforts, have not achieved relief from their intolerable psychic pain? Can an individual’s traumatic experiences be so severe that no amount of psychological care will heal them? What may be appropriate—and doable—goals for clients who hover between life and death, while also navigating both personal and real-world impediments to achieving a meaningful life? How might the concept of palliative care, designed to create a plan to address quality of life in the face of deep psychic pain, provide a framework for care?

In this panel, two clinicians engage in a dialogue centered around a case of an individual with Dissociative Identity Disorder (DID) that they both shared. One clinician (Dr. Jean Carter) has treated the individual for nearly 30 years; the second clinician (Dr. Marta Miranda) was brought onto the case in the last three years to provide adjunctive Eye Movement Desensitization and Reprocessing Therapy (EMDR). In the course of treatment, both clinicians have engaged in philosophical and, at times, challenging questions around shifting treatment goals and the ethics of suicide risk management. The presenters aim to stimulate discussion and thoughtful reflection about how to work with such difficult cases in a manner that meets the clinician's ethical responsibilities while also respecting the client's right to self-determination and autonomy in defining the life they believe is worth living.