Managing your terror all by yourself gives rise to another set of problems: dissociation, despair, addictions, a chronic sense of panic, and relationships that are marked by alienation, disconnections, and explosions. Patients with these histories rarely make the connection between what has happened to them a long time ago and how they currently feel and behave. Everything just seems unmanageable.

When people are unable to integrate their traumatic memories, they seem to lose their capacity to assimilate new experiences as well. It is as if their personality stops at a certain points and cannot enlarge any more by the addition or assimilation of new elements. Unless they become aware of the split off elements and integrate them into a story that had happened in the past but was now over, they would experience a slow decline in their personal and professional functioning.

Dissociation is adaptive: it allows relatively normal functioning for the duration of the traumatic event and then leaves a large part of the personality unaffected by the trauma.

Mary was my first encounter with dissociative identity disorder (DID), which at that time was called multiple personality disorder. As dramatic as its symptoms are, the internal splitting and emergence of distinct identities experienced in DID represent only the extreme end of the spectrum of mental life.