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This story is from the Anamnesis episode called Eureka and starts at 26:40 on the podcast. It's from , psychologist and professor at Adelphi University in Long Island, New York.
Following is a transcript of her remarks:
Deborah Serani, PsyD: We all know that when you first open your clinical practice there's always butterflies and nervousness, and "OK, I'm flying solo now. Can I really do this?" I was referred a case about a 50-plus-year-old woman who had had some fainting spells. The doctor had said that there wasn't anything organic that they found in their testing, and he thought maybe some psychotherapy could perhaps get to the bottom of what these episodes were about.
I'm gladly accepting one of my very first patients and I call the particular lady, who I'll call Gloria, and she comes in for her session. She's beautifully dressed, a very elegant, bright woman, and begins to tell me that she's had these fainting episodes pretty much all her life and that nobody can really get to the bottom of it.
Chronic Fainting?
Serani: Over the course of several weeks, we get to know each other, and I start noticing pauses in her storytelling. I actually was concerned maybe she had some hearing issues. I did ask, again, were petit mal seizures, neurologically was she worked up? And she said yes, she was.
Over the course of time further, I decide, "You know, maybe I should put her on the couch." I'm a trained psychoanalyst. I get her on the couch, and I'm actually closer to her than if we were sitting apart. I'm behind her à la Freud, and I start to notice some very strange things.
There are pauses and silence. There are body movements that are not characteristic of who I knew her to be, and suddenly I start hearing different tones of voices and stories that don't start making sense. They're not connected to what Gloria had initially been talking to me about.
I'm in supervision -- a lot of psychoanalysts remain in supervision throughout the course of their career -- and I talk to my supervisor and I say, "I think..." This is back in 1989, 1990, "I'm wondering if this particular patient has multiple personality disorder. There's just too many moments of detachment and connections that don't make sense." My supervisor, of course, is supportive, but says, "Debbie, I think this is, this is really rare. I'm not so sure that this is what's going on."
As treatment continues, I do discover certain alternates. Of course, in the sessions, I'm like, "Oh, my God, this is such a rare disorder. What am I doing? Do I know what I'm doing? Should I be treating this particular person?"
It became one of those things where I had to find a supervisor who had had experience working with multiple personality disorders because it was so rare. And the whole theory of Occam's razor, "Is it that she can't hear? Is it a neurological piece?" No, it's a dissociative disorder.
"Rare" Isn't Always Rare
Serani: What I ended up doing in working with somebody in Manhattan was to really discover as a young clinician that "rare" doesn't really mean rare. It's the 0.01% of a person who may be experiencing a dissociative disorder can be in your office. It taught me to just really trust my instincts and to be OK in the moment with a very difficult case, to say, "All right, I really don't know what to do here, but I'm going to provide support. I'm going to get supervision and I'm going to read up on it."
The case continued very well. Her fainting spells stopped, and we got to the bottom of a lot of traumatic issues. It was just one of those moments as a young clinician that I still remember 30 years later when I'm working with difficult cases or cases that are "rare." I always trust my gut and that was just a really great beginning experience to have.
Amy Ho, MD (host of Anamnesis): Working with "Gloria" was a real eureka moment professionally for Serani, and one that's not likely to be repeated.
Serani: I have never come across another case like this. I anticipate I won't. This was a very involved case, à la "Sybil," à la "Three Faces of Eve." It was one of those moments where alternates and other alternates came out, and it was just ... It almost felt unreal, surreal, like some kind of fiction. But it was a very real case for this particular woman and ended up discovering other connections to her family members, which helped make sense of the trauma that they themselves also had some dissociative and PTSD [post-traumatic stress disorder]. It was just an unbelievable experience to have as a new clinician, as I'm sure it would be as a seasoned clinician, just one of those rare moments where you go, "OK, let's see what we can do to help here."
Other stories from the Abandoned episode include "The Death of One Little Girl Helped Millions" and "Screaming Patient, No Restraints"
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