RAIN
CHAPTER TEN
Within minutes, Grissom was absorbed in his studies. Several terms jumped out at him at once.
regression The return to earlier or younger behavior and thinking. Trauma often overwhelms everyday defenses and brings about behavioral regression. Child personality states are an example of trauma-based regression. In "age regression," a person experiences him or herself at a specific earlier age. The person does not always return to the age of a child, however; age regression may take a client back a few years earlier in adult life.
Dr. Kane was right.
posttraumatic stress disorder (PTSD) An anxiety disorder based on how an individual responds to a traumatic event. According to DSM-IV, the following criteria must be met:
• The person has experienced a traumatic event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and the person's response involved intense fear, helplessness, or horror
• The traumatic event is re-experienced in specific ways such as recurrent and intrusive distressing recollections or dreams of the event
• Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness
• Persistent symptoms of increased arousal, such as hypervigilance or irritability
• Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month
• The disturbance causes clinically significant distress or impairment in functioning.
PTSD may be acute, chronic, or with delayed onset. Many individuals with DID (MPD) also have PTSD. The literature sometimes describes DID (MPD) as complex and/or chronic PTSD. Adapted from DSM-IV, p. 427-429.
Sara meets all the criteria, and then some. A month? Try a lifetime...What's DID?
• dissociative identity disorder (DID) One of the dissociative disorders in DSM- IV. There are four diagnostic criteria:
• The presence of two or more distinct identities or personality states
• At least two of these identities or personality states recurrently take control of the person's behavior
• Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness
• The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
DID is the current name for multiple personality disorder (MPD), first used in DSM-IV. In addition to the name change, the criteria were increased by two items, items C and D.
Oh, dear God...Sara does remember who she is...and me, and the rest of the team...even when she was like a child...didn't she? Grissom struggled to remember. He kept reading.
In general, individuals with MPD have a background of child abuse or other forms of severe childhood trauma. Dissociative identity disorder (DID) is the current name for this disorder in DSM-IV. Adapted from DSM-III- R, p. 272.
Oh, help. Multiple personalities? I think...I hope she is not that far gone!
dissociative disorders A group of psychiatric conditions with the disruption in the integrated functions of consciousness, memory, identity, or perception of the environment. DID (MPD) is one disorder in this category. See also dissociative fugue, dissociative identity disorder, dissociative amnesia, dissociative disorders not otherwise specified. Adapted from DSM-IV, p. 477.
dissociative fugue One of the dissociative disorders described in DSM-IV. The diagnostic criteria are:
• Sudden, unexpected travel from home or work, with the inability to recall some or all of one's past
• Confusion about personal identity or assumption of a new identity
• The disturbance does not occur exclusively during the course of DID and is not due to the effects of a substance or general medical condition
• The symptoms cause clinically significant distress or impairment in functioning.
• The onset of dissociative fugue is usually related to traumatic, stressful, or overwhelming life events. Adapted from DSM- IV, pp. 481-483.
Sudden, unexpected travel from home and work. Check.
Confusion about personal identity? I don't think so. She hasn't...
Clinically significant distress or impairment in functioning. Yes.
Traumatic, stressful, or overwhelming life events. Yes, yes, and yes.
Fugue state. I've heard of that. Wasn't there a novel...by Dean Koontz...about that?
"Okay," Grissom muttered aloud anxiously. "Dr. Kane mentioned 'associated pathologies.' Perhaps he was thinking of this, but...I haven't seen any sign of a split personality or amnesia...of course I don't know what Sara can or cannot remember..."
Sometimes it's good to forget. Sara's sorrowful words echoed in Grissom's head.
He stood up and paced up and down the small room, thinking hard.
Dr. Kane said we should tackle PTSD first. Don't get ahead of yourself. Don't assume the worst. Don't 'assume' at all.
"Relax. One step at a time. You're not qualified...based on one morning's reading!" he told himself harshly.
He sat back down and looked at the papers again. DSM-IV. What's that? Diagnostic S-something Manual, 4th edition, maybe. Dr. Kane would know.
He dialed Kane's number, but the receptionist told him the doctor was with a client. Grissom left his number and a brief message.
"Okay. I can find out from the librarian. Maybe they even have a copy, probably in the reference section. Let's go back to PTSD and age regression," Grissom instructed himself.
Before he read another word, there was a timid knock on the door. Grissom opened it to Mrs. Gonzalez and Sara, who was standing away, looking at the ground.
"Mr. Grissom," Consuela said, smiling.
"Mrs. Gonzalez, Sara, please come in. Make yourselves at home. I'll put on some tea."
Consuela came in, but Sara hesitated. Grissom instantly went to her.
"Sara, honey?" he said gently, trying to meet her eyes.
"Sara?" No answer, so he reached for her hand, relieved when hers closed around his.
"I...I'm sorry, Gil," she said in a small voice.
"Sorry? For what? You have nothing to be sorry for, sweetheart."
"I...I hurt you," Sara said timidly, gesturing at his crotch.
Grissom laughed in relief. "Oh! I'll live! Do you know how many times I've been kicked in the balls? Fifty years worth...You...if anyone deserves to have a shot at me...you do!"
Sara's face cleared and she giggled at him and finally met his eyes.
"Come in here. You don't know how glad I am to see you." Grissom moved his hand to the small of her back and guided Sara inside.
Both women stopped and stared in awe about the room.
"Mr. Grissom," Consuela said, marveling. "You cleaned! It is beautiful! I am...so..."
"Is this the same place?" Sara asked lightly.
Grissom smiled at them both. "Yes! Just a little...spruced up. Sara's responsible for the decorating," he added with pride.
"A little spruced up?" Consuela teased, "You're hired!"
They all chuckled and Grissom moved to put the teakettle on.
"Thank you for the flowers as well," Consuela told him.
"Sara picked them out," Gil said simply.
"Thank you-- for the note," Sara said quietly.
Gil stepped to her and took her hands, looking in her eyes. Mrs. Gonzalez tactfully moved to the back stoop and became very interested in all the flowers and potted plants there.
"You're welcome, Sara."
"It was very...sweet."
"Ah, good. I couldn't say everything I wanted to--I never can--but I do love you, honey, so much."
"I love you too, Gil."
"Kiss me?"
"Always." Sara leaned in and they kissed gently. He put his arms around her and kissed her again and she held onto him.
He murmured into her hair. "I missed you. Not just last night, but...whenever we spend a night apart..."
"Me too," she said into the crook of his neck, breathing in his scent, feeling his warmth and loving energy, and drawing strength from it all.
The teakettle whistled and they broke apart, smiling at each other. Consuela came back in and Grissom piled up all his papers to make room on the kitchen table. Sara glanced at them curiously, then found her unspoken question answered in his eyes.
They all had a hot strengthening cup of tea. Sara blew across the top of her mug.
"Sara, I, uh...I want to help you," he said hesitantly. Both women nodded.
"I've been reading, but I'm not...I want to help you get the help you need. It's more...it's beyond what I can do."
"Yes," Sara said. "I know I need help."
Gil breathed a big sigh of relief. "Yes, honey. And you're going to get the best help we can find. I'll be with you. Every step."
"Good," she breathed.
"Good," Gil echoed, smiling into her eyes.
TBC
A/N: The above references were taken from the APA's PTSD Glossary © the Sidran Institute, 1995-2009. Their motto is: "We help people understand, recover from, and treat trauma and dissociation." Easily found on Google. Hope you find this as valuable as I do.
By the way, those GPS coordinates? They would have taken Grissom to southern China. Oops.
To jayjay: What a wonderful review. I love it when people say they enjoy all my stories! Thanks! And thanks to My Kate for her story suggestions and interesting comments. Very helpful.