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Dissociative identity disorder

In psychiatry, Dissociative Identity Disorder (DID) is the current name of the condition formerly listed in the Diagnostic and Statistical Manual of Mental Disorders as Multiple Personality Disorder and Multiple Personality Syndrome. The International Statistical Classification of Diseases and Related Health Problems continues to list it as Multiple Personality Disorder.

Multiplicity is often used to describe wider behaviours than DID—in other words, it includes the presence of separate selves which are not part of a psychiatric disorder. In the widest sense it may include concepts such as demonic possession and two-spirits. Indeed, in several cases, doctors have resorted to exorcisms in order to treat DID. [1], [1]

The very existence of DID is questioned by some doctors and scientists. The growing consensus among most doctors and scientists is that DID exists, but that it is an iatrogenic ("caused by doctors") illness that is generally created by suggestion or self-suggestion. A few psychiatrists continue to claim that it is a severe illness that cannot be created in adult life, brought on by extreme abuse in childhood.

Table of contents
1 Theory of Dissociative Identity Disorder
2 History of multiplicity
3 Multiplicity as a social phenomenon
4 DID in fiction
5 References and external links

Theory of Dissociative Identity Disorder

The primary criterion for the diagnosis of DID is the presence of two or more separate selves within the same body, which may have very different ways of acting, thinking and speaking, and may be of different gender identities, ethnicities or sexual orientations. Depending on the severity of the condition, one personality may not recall incidents that happened when another personality was predominant. Generally there is thought to be a "primary" personality, with others being less frequent in appearance and/or less well-developed.

MPD or DID is most commonly diagnosed in people who are, typically in recovered memory therapy, found to be the victims of severe repeated trauma (usually child abuse) very early in life. Whether this abuse (often claimed to be ritualistic, sometimes satanic ritual abuse) actually happened in the majority of cases or whether false memories were induced by the therapist is subject of much debate.

DID therapists believe that in an effort to shield themselves from the trauma, patients have effectively split their mind into two parts—the person who was abused, and the rest of their self, who was dissociated from the traumatic event and protected from its effect. Over time, and with repeated traumas, they become adept at masking their true self. In effect they become human chameleons in an attempt to protect themselves from anything that might harm their psyche further, and later, to keep anyone from discovering their secret. Presumably, the victims will suffer from various general symptoms (such as depressions, sleeplessness and headaches) in later life. The therapist then has to uncover the split personalities and the suppressed memories in order to restore balance.

History of multiplicity

The existence of multiplicity is currently a topic of much debate within the psychological community. Reports of individuals who seemed to display more than one discrete self date back to the 19th century, and some have speculated that cases of 'possession' described in earlier centuries were actually cases of multiplicity. 'Dual personality' was closely associated with spirit mediumship in the 19th and early 20th centuries, as some believed that the different selves were actually spirits who had taken up residence in the medium's body. Early psychoanalysts attempted to attribute multiple personality to a variety of causes, including manifestation of unconscious desires, head injuries, and the oppression of women.

Psychoanalyst Morton Prince, who later published a book on his experiences in treating Sally Beauchamp, a multiple client, believed that multiplicity was due to the disintegration of an original, unified personality into separate pieces. He translated desaggregation, a word coined by the French analyst Pierre Janet, as 'dissociation,' and used it to refer to the process by which the original personality was supposed to break apart. Although he did not attempt to theorize on a universal cause for dissociation, he believed that multiplicity needed to be cured by integrating all the selves into the 'original' personality.

Several popular accounts of multiplicity, most fictionalized to some degree, were published during the first half of the 20th century, the most famous being '\'The Three Faces of Eve'' by Corbett Thigpen and Harvey Cleckley. Thigpen claimed to have integrated all the selves of 'Eve,' a multiple client, and the book was so popular it was later made into a movie. Several decades after the book's publication, the real 'Eve,' Chris Costner-Sizemore, came forward to report that much of the book was a fabrication by Thigpen; although she really was multiple, by her own account, she had never actually integrated.

The actual diagnosis of 'Multiple Personality Disorder' did not exist until the 1970s, when Sybil, the most famous modern account of multiplicity, was published. 'Sybil,' whose real name was Shirley Mason, was a patient of Freudian analyst Cornelia Wilbur. Wilbur treated Mason for over a decade and believed that her client's multiplicity had been caused by severe sexual abuse in childhood, which had caused her original personality to 'split off' separate selves, each of whom performed the function of enduring abuse for her. In Wilbur's view, all multiples consisted of an original, depleted self and the many personalities who had dissociated from it as a result of childhood trauma. In order to restore the patient's original self, it was necessary to remember all the childhood traumas which had caused the 'splits,' and then integrate all the personalities; only then could the patient live a full and productive life.

Wilbur later went on to specialize in treating multiples, continuing to enforce her view that all multiples had a history of severe trauma in childhood and could not live functionally without recovering their traumatic memories and becoming integrated. She believed that it was routine for multiples to lack a communal memory and to be unable to remember things done by other selves. The diagnosis Multiple Personality Disorder was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders, and several popular, often highly-embellished and fictionalized case histories of multiples were published throughout the 1980s, all after the model of 'Sybil.'

Allegations of iatrogenesis

Robert Rieber of the John Jay College of Criminal Justice in 1998 examined tapes regarding the Mason case and came to the conclusion that the multiple personalities were induced in the patient by her therapist, who, in sessions which included the use of drugs, carved out personalities for the different emotions, while dismissing any attempt by the patient to deny her multiplicity. Critics charge that this allegation of "denial" is used to force patients to go along with a therapist's psychological model, be it satanic ritual abuse with subsequent dissociation or abduction by aliens (a similarly large phenomenon). In Mason's case, memories of severe physical abuse were also "recovered": Her mother allegedly filled her bladder with ice-water to stop her from urinating, and then forced her to listen to her mother playing on the piano. In reality, no evidence for these events was ever found.

Mason's other therapist, Dr. Herbert Spiegel, also concluded that Mason's multiplicity was induced: He noted that Mason was perfectly capable of expressing her emotions without using different "personalities", and that the idea to use these personalities came primarily from Wilbur, not from Mason.

The diagnosis, which had always been a subject of much debate, became highly controversial in the mid-1990s. After approximately a decade of popularity among therapists and talk-show hosts, the recovered memory movement fell into disrepute. Clients began to report in increasing numbers that they had been misdiagnosed with multiple personalities, and led to believe that they had experienced traumas in childhood which had never actually occurred, including satanic ritual abuse. Many of the patients who remained in therapy continued to get worse instead of better, which led many psychologists to conclude that multiplicity was usually or always iatrogenically induced through a combination of social and therapeutic influences. The diagnosis MPD was changed to Dissociative Identity Disorder in the fourth edition of the DSM.

A classic case of a questionable diagnosis was the Hillside Strangler case in the US. Kenneth Bianchi, an accused serial killer who allegedly strangled multiple women in Los Angeles, was diagnosed at his court-ordered psychiatric evaluation as having MPD. However, later investigation showed that Bianchi's behavior was not in fact consistent with the MPD diagnosis. This is commonly attributed to the joint effects of suggestion (iatrogenesis in clinical terms) and deliberate deception from Bianchi (malingering).

Multiplicity as a social phenomenon

If Sybil-type MPD/DID is rare or iatrogenically induced, multiplicity per se--the existence of more than one self in a body--is still a phenomenon worth studying. With the advent of the Internet, increasing numbers of self-acknowledged multiples who have never been diagnosed or in therapy have come forward to report that they are living functionally without need of integration. Not all have a history of childhood sexual abuse; many report not only having clear memories of their childhood, but having been multiple for as long as they could remember. Since they do not suffer from severe depression, amnesia, or dangerous behavior, such multiples have rarely come to the attention of therapists, having had no need for their intervention.

In addition, many healthy multiples have called into question the concept of integration of selves. Several people who knew Shirley Mason reported that despite the statements made in 'Sybil,' she, like Eve, remained multiple even after her supposed integration. Some believe that true integration is impossible, or at least impractical, for genuine multiples. It remains to be seen whether the scandals and lawsuits of the 1990s will prevent serious research from being done on functional self-identified multiples, or from non-Wilburian paradigms of multiplicity being studied and considered.

Because such multiples do not experience their condition as disordered or sick in any way, some have proposed that the diagnosis of DID be removed from the DSM entirely, or revised to classify multiples who have difficulty communicating and sharing memories and/or wish to integrate.

This desire is supported by critics of DID therapy within psychology, sociology and criminology, who would also like to see multiple personalities to be considered a lifestyle (by choice or by experience) rather than a disease. It should be noted that from a psychological standpoint, DID/MPD may be considered desirable by an individual:

  • The victim role assumed together with the identity as survivor suffering from severe trauma may provide elevated social status and additional care by friends and relatives. Persons who suffer from lack of empathy by others may openly accept this role in order to call attention to themselves.
  • The ability to act under different identities may be considered useful. Unwanted feelings or actions can be blamed on other personae, behavior that is normally taboo can be expressed without inhibition. For instance, many multiples have child-personalities, interested in "childish" activities like watching children's television, talking and writing without paying attention to syntax etc. Multiplicity allows these acts of regression, which some people may unconsciously desire. In extreme cases, alternative personalities may even be blamed for criminal acts.

Because of the known risks associated with the disorder, most critics demand that therapists who induce multiple personalities in patients by creating false memories and encouraging their patients to assign names and characters to their different emotional states should no longer be allowed to practice. Interestingly, critics of MPD/DID therapy and self-identified natural/functional multiples share many of the same criticisms of the traditional MPD/DID paradigm. These include the emphasis on recovering abuse memories which may or may not be real, the status associated with victimhood and dysfunctionality, and the blaming of "other personalities" for irresponsible or criminal behaviour.

DID in fiction

The idea of multiple personalities has been popularized by many bestselling books and some movies. The first novel to feature multiple personality prominently was The Birds' Nest, in 1954, by Shirley Jackson, which was made into a forgettable 1957 movie called Lizzie. Interestingly, the movie version of Three Faces of Eve, starring Joanne Woodward-- which was released in the same year-- drew heavily on Jackson's work to a point where some consider Jackson to have been plagiarized. The book about Sybil was turned into a 1976 TV movie, the 1994 mystery Color of Night, starring Bruce Willis, the 1996 movie Primal Fear and the 2003 thriller Identity also feature multiple personalities in fictional crime scenarios and explore the idea of responsibility for another personality's actions. Various movies, including Never Talk to Strangers and Session 9, and episodes of popular TV shows such as X-Files and Judging Amy, have used the now-cliche idea of multiples with a hidden "killer personality" for cheap drama and thrills. Touched by an Angel goes so far as to imply that multiples are actually demon-possessed. These movies and shows pay little attention to the controversy surrounding the disorder, but the idea of multiplicity is a powerful storytelling device.

See also:

References and external links




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