The mind, once expanded to the dimensions of larger ideas, never returns to its original size. ~ Oliver Wendell Holmes


Monday, November 21, 2011

WHAT IS DISSOCIATIVE IDENTITY DISORDER (DID)?


Multi-Personality Disorder (MPD) or Dissociative Identity Disorder (DID) is defined as the presence of two or more distinct personalities that continually exert power over the behavior, actions, perceptions, memories and appearances of the person or host, often accompanied by amnesia or the inability to remember events occuring from one state to the next.

This condition has been subject to debate in medical, social, anthropological, philosophical, religious, legal and public arenas for years.  On one side, we have the skeptics who believe this is a manifestation of the power of suggestion during hypnotism, false memories, deception, or the old standard - “hysteria” (talk about one large step backwards).   Conversely, there are countless professionals who see this as a serious illness in which a personality becomes so severely fragmented, that the various parts are no longer able to connect with one and other.

It has been used as a defense in courtrooms, creating contention between forensic psychologists and prosecutors.  The question becomes - When an "alter" has allegedly has committed a crime, who should be held accountable - the host or alter ego?  And how do we handle the logistics of sentencing one or the other?

So what causes this disorder? Can it easily explained away by misfiring neurons or electrical impulses within the brain?  Is it biologically or chemically induced?  Some might argue that it involves possession by an unseen entity.  Others may believe that the patient is momentarily lost in the time/space continuum slipping from one quantum dimension into another.  Maybe it’s a primitive behavior allowing one to adapt to a given environment or situation?  Does the Freudian Conscious Theory offer the answer?  There are as many concepts as misconceptions, variables and presentations, and most of all – questions yet unanswered.

We have all experienced moments of dissociation, whether while daydreaming, getting caught up or lost in the moment or simply zoning out.  There are times we get a little carried away when trying to make an impression or fitting in with the crowd.  Altered states of mind are induced by meditation, hypnosis or sleep.  At times we may “act out of character” leaving us questioning how we could possibly be so brilliant, utterly reckless and stupid or anything in between. We often “pass the buck” uttering clich├ęs such as “The devil made me do it”, “I took a leave of my senses”, “It was divine inspiration”, or “It was the alcohol/drugs/disease talking.”

Intentionally or not, we may forget events or moments through a number of mechanisms including “selective memory”, yet another coping mechanism. Although this ability comes naturally for most, research led by Gerd Thomas Waldhauser, from Lund University in Sweden has shown that we are capable of training ourselves to forget or repress traumatic, embarrassing or unpleasant memories if we suppress them long enough. As quoted by Letitia Landon: “Were it not better to forget than to remember and regret?”

If we combine these factors with the dynamics of the human mind, an infinite number of results may occur depending on individual circumstances.

Our “personalities” are a highly complex and unique conglomeration of traits that influence cognition, motives and behaviors in response to various stimuli.  They may include adaptive or maladaptive aspects.  Certain traits may seem insignificant or merely of nuisance value.  For most of us, the brain is capable of filtering through this, compartmentalizing various aspects and qualities in an effort to avoid cognitive dissonance or the anxiety produced when faced with contradicting information or perceptions.  In turn, we may create a separate identity or “alter ego” that behaves contrary to the standards we were brought up with or one that is more effective in dealing with particular stresses or triggers.  When heralded by circumstance or chemical influence, they may become distorted and greatly amplified.  For most this is a fleeting moment, or until the effects of a given substance has worn off.  For others, however, it may become a way of life, consciously or subconsciously.

Dissociation is an innate survival mechanism that kicks in to protect us against pain, stress, anxiety, guilt or shame that is more than our minds can handle.  However, when one struggles with condition such as Borderline Personality disorder (BPD), the response may become ingrained as a means of coping.  Self-perception becomes highly distorted and personality, highly fragmented and disconnected.  In order to deal with the overwhelming chaos of mixed emotions and associated characteristics and behaviors, the psyche splits them, assigning them to separate entities.

The creative mind breathes life into each new persona giving them their own unique history, memories, appearance, voice, mannerisms, characteristics and means of expressing themselves.  This is a defense mechanism brought on through a desperate need for validation and acceptance. Although this may seem foreign and disconcerting to others, this action enables the patient to display repressed characteristics/emotions, giving them a voice and visibility to the outside world.  

Having faced this condition myself as a young adult, I can best explain it in terms of viewing oneself in a full-length mirror.  As long as its surface is smooth, it reflects back a true image of you as a whole. Distort or manipulate the surface with abuse, trauma, neglect (mental, physical or emotional), and you will see what those responsible want you to see.  If the stresses exerted upon it become too much, the mirror will shatter, as does your psyche.  Each piece is different, offering its own distorted reflection of limited aspects of us.  When we try to put the mirror back together, or “reintergrate” the pieces, it may not reflect the original image.  Some fractured pieces may be missing or damaged. Others may no longer fit.  However, this is not always a bad thing.  As beautifully quoted by Barbara Bloom ~ “When the Japanese mend broken objects, they aggrandize the damage by filling the cracks with gold. They believe that when something's suffered damage and has a history it becomes more beautiful.”

Alters come and go depending on triggers and circumstance.  Some may be aware of each other and are able to converse.  On the other hand, there are those that step in, pushing others aside.  When this happens, it feels as though an unwelcome guest has barged in and taken control of your mind and body.  In my experience, amnesia may or may not occur.  I don't believe this is a "one size fits all" condition with easily defined borders.  In my opinion, each presentation is as unique as the individual experiencing it.

It is important to note that, although it may seem as though an individual is "acting", true DID is not a controlled exercise or dramatic performance intended to fool and manipulate others.  Unfortunately, as with so many things, there have been those who have muddied the waters for their moment in the spotlight or financial gain.

"Sybil”, the 1973 acclaimed novel/movie described the treatment of Sybil Dorsett who suffered from Multi-Personality Disorder and sparked a revolution in popular psychology. It’s no surprise that this resulted in an enormous increase in the number of cases diagnosed, as fads and fashion are often products of the media. The public, as well as medical community were eager for answers and thus became subject to the power of suggestion. The question became – was this story true or was someone trying to pull the wool over our eyes? According to Sybil Exposed, a new book by author Debbie Nathan, the answer is “readers beware”; most of the story is based on lies.  Questions regarding the patient’s and therapist’s motives, honesty, and the possibility of false memories planted as the result of hypnosis have been raised. However, as misguided as this case may have been, it is not grounds for dismissing DID nor the countless recorded cases of it.

More recently the subject was resurrected and given a new life in the popular TV series “The United States of Tara”, a comedic drama created and produced by Steven Spielberg which began airing on Showtime in 2009. Once again, the plot revolved around a female suffering from DID.  However, in this case, it was portrayed as a condition that one could live with given a supportive family along with proper treatment. While it shed light on a deeply stigmatised condition, the unprompted and sudden changes in character were sprinkled with an overdose of creative license, designed to entertain rather than to represent “real” patients (although I do not discount the fact that some may relate to this type of expression by alters).

Whether you suffer from DID or know someone that does, understand that it is a coping mechanism that kicks in when facing painful or traumatic events, or when perceived triggers threaten us. By nature, we try to reduce anxiety and confusion by attempting to oversimplify the human psyche as we are challenged to fit square pegs into round holes. Each alter ego is a part of us and serves a purpose, in spite of whether it strengthens us or trips us up.

Acceptance is crucial as each alter has a story waiting to be heard and issues that need to be resolved before it can return to its rightful place in the bigger picture. Look for the main root, the time and place of birth of alter and address the deeper issues.  In time, the coping mechanisms will no longer be necessary. Most of all remember, each ”personality” is part of a soul trying to find its way home.