Psychology

Understanding Dissociative Identity Disorder



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While some professionals in the mental health field dispute the validity of research and published cases of patients diagnosed with Dissociative Identity Disorder, other professionals in the field disagree. The current controversy among the profession is more about what the proper symptoms are, what diagnosis is the best, and what treatments are most effective rather than whether or not the disorder is real. The opposing arguments serve as an indicator that more research and publications are required to further understand Dissociative Identity Disorder.
A mother gives birth and a child is born. The child is socialized, thus learning how to live in a society, and grows into maturity. The child then grows into an adult and their mind matures. The child interacts with others and with the world, sometimes aware and sometimes not. It's these varying degrees of awareness that separate each of us from each other. It would seem that the more awareness we possesses in our minds, then the more power we have in the world.
The child, for example, sees that it is snowing outside by looking out of the window at the backyard and wants to build a snowman. The child has the normal amount of awareness for one that is in the processes of being socialized and so the child has series of thoughts about the snow and how to achieve what he or she wants. The child knows that the door is locked and that the rules of the house forbid him or her to go outside without getting permission first and so the child's mind then deliberates and comes to a conclusion. The child decides to go and get permission because the consequences of going outside without it are not worth the amount of fun the child was expecting to have. The child's level of awareness influenced his or her actions and subsequent thoughts to act in a certain manner. The older that child becomes, the more complex his or her thought process will become and inevitably their levels of awareness will increase as well.
Now, what if something happens to the child while his or her socializing is still taking place? Something traumatic happens to the child, for instance, and forces the child's level of awareness to recede. Something so devastating happened to the child that his or her mind becomes entangled like a ball of yarn, with the awareness, memories, and feelings all mixed into each other. When the child's mind becomes scrambled, how can he or she be expected to function normally in conditions such as these? And so, the child may detach him or herself and go somewhere in their mind; somewhere it is safe.
Trauma to a child and tragedy to an adult are equivalent to each other as they both tend to engulf our worlds, force themselves upon our minds, and demand our immediate attention. However, what if at each of these stages in our lives, our minds are not yet ready to handle such trauma and tragedy? Something happens to us in those moments, inside our minds, that we seemingly have no control of. And with the complexity of our minds, at each level of awareness we encounter, it is difficult to fathom exactly how the mind works when an unexpected tragedy happens to us.
If a child hurts his or her hand and it's not too serious, then we apply a Band-Aid to make the child feel better, even if the accident does not warrant one. And if a child bumps his arm on something and asks that his or her mommy or daddy kiss the bump to make it better, is the kiss actually making the bump heal quicker? In both instances, the factor that makes the child better is not the Band-Aid nor the magical kiss from mommy or daddy, but the reassurance the child receives that he or she will be fine. From an early age, the child develops his or her own boundaries and safety zones. And when those boundaries are crossed and zones are entered by someone or something out of the child's control, then the child is forced to react in someway. It is from these varying degrees of reactions that we begin our study of dissociation.

Dissociation is merely a word to describe how a person detaches themselves from awareness at any given point in their lives when their mind has problems dealing with certain events. Rita Carter explains it well in her article for New Scientist, when she writes about dissociation in a way that is easily relatable for those of us outside of the mental health profession. She explains it this way: "And dissociation is not itself abnormal-it is simply a reflection of the brain's ability to process information along parallel pathways and at different levels of consciousness. You are dissociating when you get "lost" in a book or find that you've carried out some routine task (driving is the usual example) without being able to remember it. Far from being dysfunctional, this everyday type of dissociation can give the imagination free rein or leave the body to carry out routine tasks while the conscious mind roams elsewhere" (36).
Also in Rita Carter's article, she writes about the study of dissociative disorders and looks to professionals in the field for research and meaning. She summarizes the work of one therapist who specializes in dissociative disorders. The therapist reports that her clinical research points out that 30 million people are afflicted in North America. The therapist believes that the dissociation is linked to childhood abuse and theorizes that abused children dissociate as a way to get away from horrible events going on around them (36).



Dissociative Identity Disorder, as it's called now, wasn't always referred to as such but rather was simply known as Multiple Personality Disorder. The published manual by the American Psychiatric Association called Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) identify it as formally being Multiple Personality Disorder (Psychiatric Disorders: Diagnostic). The DSM-IV is widely referred to by professionals in the field and is referenced in many academic journals. As AllPsych Online reports, "Mental Health Professionals use this manual when working with patients in order to better understand their illness and potential treatment and to help 3rd party payers (e.g., insurance) understand the needs of the patient. The book is typically considered the bible' for any professional who makes psychiatric diagnoses in the United States and many other countries" (Psychiatric Disorders: Diagnostic).
AllPsych Online summarizes the following about Dissociative Identity Disorder as taken from the DSM-IV. "DID is associated with severe psychological stress in childhood, most often ritualistic sexual or physical abuse" (Psychiatric Disorders: Dissociative). Given that the DSM-IV is widely utilized as a reference in the Mental Health profession, some credence must be awarded to the information it presents. Medical Science, as with all other sciences must be scrutinized in order to better serve mankind and mental disorders like Dissociative Identity Disorder are not exempt.
The idea that a person can have two separate personalities, in essence two separate people, living within the same body is difficult to fathom. Not only is the idea difficult to grasp mentally, for the average person but it would seem that the idea is equally as difficult for the Mental Health professionals and the patients to understand as well. AllPsych Online summarizes the following about the symptoms of Dissociative Identity Disorder as taken from the DSM-IV. "The primary characteristic of this disorder is the existence of more than one distinct identity or personality within the same individual. The identities will take control' of the person at different times, with important information about the other identities out of conscious awareness" (Psychiatric Disorders: Dissociative).

Focusing on the symptoms is an important aspect of the disorder, as many debates have risen in the Mental Health profession over the years. Court TV's Crime Library briefly describes the differences in professional opinions that serve as the focal point of the various debates concerning Dissociative Identity Disorder in an article posted on its website. The article states, "There is probably no greater divide in the professional world than that regarding the authenticity and diagnosis of this disorder. It ranges from those who insist there is no such phenomenon to those who believe every reported case is genuine and we have not yet begun to uncover them all" (Multiple Personalities: Dissociative Identity Disorder). By the fact that the professional world is so divided in their opinions concerning Dissociative Identity Disorder, it is apparent that more research is required to understand its symptoms, diagnosis, and treatment.
Knowledge, in today's society, is power and the more knowledge we possess about this disorder will help Mental Health professionals better recognize its symptoms. By accurately accessing a patient's symptoms, a proper diagnosis can be made and the patient can then begin the healing process. By properly diagnosing the patient, including helping them understand what is happening to them, the patient and those who care for them can begin to work through and overcome the disorder. By understanding the disorder better, the patients, professionals, and society can begin to accept everything this disorder encompasses. Dissociative Identity Disorder is not devoid of research but the reality is that, like with most sciences, there is research for both sides of the debate. Our study will now focus on a few of the opposing arguments surrounding the disorder.
In the first part of a two part study on the critical examination of Dissociative Identity Disorder for the Canadian Journal of Psychiatry, the authors conclude that the disorder is an imagined illness that is, at times, induced by the disorders' proponents. The authors reference available literature and state that there is no definitive proof to support that the disorder is brought on from trauma early in a child's life. The authors also surmise that the disorders' diagnosis is not a reliable one (The Persistence of Folly: Part I: Abstract). In the second part of the study, the authors continue their critical examination of Dissociative Identity Disorder and examine the effects on the patients by the disorders' proponents, concerning their "diagnostic and treatment methods." They continue to critically examine the available research and some factors that they believe are some causes for the diagnosis being unreliable. One of the factors they examined concerning the diagnosis was that the definition of "alter personality" was not clear enough. The authors also conclude that due to the disorders' unreliable diagnosis, they believe that the judicial system could not accept testimony that favors Dissociative Identity Disorder (The Persistence of Folly: Part II: Abstract).
We should also note that in Court TV's Crime Library article referenced earlier, its conclusion lends support to the arguments against Dissociative Identity Disorder. The article concludes that "While other personalities can be elicited through hypnosis, it's also possible to affect a suggestible person with hypnosis in such a way that they will act as if they have different personalities-especially if they have something to gain. In fact, some critics insist alter personalities are nothing more than social constructs, suggested by a therapist to a vulnerable patient and supported by the social milieu (including insurance payment). In short, there is no clear consensus among professionals on the disorder" (Multiple Personalities: Dissociative Identity Disorder).

Despite current debates about the validity of the disorder, it is important to note that the disorder is not a new one, however rare it is, but has simply evolved over the last two centuries. Our study will now shift focus to the progression of the disorder from its origin to the late 20th Century. We will begin by citing a case study from the 19th Century as reported by Dr. Eric Carlson in 1987, then the editor of the Classic in the History of Psychiatry and Behavioral Sciences reprint series (Carlson 315). "Mary Reynolds emerged in 1811, as the next multiple personality, often identified as the first in history and undoubtedly the best known case of the early nineteenth century. As she went through her shifts to a second personality in the hills of western Pennsylvania with only one physician in the region, it is not surprising that no one tried hypnosis with her. What is of interest is the terminology introduced in her case in 1816 by Samuel Latham Mitchill of New York City. He spoke of her as a case of "a double consciousness or a duality of person in the same individual" (Carlson 317). Part of Carlson's study also focused on auto-hypnosis and self-hypnosis. He reported that both were similar but not the same. Auto-hypnosis takes place when hypnotic trances were brought on spontaneously and self-hypnosis were hypnotic trances that were brought on purposefully (Carlson 319). Regardless of the future outcome of the studies of Dissociative Identity Disorder, it's paramount we recognize the pioneering work that took place since the first reported cases.
The importance of the early work concerning the disorder is evident by the advances of today, by which the Mental Health profession uses as a foundation for their work. In a paper written for Social Behavior and Personality: An International Journal, authors Ronald Kelley and Frank Kodman "offer a perspective of the MPD phenomenon based on current clinical experience. The co-authors representing clinical psychiatry and clinical psychology are active in the treatment and research of over 60 patients manifesting the MPD disorder" (A More Unified View: Abstract). The authors begin by reporting that in recent years, the number of reported cases have risen. They, in turn, speculate on the rise of cases by stating that the "number (of cases) is now approaching epidemic proportions." They also suggest that "The need for a theoretical perspective is self evident and the scientific study of this syndrome is just beginning" (A More Unified View 165). Also, closely related to the 19th Century research on auto-hypnosis, the authors offer their explanation concerning this type of hypnosis. They report that "The altered personality states are commonly view as auto hypnotically induced states of consciousness." They support their view with the hypothesis "that children who have been severely punished tend to become more easily hypnotized." The authors further suggest that hypnosis may be used to treat the disorder (A More Unified View 166). Dissociation causes memories to be repressed, hypnosis helps recover memories and so the authors conclude that "Dissociations can play a role in healing or in creativity as well as in producing defense alters or states" (A More Unified View 167).

From being a fallacy to treating real patients suffering from some kind of real disorder, the debates are numerous. With the strong division concerning this disorder from different experts in the same Mental Health profession, it is indeed evident that more research is required to better understand what is happening in these patient's minds. No matter how the research favors one view over another, there are still people in our society who need real help in dealing with this problem of multiple personalities. To conclude our study, we will look at a famous case study from the 20th Century involving a woman named Chris Sizemore, who was known as Eve. Court TV's Crime Library posted an article on its website entitled Eve and Sybil. With much controversy surrounding the case of Sybil, we will focus on Eve for our study. The article states that the case of Chris Sizemore, who was known as Eve, was told in a movie called The Three Faces of Eve. The case involved a woman "who suffered from a rare disorder that came to be called MPD." Eve dissociated when she would run to get help, as later hypnotic treatment proved that the trauma had most likely only occurred around her rather than to her. "At one point, Sizemore tried to strangle her own daughter and afterward had no recollection of the act, so she checked into a psychiatric hospital. The doctors referred to her personalities as Eve White, a wife and mother; Eve Black, a party girl; and Jane, a mature intellectual. After a year of therapy, they declared her three alters had integrated (meaning the personalities merged into one single personality), which meant she was cured." She was not, as the doctors stated, cured, as 22 more personalities showed up. She went into therapy again with someone different and wrote a book about her experiences. "It took twenty years of intense work before she realized she could control her own life. She eventually became normal,' but her condition had lasted some 45 years" (Multiple Personalities: Eve and Sybil).
Dissociative Identity Disorder is a real problem that affects many more people than one might care to know and it is a problem that is rooted in the human mind. Much more research is needed to better understand this condition and while debates are being waged as to its authenticity, people are suffering. With arguments concerning symptoms, diagnosis, and treatments it would seem almost impossible to see any progress with the patients or the clinicians. First a patient must seek help, be accurately diagnosed, and then treated in order to be cured.
We must wear another's shoes in order to understand what they are going through, as the saying goes and so we must try to do just that with those who are unfortunately afflicted with this disorder. Imagine, for a moment, that you were that child who was severely traumatized and you dissociated out of instinct and escaped to a safe place somewhere in your mind. You then return when the trauma is gone, without memory of what happened because somewhere deep inside your mind you decided, unconsciously, that you couldn't handle the truth of what happened. You then go on living your life, not bothered by anything from your past, and then one day something happens to you that causes you to dissociate once again. Something happens to you, inside of your mind, which forces you to regress back to that safe place you found as a child. You may wake up somewhere and not know how you got there, or wake up with someone who you do not know. Or maybe you wake up in a hospital, injured, or in jail because you hurt someone. Or maybe you wake up in a mental hospital with absolutely no memory of who you are. What if, while you were retreating in your safe place someone else came to the foreground and took control of your life? We cannot judge what we do not know and so it is paramount that we discover everything there is to discover about the disorder known as Dissociative Identity Disorder.

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