“Because, we’re the same person,” the famous line that twisted the whole plot of the 1999 hit blockbuster “Fight Club” awed many people including myself. For some reason, the thought of having two completely different identities still amazes me today. Dissociative Identity Disorder “is a severe condition in which two or more distinct identities, or personality states, are present in – and alternately take control of – an individual” (Stephens, 2005).
Although in the case of “Fight Club” the narrator’s disorder was a more severe case, in which both his identities had their own separate lives, the nature of Dissociative Identity Disorder (DID) for many cases shows only a few distinct characteristics, because the identities are not fully independent. That is the reason the name of the disorder was changed from “multiple personality disorder” to DID (Barlow & Durand, 2005).
Now before we get into the fun waking conscious and legal issues in DID, let’s look at some statistics and causes of this disorder. Although Hollywood films portray the disorder for the subject to have two distinct personalities, the actual number reported by clinicians is closer to 15 with a female to male ratio of 9:1, these findings are based on accumulated case studies (Barlow & Durand, 2005). A large portion of patients diagnosed with DID are also diagnosed with other psychological disorders, to make this more clear, a sample of over 100 patients were found to have an average of seven additional disorders on top of the DID (Barlow & Durand, 2005).
The cause of DID seems to be universal, in 97% of the cases, significant trauma was previously experienced. The patient was extremely and unspeakably abused as a child, usually sexually or physically, with 68% reporting incest (Barlow & Durand, 2005). From experiencing such trauma, there is a “wide-range agreement that DID is rooted in a natural tendency to escape or ‘dissociate’ from the unremitting negative affect associated with severe abuse” (Barlow & Durand, 2005).
Steering away from the physical and sexual abuse relating to DID, the disorder in itself is extremely interesting and perplexing. Hollywood films only add to its compelling nature by over dramatizing the identities, creating a “what if” phenomenon in all its viewers, “what if I had another identity”. In my experience, everyone wants to be someone better, everyone has flaws that they wish magically disappear, this thought of DID, having a smarter, “smoother”, and overall better identity is what drives people to be so fascinated with this disorder. We live our lives day by day, as our waking conscious builds our model of the world. Although many of us will never get to experience the real clinical DID, Robert Ornstein believes that “We all experience mind split.”
He gives a very real example of how many of us just feel “out of it” and suddenly snaps back to reality, with absolutely no recollection of time (Ornstein, 1991). “Reading a sentence, we are consciously aware of meaning but we are not usually concious of the spelling of words, hence the difficulty of proofreading (did you notice that consciously was misspelled earlier in this sentence?). And we are not conscious of grammar unless wrong it being” (Ornstein, 1991). So with Ornstein’s example, we can somewhat create a simulation of what a person with DID may feel like. One big factor in DID is memory loss or amnesia prior to the “switch”, just like we are conscious of the meaning of a sentence, but not particularly the spelling, a patient with DID, or “multiple selves” although may be aware of the other selves, but not the specific situation (Ornstein, 1991) thus resulting in a memory lapse.
Eric Eich, et al., did a research study in 1997 on nine patients with DID. What they were looking for was the relevance of interpersonal amnesia among the patients to see if memories of certain events experienced by one identity, could be recalled later by that same identity, but not the alters. The results further strengthened the reasoning for memory lapses in patients with DID, as the patients in the study after a test of free recall, did very poorly, where only one word out of 180 presented to a patients “p1” identity was properly recalled by their “p2” identity. In addition, none of the 180 words were recalled when they were initially given to the “p2” and asked for recall by the “p1”. (Eich et al., 1997). Although their study did not employ all the possible ways of measuring interpersonal amnesia, their results are fairly consistent with other scientific findings on the subject, although one interesting finding in the study was that the “leakage” of information that occurs from one identity to the other “depends on the extent to which encoding and retrieval processes are susceptible to personality-specific factors” (Eich et al., 1997).
“Our normal waking consciousness builds us a model of the world, based on sense and body information, expectations, fantasy and crazy hopes, and other cognitive processes. If any of these factors is radically altered, an altered state of consciousness may result” (Ornstein, 1991). If we look at that quote and break down its meaning, it is clear then as to why so many victims of severe physical or sexual abuse may “dissociate” and form alter identities. If their “real” world is drastically destroyed, then they must form these “alters” to cope with their shattered world, in essence they create a stronger identity able to cope with the traumatic events of which the previous could not.
DID at times, takes attention away from the subjects being the victim, a good example of this is when DID patients turn to criminal activities. When later presented in court, the subject has no recollection of his crimes (Noonan 2000). Now the question in focus is whether the subject is responsible for his actions (particularly in the case of homicide), or if he can be released to a mental institution for reasons of insanity (Noonan, 2000). Assuming the subject is not faking DID, judicial approaches to determining responsibility can be very challenging as the court would have to decide first if the subject actually meets the diagnostic criteria for Dissociative Identity Disorder set forth in the DSM-IV. After determining if DID is present, then an assessment of the subjects host personality would have to be taken (most likely by a professional i.e. forensic psychiatrist) to determine if the host was aware of the alter personalities actions, and whether or not the host assisted in the criminal activity (Noonan, 2000).
Many times in these cases, a defendant in court, on trial for serious charges (e.g. murder) may fake DID to get off on a plea of insanity. With this in mind, there have been many ways to determine whether or not the defendant is malingering, one method often used is having each alter take the Minnesota Multiphasic Personality Inventory (MMPI) (again usually administered by a professional). The MMPI is such a unique test in that it does a really accurate job in measuring ones personality, so if the subject indeed does have DID, the MMPI tests taken by the alter identities should vary considerably. (Noonan, 2000). Other ways of determining if one is faking DID is often by structured interviews with psychologists. In one case, a psychologist had every reason to believe his subject (a serial rapist and murderer) met the criteria for DID, until he did one last test; the subject claimed to have two identities, but when the psychologist mentioned that the usual case for DID is three identities, the subject quickly created a third, unexpectedly. On this basis, the subject was found guilty and sentenced to life.
Finally after going through the fun times of altered identities and trying to evade murder, it is time to put a stop to this train of DID. Treatment of DID however is very complex in it nature, mainly because you are trying to just down possibly hundreds of different identities. The best treatment for DID is definitely long-term psychotherapy, where a therapist must gather as much information on the subjects past and use mapping techniques to bring each identity together (Kluft 1999). Getting the subject’s history is particularly important, as the therapist must take extreme caution not to jump right into healing the past trauma without prior background knowledge (Kluft 1999).
In treatment, the therapist wants to get to the threshold of moving toward a resolution, thus integrating the alters, essentially bringing them together, working out the differences. Once the integration step is accomplished, it is downhill from there, now the therapist must focus on coping skills for the patient after his new found resolution among his identities. These are skills dealing with relationships and life decisions. Once the subject gets a feel for these coping skills, the therapist will want to solidify these skills, making sure the subject has mastered them and is able to use them as if they were automatic. Routine follow-ups are necessary obviously to make sure the subject continues to use the learned skills and does not relapse to the alter identities (Kluft 1999). Although this is a very effective method of treatment for DID, it is important to know every case if different and this method will not work on everyone with the disorder.
“DID reflects a failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self” (Stephens 2005). To the many of us without DID, we may never know exactly how that feels, but if we want to get close, we should listen to Robert Ornstein, and just proofread a paper.
References
1) D.H Barlow, V.M Durand (2005). Abnormal Psychology: An Integrative Approach,fourth edition. Somatoform and Dissociative Disorders (pp. 191-198). Belmont: Thomson Wadsworth
2) Eich E, Macaulay D, Loewenstem R.J, Dihle P.H (1997). Memory, Amnesia, and Dissociative Identity Disorder. Psychological Science 8 (6), 17422 doi:10.1111/j.1467-9280.1997.tb00454.x
3) Kluft, RP. (1999). An overview of the psychotherapy of dissociative identity disorder. American journal of psychotherapy, 53(3),289-319.
4) Noonan, J.R (2000). Dissociative Identity Disorder and Criminal Intent: An approach to determining responsibility. In R.E Geisel man (Ads.) Intersections 3: Psychology/ Psychiatry/ Law (pp. 169-185). Balboa Island: ACFP Press
5) Ornstein, R (1991). Evolution of Consciousness: The Origins of the Way We Think. New York: Touchstone
6) Stephens, L (2005). Dissociative Identity Disorder (Multiple Personality Disorder) Retrieved May 30th, 2008, from http://psychologytoday.com/conditions/did.html
