“If someone with multiple personalities threatens to kill himself, is it considered a hostage situation?” – George Carlin
San Francisco California
Dissociative Identity Disorder (DID)
by Robert M. Goldstein
No one has multiple personalities.
How easy it is for myth to replace simple fact when it comes to mental illness.
Multiple Personality Disorder became Dissociative Identity disorder in 1994 to reflect a new paradigm for understanding how such a condition exists.
Dissociative Identity Disorder is not more than one personality; it is less than one personality.
Dissociative Identity Disorder is the fragmentation of a single identity into roles and areas of competence. As we move through the life cycle we adopt different roles.
A teenage girl graduates high school, and becomes a young adult.
She enters medical school and becomes a doctor as a practitioner and a role.
She marries and becomes a wife.
She gets pregnant and becomes a Mother.
She slides from role to role without thinking and uses memory to create an internal timeline that allows her to create a unified sense of self.
She can nurse her baby and affectionately tell her husband about the patients she saw that day. A person with DID does the same thing but there is a problem.
Rather than transitioning from adolescence to young adulthood the person with DID creates new identity or personality state that may have little or no memory of life as a child or adolescent.
Each personality state creates a body-image and a sense of itself as distinct from the whole. These fragments of identity may deny knowledge of one another, be critical of one another and be in open conflict.
The characteristics of these different identity states—such as name, reported age, gender, vocabulary, general knowledge, and predominant mood are often different from the primary identify but are essentially similar in basic structure.
This is one of the reasons that DID is so difficult to detect. To the observer someone with DID may seem moody or may seem to have a mood disorder.
The life of someone with a severe dissociative disorder is marked by disruptions in behavior, broken relationships, abandoned projects and difficulty in the workplace.
The best and most public example of this is Marilyn Monroe. Whether or not Norma Jeane Mortenson had DID the character of Marilyn is an excellent example of a personality state designed to fill a roll.
Marilyn’s job was to sexually disarm the world and make it love her.
She succeeded brilliantly and is still doing it.
Imagine that my hypothetical doctor forgets everything about being a doctor when she goes home and becomes a wife.
Imagine that she forgets everything about being a wife and believes that she is a teen when she goes home to visit her parents.
The internal experience of someone with severe DID is that these identity fragments are separate from the self.
He may feel as if his body is taken over by an outside entity or as if he is not in his body at all.
Identity fragments are called alters.
Alters may have different ages, a different gender from the physical body; a different name, or no name; and different skills of daily living.
It is not unusual for someone with DID to enter therapy and express what appears to be a proliferation of identities.
What is really happening is that the alternates emerge as they build a trust with the therapist.
The appearance of hidden identity states is a sign of therapeutic progress.
Severe dissociative symptoms are most often the result of a history of prolonged physical and psychological childhood abuse which means that Dissociative identity disorder is a severe and complex form of posttraumatic stress disorder (Kluft, 1985; Spiegel, 1984; Spiegel & Cardena, 1991).
How does it happen?
Not all abused children develop a dissociation disorder; however, studies show that abused children demonstrate more dissociation than children who aren’t abused.[3, 4]
Dr. Richard Kluft views the condition as a chronic dissociative PTSD that begins in childhood.
According to the International Society for the Study of Trauma and Dissociation physical and sexual abuse in childhood cause dissociative disorders (e.g., Putnam, 1985). Dissociation is an adaptive response that reduces the overwhelming pain of the abuse.
When the dissociative strategy continues into adulthood the dissociative adult automatically disconnects from any situation that seems threatening.
This leaves the person “spaced out” and unable to protect themselves in conditions of real danger.
For trauma survivors with dissociative disorders losing time is normal and they may not be aware of how much time they lose.
For me the disruptions in time includes age sliding.
I know how old I’m supposed to be but not how old I am.
I don’t know what I look like, I don’t recognize pictures of myself or I recognize them as other people.
At my best I have the disciplined mind of a trained academic and at my worst I am confused by simple directions.
Prior to becoming too symptomatic to work I was the director of a mental health program in San Francisco.
I knew that something was wrong with me but I didn’t know what it was.
The first suggestion that the problem might be DID came from my assistant.
A week before I stopped working she said, “I don’t know who you are, but you’re not Rob.”
My first reaction to the diagnosis of Dissociative Identity Disorder was to feel guilty about it, as if I was morally flawed.
“Dissociative identities exist in a third reality, an inner world that is visualized, heard, felt and experienced as real. This third reality is often characterized by trance logic.
In trance logic, ideas and relationships of ideas about things in reality are not subject to the rules of normal logic. Because they are kept in separate compartments, contradictory beliefs and ideas can exist together; they do not have to make sense. In the internal world the alternates experience themselves as separate people. There is a pseudo delusional sense of separateness and independence.
Trance logic is characteristic of dreams and hypnosis.” Elizabeth F. Howell
My alternates are well-educated, skilled in their roles, and tend to be playful and witty.
Most people online can’t tell that the “person” they’ve met is a “face” that is no longer in use in life but is highly adept at “appearing” normal.
The debate over the ‘reality’ of Dissociative Identity Disorder is of no consequence to me.
People use all of their being to survive, this includes the mind.
Even if Dissociative Identity Disorder doesn’t exist the “delusion” that one has separate selves is still an illness that causes suffering for the patient and the people he loves.
I consider myself a decent man, and I do my share of the heavy lifting in my friendships by working to manage those aspects of my illness that are under my control and by taking responsibility for those that aren’t.
My advice for anyone who has a friend with DID or who is considering friendship with someone who has DID is learn about the illness.
Expect your friend to be hyper-vigilant and forgetful.
Expect him to express contradictions in opinions.
Expect him to need downtime; especially if he is in therapy.
Expect him to be completely loyal to people who treat him with respect.
People who are unable to tolerate ambiguity have no business involving themselves with anyone who has a PTSD and CPTSD.
If you think that you know what DID is because you have seen or read Sybil and the Three faces of Eve, you’re wrong.
In a post about the partners and friends of people with DID Holly Gray, on the Dissociative Living Blog, says it best:
“Those of us with DID don’t have the option of walking away from it. You do. For my part, I’d like to remind you that no matter how it feels, DID isn’t forced on you. You can leave, or choose not to get involved at all. Those of us with this disorder would spare you if we could. So when it gets rough – and it will get rough – please remember this: living with Dissociative Identity Disorder is a decision you’re making, not something we’re doing to you. Blame us for our choices and behaviors … not for having DID.”
Dissociative Identity Disorder is one of the most misunderstood of all of the misunderstood mental illnesses, and that makes living with it far more difficult than it has to be for many people.
Exposing these misunderstandings may not seem to accomplish much. But I believe that if we continue to talk openly about DID and other mental illnesses, the lives of people with mental illnesses twenty years from now will be less painful and more productive.
(c) Rob Goldstein 2014-2016
this is… The Neighborhood