“If someone with multiple personalities threatens to kill himself, is it considered a hostage situation?” – George Carlin
from
San Francisco California
Which Mask Shall I Wear Today? by Robert M. Goldstein
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.
click image to enlarge
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.
The international Society for the Study of Trauma and Dissociation
For trauma survivors with dissociative disorders losing time is normal and they may not be aware of how much time they lose.
A Flight of Ideas by Robert M. Goldstein
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.”
Inside Dissociative Identity Disorder: Introduction
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
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I wish more information about DID included Co-consciousness. All you ever read about it is the typically thought presentation but there are number of people with DID who are Co-conscious and are aware of their alters.
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The analogy of the woman and her progression through life made so much sense to me. I wonder about myself. I have horrible abuse in my past. I am dealing with it and do not feel like myself on a daily basis. I often say I miss myself. I never know what I will wake up and be like. My issue is, how do I know. How do I find and communicate with parts? I just know they are there. Will this happen with more time? The ability to distinguish between the fragments?
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Thanks for re-blogging this Kendall. I re-read it because I don’t remember writing it. It seems comprehensive. I see a few typos and a brief lapse in logic but other than that I did ok…:)
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Hahahaha…. well that kind of seems appropriate
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It illustrates the point…:)
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One brief addition: We will not understand disorder until we understand the well ordered soul, and modern psychology and psychiatry systematically exclude the wisest minds that have studied the mind, in an attempt to be scientific in the modern sense. The result is our DSM and drug industry. Mental disorders as distinct from personality disorders require first an understanding of the faculties gone awry, as the Bro. up the page has said. The height of the understanding of the human mind available through long and painstaking study of Plato and Aristotle would be a good start. Carl Jung is the only shrink ever to make much of an effort, and from his study we suspect that the dissociations are due to terrible things, like sexual abuse, that the subject cannot integrate into their understanding of themselves and their world. Nor can anyone else integrate these either, but the work of healing will proceed, with prayer, in this direction.The DSM is such a joke because it assumes an understanding of the well ordered soul without ever having raised the questions or pursued the study, and resists such criticism to protect the arrogant assumption of knowledge and the six figure salary. Let us begin anew from Socratic ignorance, and realizer that a forty year study will not yield anything like the certainty required for the arrogance of the DSM. Their terms do not even cohere: Is ordered the same as adaptive? and these the same as normal and compliant, self actualized and successful? Functional in what work? Yeah, what, Mr. Shrinkola, is the proper work and virtue of man?
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The DSM is really a system of billing numbers used by providers to bill Medicare and insurance providers. The greatest sell out of all was the decision by mental health to allow a medical model to determine which patients will have access to treatments and how.
Everyone must have an Axis 1 diagnosis because without one no one gets paid.
For instance, most insurance providers exclude coverage for personality disorders because they are hard to treat with pills alone.
In other words, a system that has no room for a psychodynamic understanding of the mind has no room for diseases of the mind; such as those illnesses we call ‘personality disorders’.
What we might try to understand is that figuring out the ‘mechanics’ of how the body works is not the same as figuring out the mystery of how it comes to have a mind…what we call life.
Life is much more than a beating heart and the ability to process food and oxygen.
When we get back to the fact that we are all walking testimonies to mystery we might also get back to expanding the definition of the ‘sanctity’ of life to those who are born.
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Visit the psychology section of the website, where there is an article “Notes toward a philosophic psychology,” a free essay basically setting a new foundation for psychology by turning to Socrates. This thing they are doing now is contrary to the Hippocratic oath and has no basis in science, diagnose and drug ’em up for profit, etc. It is very dangerous to society, and they are quite liable.
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agreed…of all of the professions psychiatry had the most potential for setting civilization on a course toward broader human rights and the liberation of the mind.
They sold us out for billing codes.
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Consider Plato’s Phaedo, about 97-99 on cause, then consider the account of the causes in our psychology and psychiatry. Time for a new start..
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Agreed!
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Is it just billing codes? Or is it that it’s also really, really, really hard to carry a light into the darkness every day?
Creating a well-functioning society isn’t the job of those tasked with rescuing the broken. By then we’ve all failed our brothers and sisters.
I got a kick out of the father in “Leave It to Beaver,” but he was a pretty good role model for people that subscribed to the “spare the rod and spoil the child” theory of parenting. We’ve come a long way. Psychology has helped, but it’s not the end-all and be-all of social health.
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Excellent post Rob! I thank you very much for sharing. I haven’t been diagnosed correctly yet, but I see a new doctor in May, so here’s hoping that he gets it right.
I used to think I just had Bipolar, now I see a bit of myself in a few other things. So thoughts and prayers that everything works out.
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I hope that you get a correct diagnosis so you can get the treatment that works. It’s easy to see yourself in almost everything since mental illnesses are normal psychological processes gone awry.
I would like to the burden of proof is one the people who think they have all of the answers.
I would phrase the question like this: “Will you explain my subjective experience of my own mind is not valid without resorting to character assassination?”
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That is precisely what mental illness is – normal psychological processes gone awry – that might happen to any one. As a priest I use the word dis – ease as in a mind not at ease or ill at ease, uneasy intending that ease can be restored or alleviated. I am sometimes more uneasy than at other times but accepting the state seems to help me.
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Thank you for your comment, Brother Andrew.
Let us all pray for the day that we understand that NO ONE chooses to die on the streets of our cities and that we demand an appropriate allocation of government funding to provide people with mental illnesses with the treatment we need.
Yes–Government funding, because in a healthy democracy the people are expected to use their government to improve the quality of their lives.
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I know I owe you a sermon – I shall get there.
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I apologize for any errors. When I write with intensity I tend to forget to edit my post.
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I was fired from the grammar police years ago…I saw no nothing …:)
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I have CPTSD and the DSM won’t even recognize it because it might “confuse” people. I’m like, what people?! The ones already suffering??? Who have always needed answers or validation?? or the ones who admit it never happened?! CPTSD is also known as DTD developmental trauma disorder. I never thought I showed any signs of disassociation until my well versed trauma therapist brought it to my attention. I never went into a full trance state,I was just always told I was “daydreaming”. Yeah, daydreaming I was anybody but me. Any way our young selves could avoid reality because it was too painful. It happens. But yeah, it’s argued someone who is transgendered is making it hard on themselves(no it’s making it hard for people around them because they can’t accept or don’t want to understand differences) or if you’re gay it was a choice. Yeah, well, I am sure people (such as me and many others) who suffered from chronic childhood abuse and trauma thought that was a choice too, right? Or we were just making it hard on ourselves. That must be it we probably asked for it. What? by existing? SIgh. It is sad how ignorant some people can be because they have no idea what it is like to be that small and vulnerable and afraid and had to suffer for so long wondering what was it you did? And why it had to be you. The brain was just taking care of the child the best way it could because obviously a caretaker was not. I wish I could end all that hateful nonsense. And the hate that is created unnecessarily because we were the ones that were supposed to be ashamed.
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There is no reason for you to apologize.
I can think of few circumstances more frustrating than to be in pain, to watch one’s life fall apart for inexplicable reasons, and then realize that the people who have placed themselves in the position of acting as your healers are hopelessly out of touch with your pain, and the economic depredations brought on by your lack of access to treatment for your illness.
To have academics dismiss your reality and consign you to a life of pain because to validate your experience would prove their pet theories and biased statistics wrong is infuriating.
We who have to live with the consequences of choices that we would make for ourselves rarely get to voice our experience.
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I am not a church goer but all I can say to you is PREACH! I was invalidated for most of my life. I was either stupid or defective or as my dad so lovingly called “idiot savant” and it wasn’t just at home it was my teachers my peers my “friends” by the time I got to college I had been gaslighted so bad that EVERYONE I knew were the ones who needed therapy and there I was sitting in the office getting diagnosed bipolar you know, that was I was just the crazy bitch. It infuriates me so bad all the times I told my mom how sad I was and would just sob to the point hyperventilation. You can imagine my hesitance to trust an adult, because I was terrified to say that things were not right at my house. That I would continue to be accused of being crazy. I thought of course who would believe? what would I even say? Who do I even talk to??? I finally got all that validation as I got older not from the supposed family who just loves me so much. No. I found other people. Good people. Trustworthy. Ones I respect and trust. That’s the thing as you get older you get to choose. We didn’t choose our parents but we can choose people who do make us feel safe.
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Thank you again…What you describe the syndrome of the ‘identified patient’…the ‘identified patient’ becomes the one who carries the families ‘craziness’…in many instances the identified patient is the child who is actually capable of transcending the family pathology and naming it. This is why unhealthy families are so destructive to them.
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Sorry to bogart the commennt section but this type of stuff trauma related really speaks to me and also infuriates me that it’s not addressed as an issue at all. So, I believe one of the main reasons the DSM won’t acknowledge these complex trauma issues is because it just seems so much easier to blame it on a chemical imbalance a genetic disease etc.. etc.. Imagine all the people who didn’t have abandonment issues or severe mood swings or unstable emotions or suicidal ideation or even learning disorders. I mean do you blame a kid for having add growing in an environment where his body was just merely taught to survive and stayed that way? That would mess up my ability to concentrate. Or someone who suffers from extreme anxiety because they’d wait and wait until someone finally showed up and then they had to watch it over and over again. Some mental illness absolutely is genetic and some absolutely is simply a chemical imbalance. But how much of that could have been prevented if someone had to take accountability for why their kid is “ill” or crazy or you name it. It is easier for the parents to let their kids hide under these labels suffering even more ostracism and shame and treated differently because a parent especially ones like mine who have done absolutely done nothing wrong and it is always someone else’s fault. It’s not because the trauma diagnosis would confuse people. It just makes it easier for everyone else. And although it would help so many people and save so many lives and answer every lost, sad, “defective” person’s questions. The ones who don’t acknowledge just get to keep on telling everyone that the child did for it attention they’re faking it oh, you’re just so melodramatic. They just keep saying that. While so many stay silent and take it. Because it’s easy, for them. Change is hard when it comes to taking accountability for everyone else’s fault.
*drops mic*
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Excellent post Rob: I feel like I know a lot more about DID than I did before I read it.
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Thank you Josh…I am willing to do what I can to make DID easier to understand. Thank you for reading the post.
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Very informative. What is the prognosis with this? Do most people eventually integrate all the facets into one? I wish you all the best in this difficult struggle.
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Excellent question.
As with any progressive syndrome the earlier the problem is detected the more likely it is to resolve.
Many of the obstacles to successful treatment outcomes are systemic.
This is true of all disorders of the mind at this point in our history.
Full access to all modes of treatment will improve the outcome at any age.
Thank you for reading the post. 🙂
To learn more about dissociation disorders treatment I recommend the International Society for the Study of Trauma and Dissociation: http://www.isst-d.org/
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Thank you Laurel! One thing I didn’t emphasize in the essay was that Dissociative Identity Disorder, like all disorders of a normal processes gone awry is on a spectrum.
There are healthy forms of dissociation that we use every day without thinking…
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Thank you for the well thought out description, Robert. Love your artwork as well. Bravo!
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Thank you for the comment. I hope that my description of DID helps to clear some of the confusion about what it is and how it happens.
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This is a powerful read. Thank you for posting.
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Reblogged this on Art by Rob Goldstein and commented:
Day 5 of Mental Health Week in the Neighborhood! Today’s topic is Dissociative Identity Disorder.
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Thank you for blogging this and for inviting me to participate in the Neighborhood’s Mental Health Week. If anyone has any questions please ask them…I will answer all questions to the best of my ability!
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