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Re:Mulitipersonality disorder
Todd · 04/19/03 at 1:39 PM ET
Multiple personality of dissociative identity disorder is based on the difficult but important concept of identity sense and how it is maintained, and it is one of the more controversial diagnoses in modern psychology/paychiatry. The controversy concerns two things: (a) it's existence and explanation, and (b) its incidence. In my opinion, the skepticism over the sometimes reported high incidences of multiple personalities is probably warranted, but some of the skepticism over its very existence is exaggerated and depends upon plausibility arguments rather than lines of scientific evidence. I think the condition probably exists in something resembling the popular image in media accounts, but has a very low incidence in that most severe and dramatic form. The plausibility argument against the illness is supported by our natural unified sense of identity, seems so natural and seamless that we take it for granted except under extreme conditions such as neurological damage and severe mental illness, where the cracks in its construction begin to show.(1) Once you begin to see in more detail how our sense of identity is constructed over time, it becomes more plausible that something might go seriously and systematically awry with the process. People maintain their sense of identity differently as a result of different developmental histories. Severe, unavoidable, and persistent trauma in particular is believed to have a significant effect on our ability to maintain an integrated sense of identity from time to time and place to place. The concept of multiple personalities goes way back to the observation that human behavior is perceived by us as being organized by plans, goals, and distinct dispositions; and that people sometimes seem to act according to very different sets of plans, goals, and dispositions at different times and circumstances. The cases now considered as candidates for a diagnosis of dissociative identity are believed to be expressing roughly the same syndrome as people who were once considered to be possessed by demons. Early psychological theories of identity (2) began to piece together the complex picture we have today, that identity is not a single unified thing but a mosaic of ongoing construction with some aspects more stable than othes. The changing sense of how identity was created and maintained became part of the debates over Freud's ideas about the unconscious mind.(3) An actor can take on a role with great conviction and temporarily alter *our* sense of who they are. When someone does this so well that they consider *themselves* to be different people at different times, they are sometimes said to be suffering from multiple personalities or dissociative identity. However, this is technically a problem because it is somewhat a matter of degree. A highly hypnotizable person in a stage hypnosis show, I obviously one who is not specifically play-acting, can also take on a role to such a degree that they don't report being the same person. The distintegration of their unified identity sense in this case is temporary, however, and appears to be a matter more of focus of attention on their role rather than having separate stable personalities. In MPD/DID, the presumption is that they not only focus different in their different roles, but also have formed separate and distinct stable memories, plans, and dispositions to some extent. The degree to which this occurs, and the causal model for it are a subject of ongoing theoretical controversy, with most researchers tending to be skeptical about the incidence of the disorder, and its explanation as truly dissociated identities.(4) Technically, the thing that distinguishes them from someone acting different roles is that actors tend to share some of their mental state between their roles. In MPD/DID, there is an apparent "amnesic barrier" between the different roles, so the person does not recognize their roles as being played the same person. There are various kinds "leakage" between them, but little or no explicit recognition that the different "personalities" are aspects of the same person. Infamously, MPD was far more heavily diagnosed initially in North America than other parts of the world, for various cultural reasons, and this was part of a great wave of skepticism about its legitimacy as a traumatic disorder. In general, researchers who study this type of disorder consider MPD/DID to be legitimate but extremely rare, and that it's incidence is related to the prevalence of cultural beliefs in the possibility of multiple personalities and the availability of mental health practitioners willing to support the diagnosis. The MPD diagnosis has often been used to support the questionable contention of widespread "ritual abuse," by "Satanists" and this has made it more controversial than it might otherwise be, by resurrecting the argument over the incidence of systematic child abuse and incest that started with the reaction to Freud's work. The nature of the illness lends itself to great drama and so great skepticism, and also it is true that it is in part "constructed" psychologically as a result of psychological development rather than being something like affective disorders that more directly wax and wane with physiological status and more directly can be correlated with intergenerational family history. However, the link to early trauma is a relatively strong one, and there is good evidence from a number of other lines of evidence that indicate the real possibility that identity sense can effectively "split" to some degree. The result is that you really don't have a definitive test for whether someone is a "real" case of DID, because the difference between convincing you and convincing themselves is hidden within their own experience. The diagnosis can be problematic if you need to know where the line between role taking and amnesic dissociation comes in. This becomes an issue for example when DID gets hauled into court as a defense. The neccessarily simplistic (and normally "mostly" accurate) assumptions we make about human identity and human responsibility break down when you begin to doubt that someone has a continuing sense of memory and an ability to commit to decisions and plans over time and take responsibility for them. For a broad and thoughtful overview of the issues (essentially skeptical, but overall relatively balanced), see Ian Hacking's "Rewriting the Soul: Multiple Personality and the Sciences of Memory," Princeton University Press, 1998. If you want to begin a more detailed technical investigation ofthe topic, its history, and the lines of empirical research involved, a good starting place would be Carol North's "Multiple Personalities, Multiple Disorders: Psychiatric Classification and Media Influence," Oxford University Press, 1993. Refs: (1) Feinberg, Todd, (2001). "Altered Egos: How the Brain Creates the Self," Oxford University Press. (2) Prince, Morton (1905/1978). "The Dissociation of a Personality," Oxford. (3) Ellenberger, H.F. (1970). "The Discovery of the Unconscious," London. (4) Spanos, Nicholas (2001). "Multiple Identities & False Memories: A Sociocognitive Perspective," APA Press. kind regards, Todd
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