The Crowded Room starring Leonardo de Caprio looks set to focus the spotlight on Dissociative Identity Disorder (Multiple Personality Disorder). It is based on the story of Billy Milligan, a murderer rapist who was later diagnosed with Dissociative Identity Disorder.
An excellent article by Kirstin Fawcett of US News was published this week and should help improve understanding of Dissociative Identity Disorder by addressing several key misconceptions.
The Crowded Room: Dissociative Identity Disorder. Did you know…
With DID patients, if they feel hostility or aggression they take it out on themselves with self-harm… They’re self-destructive and repeatedly suicidal, more so than any other psychological disorder. So that’s what’s typical – not this wild aggression, or stalking women [or robbery].
– Dr Bethany Brand, psychologist
What is Dissociative Identity Disorder (Multiple Personality Disorder)?
Another misconception is that “alter” states in DID are as defined and separate as, say, Toni Collette’s in “The U.S. of Tara.” Although a small subset of patients experience what clinicians call a “florid presentation,” a majority of people with DID experience much more subtle transitions between their various identity states.
– Kirstin Fawcett, US News
Ruby Wax, famous comedian and author, setup http://blackdogtribe.com to allow people with depression to talk about it. She also wrote a stand-up show whilst recovering from a depression so severe she needed to be hospitalised.
It’s so common, it could be anyone. The trouble is, nobody wants to talk about it. And that makes everything worse. – Ruby Wax
Check our her blog post about why she won’t shut up about stigma, and the importance of connecting with others.
When a person has Dissociative Identity Disorder, or a similar form of Other Specified Dissociative Disorder (known as DDNOS-1) responsibility gets complex. DID can only be diagnosed if alter identities exist and can take control of the body, they usually act in a different way to the person normally in charge, sometimes in a child-like way, or a protective way. In DID this can cause difficulties because an alter identity may behave in a way which is unacceptable to you (ignoring friends, being rude to people), or may do something which is illegal (for example, a hungry child alter could steal someone else’s candy). The amnesia present between different identities may mean that others are not aware of what has happened, or they may be able to “watch” as it happens but not prevent it, which is known as co-conciousness. An important concept in healing is for all alter identities to begin to communicate and work together, and this involves taking collective responsibilityfor the actions of any other identities. The treatment guidelines also advice this:
“…the patient is a single person and generally must hold the whole person (i.e., system of alternate identities) responsible for the behavior of any or all of the constituent identities, even in the presence of amnesia or the sense of lack of control or agency over behavior.” – Dissociative Identity Disorder Adult treatment guidelines
By being willing to take responsibility (and accept any consequences) as a result of an alter identity’s actions, it may (over time) lead to an internal discussion about behavior, responsibility and consequences. Shame should not be part of this – switching identities, and losing control to another alter is a symptom of DID. Going back to an example of a child alter stealing candy, does the child alter know that this is both wrong and illegal? Does he/she know what the consequences of doing this again are? Does the child alter know how to find food or prepare food? Is there something that an adult alter can do in advance to make sure the child alter does not go hungry? In taking responsibility for actions of all alters/parts greater co-operation and stability can be achieved for all.
Dissociative identity disorder – the crime myth
Dissociative identity disorder is strongly associated with being the victim of a crime (especially child abuse or sexual assault), and recent research found that mental illness was not a cause of crime. The study look at all “Axis I” mental disorders, which includes all dissociative disorders. What is associated with crime is malingering, which means intentionally faking a mental or physical health condition for personal gain (for example to avoid criminal charges, or evade other responsibilities like military service). Several studies now identify how malingers (people knowingly faking a disease or disorder) can be distinguished from people with Dissociative identity disorder, including Thomas (2001) and Brand & Chasson (2014). Dissociative identity disorder (unlike psychosis) is rarely (if ever) successful as a legal defense. The diagnostic descriptions and symptoms of Dissociative Identity Disorder often described “self-destructive” behaviors, but do not refer to any violence toward other people.[See Kaplan & Sadock (2008), DSM-5]
Today I stumbled across an excellent article by UK psychotherapist Valerie Sinason about Dissociative Identity Disorder and the difficulties in both diagnosis and treatment which exist within the very traditional British public health care system.
Without early specialist training on the consequences of abuse, professionals are attacking each other’s contradictory diagnoses without realising the aptness of Walt Whitman’s words “I am large. I contain multitudes”.
We cannot see what we cannot bear – John Bowlby, psychoanalyst
Compared with Freud’s ability to recognise the traumatic aetiology of hysteria one hundred years ago (Freud, 1896), contemporary clinicians have found it extremely hard to bear the horrors of patients’ objective lives. Sometimes (Hale & Sinason 1994) psychotherapists’focus on the internal narrative is a defence against the historic external reality.
However, as de Zulueta (1995) comments: “a refusal on the part of psychiatrists and therapists to validate the horrors of their patients’ tortured past implies a refusal to take seriously the unconscious psychological mechanisms that individuals need to use to protect themselves from the unspeakable.
Both quotes come from the revised edition of Attachment, Trauma and Multiplicity by Valerie Sinason (Editor), which contains contributions by both survivors of trauma with Dissociative Identity Disorder and professionals working with psychological trauma.
Does the NHS have (undiagnosed) Dissociative Identity Disorder?
Recently I heard a therapist who does a great deal of trauma work in the UK refer humourusly to the British NHS health care as having a so many separate states that do not communicate with each other, and typically have different and opposing ideas, that it felt as if the NHS system itself was in fact suffering from dissociative identity disorder… Sinason writes about “Fragmentation within professional teams” as well as between them:
“the psychiatrist who meets a frozen DID patient who shows only one state (as a result of correctly assessing their psychiatrist’s inability to deal with the subject) then attacks the other psychiatrist/social worker/psychologist/psychotherapist who points out the fragmentation into states. We are then witnessing the trauma-organised systems… that systemically mirror the DID experience.”