Biology 202, Spring 2005
Third Web Papers
On Serendip

Now imagine your friend confides in you that her behavior can be contributed to Dissociative Identity Disorder (DID), formally known as Multiple Personality Disorder (MPD) a psychological disorder that affects memory and identity (1). Would you believe that it is possible to have more than one identity? Whether you said yes or no, or you were unsure, the diagnosis of DID as a real disorder is highly contested among professionals.

To understand this debate, one must first understand what Dissociative Identity Disorder is, and it is diagnosed. DID is thought to occur as a result of serious abuse as a child, whether it is physical, sexual, or psychological. Because children are unable to cope with such emotional trauma, they dissociate themselves from the actual event. As a result, children often create a new identity, one that can deal with the emotions they are incapable of handling (1).

One of the major characteristics of a DID diagnosis is having two or more personalities, both of which can become the dominant personality at any given time (1). Even though the beginnings of DID occurs during childhood, symptoms of the disorder do not emerge until adulthood. These symptoms can include confusion or disorientation, hallucinations, feelings that one's body is transforming, experiencing a daze or trance-like state, depression, and anxiety attacks (1). In addition, it is thought that those who have the disorder become so skilled in dissociating their feelings that even mild stressors occurring in every day life can trigger an episode of changing identity (5). It is estimated that DID affects about 1% of the population (2) and five times more women then men are diagnosed with the disorder (3).

The main therapy for treating Dissociative Identity Disorder involves hypnosis. During this process, the therapist attempts to have each "self" relieve the traumatic events (1). It is thought that once each "self" is able to confront the past and deal with the pain, integration of all the selves into one overarching self can be achieved (1). The goal for this kind of therapy is not only integration of the selves, but also acceptance of the memory and history of the trauma. Once this is achieved, dissociation from the feelings that are associated with the trauma is no longer necessary (1).

While Dissociative Identity Disorder is listed in the DSM-IV as disorder, there is debate among professionals about the actual cause of the disorder. Paul McHugh, a former professor of Psychiatry at John's Hopkins Medical Institutions, believes that patients acquire DID from suggestions by their therapists (4). This construction of DID occurs when patients in therapy are especially sensitive to suggestion and hypnosis. Throughout the course of therapy, patients are told they have Dissociative Identity Disorder, and therefore, feel compelled to act in a way that is consistent with the criteria for the disorder (4). One possible explanation for this can be accounted for by the research done with expectancies. The influence of one's own belief that something will happen often makes it so. For example, research with lab rats assigned randomly to the categories of "smart" or "dumb" are found to perform consistently with their label because that is what the researcher believes to
be true (6). These expectancies yield more powerful results in close social settings such as therapy (6). McHugh suggests that by not dramatizing therapy, patients can work through their personal issues by focusing on the real problem at hand (4). While McHugh seems to acknowledge the fact patients who are diagnosed with DID do have emotional problems, he believes that therapists enable their patients and the symptoms by focusing so heavily on them (4).

Similarly, there are people who feel as though DID is the ailment of the moment due to popularization of disorder by the media in the books The Three Faces of Eve and Sybil, which was later made into a movie (6). Before such publications, DID was a rarely diagnosed disorder, with about two diagnoses a year prior to The Three Faces of Eve, to as many as 50 a year following the release of the book. The numbers of diagnosed cases of DID increased again, this time to 2,000 cases a year, after Sybil. It is thought that these media productions somehow influenced people by "teaching" them what DID is supposed to look like (6).
In addition to being critical of the etiology of Dissociative Identity Disorder, others are critical that the DID even exists at all. Since the DSM-IV changed the name of the disorder from Multiple Pesonality Disorder to Disscociative Identity Disorder, the semantic debate seems to have decreased. However, the philosophical basis behind this debate still exists. Because the diagnosis of DID relies on the objective criteria of having more than one identity, it is questionable as to whether it is possible for this to actually occur. If personality or identity is defined as the brain's combination of reactions to external and internal inputs at any given time, then it could be possible for someone to switch between feelings and behaviors many times in one day. Perhaps someone wakes up on the wrong side of the bed, but then receiving a letter from a friend in the mail makes them feeling happier. Suppose later in the day, running out of gas while driving to the grocery store spoils their mood. They become grumpy, and as a result, their behavior changes to reflect their mood. The question then becomes, at what point is this switching of feelings and behaviors seen as "abnormal" relative to what the person usually experiences. One could argue that changing behaviors and moods several times in the day is a relatively common experience. At what point, however, is switching behaviors indicative of alter personalities (5)?

Because the definition of alter personality is not clearly defined in the literature by those who believe that DID is real, skeptics such as August Piper, Jr., a psychiatrist, question the idea that alter personalities can actually exist (5). For example, Piper cites the lack of a solid definition of an alter personality being responsible for instances in which people have been diagnosed with numerous personalities, and in one case as many as 4,500 different personalities in one patient (5). With numbers such as this, it can become easy to question the credibility of the disorder.

In addition to looking critically about the diagnosis and existence of DID, one must look to the implications if such a disorder is legitimate. For instance, how should people who are diagnosed with DID be treated with regards to criminal acts? Should people with supposed different identities be held accountable for acts that were committed by these identities? Cases have been documented with defendants diagnosed with DID having sentences overturned due to having a mental illness (7). The underlying question in cases such as these is the question of free will. Are people with multiple identities really in control of what they are doing? Or are they hosts to activities they cannot control? While the different identities seem to be very different in their behaviors and personalities, most literature stresses the importance of recognizing that there are not necessarily several people living in one body. In fact, the fragmentation into identities is seen as a manifestation of the same person in
many different forms (2). From this standpoint, it would seem that while people with DID may not necessarily realize when they have switched into one of their alters, because it is a manifestation of who they are, they should be held accountable for their actions, no matter which alter is actually committing the act.

Looking at all the evidence and counter evidence to the legitimacy of Dissociative Identity Disorder as a spontaneous, organic occurrence, one must still ask the question: is DID real? It seems that while traumatic events such as extreme abuse, especially during childhood, could lead to psychological problems such as dissociation and denial of feelings. Despite this, it seems questionable that this dissociation could lead to many different forms of one person, as DID suggests. It makes sense that a traumatic event could shape the person one becomes, and the way she might behave and react during certain situations, but there seems to be a difference between an event influencing the way one lives her life, and one having certain identities to deal with certain situations. In cases such as this, it is important to remain cautious in diagnosing a person with DID because of inconsistencies about the etiology and the realness of the disease. On the other hand however, one should not be so overly cautious as to deny those with legitimate problems the treatment they need to recover. All in all, it seems as though diagnosing and treating Dissociative Identity Disorder is a delicate balance between enough belief in the patient's problems to provide the help people need and enough skepticism to keep from enabling patients to continue disordered behavior.

References

1)Understanding Dissociative Identity Disorder Canadian Mental Health Association

2)Dissociative Disorders Sidran Institute

3)Dissociative Disorders Health webpage

4)Multiple Personality Disorder by Paul McHugh

5)Multiple Personality Disorder: Witchcraft Survives in the Twentieth Centry by August Piper, Jr.

6)Reasons for Caution about Diagnosis of DID/MPD by Russ Dewey

7)A Case for the Insanity Defense Court TV's Criminal Library


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