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Biology 202
2001 First Web Report
On Serendip

Dissociative Identity Disorder

Sural Shah

A small town in the middle of Nowhere, America is suddenly the victim of a serial killer. In a community in which everyone seems to know everyone else, and life could not be more Norman Rockwell-esque if it tried, gruesome deaths and possibly even sexual crimes are occurring at an alarming rate. Is the murderer the doctor who just came to town, or maybe the mailman's new wife? After a long and drawn out investigation, the trusty sheriff (or maybe a local writer - this part is interchangeable) realizes that the true culprit is a housewife who had spent her entire life in Nowhere. How is this possible, one may ask, in this perfect little town, and the answer, of course, is obvious; this poor woman has multiple personalities, and exists as Suburban Suzy most of the time, but morphs into Serial Killer Suzanne before committing a murder.

In Hollywood, this scenario is one that is often used when there is a lack of alternative, juicy plot lines available. Known officially as Dissociative Identity Disorder (DID) (3), Multiple Personality Disorder (MPD) has been utilized for years by both the entertainment industry and psychiatrists to explain how a single person may experience a separation from his/her thoughts, memories, feelings, actions or sense of identity (4). Almost one percent of the general population may be affected by this disorder, though many people are misdiagnosed and are therefore unaccounted for in terms of statistics. Its symptoms may include, among others, depression, flashbacks, 'out of body' experiences, amnesias, time loss, headaches, and violent tendencies towards themselves and others (4).

Considered to be the effect of severe trauma in early childhood, DID is commonly described as a 'highly creative survival technique' that a child uses to 'escape' from extreme, repeated physical, sexual, and/or emotional abuse (4).. DID is classified as one of four main kinds of Dissociative Disorders (DSM-IV), as it is a mental disorder in which normal consciousness or identity is split or altered, after an intense psychological trauma (5). During dissociation, one is not able to associate certain information as one normally could, thus allowing a temporary mental escape from the fear and pain of the experience. This process can, at times, result in a memory gap concerning the trauma which may affect the person's sense of personal history and identity (4), and may even result in fragmenting among one's 'self' (6). The only ways to treat DID are long term, intensive psychotherapy, as well as through some medications, hypnotherapy, and art or movement therapy (4).

As DID is caused by traumatic episodes, it is also often classified as a Post Traumatic Stress Disorder (PTSD). Eighty to a hundred percent of those diagnosed with DID have a secondary diagnosis of PTSD (4). Biologically, this is very significant, as the effects of PTSD's have been noted on a physiological and neurological level. Researchers have noted that mental imprints of traumatic experiences remain consistent within the brains of the experiencer over long periods of time, much unlike with normal memories, which disintegrate over time. These trauma memories often contain a large amount of emotional and perceptual elements rather than declarative ones. Pierre Janet, a researcher in the nineteenth century, wrote, "It is precisely because there is no immediate accommodation that there is complete dissociation of the inner activity from the external world. As the external world is solely represented by images, it is assimilated without resistance (i.e. unattached to other memories) to the unconscious ego" (7). All of this information supports the idea that memories after traumas are encoded differently than normal memories and may interfere with hippocampal memory functions because of extreme emotional arousal (6).

Research has also shown that having a dissociative experience at the time of the trauma is the most significant precursor to later PTSD, and that continued use of dissociation increases one's likelihood of developing DID, where separate identities are linked to different traumas. These repeated dissociations may eventually be the cause of fragmentation of one's mental state into several spearate entities, which may eventualy become internal 'personality states' of their own (4). In neuroimaging trials of individuals who were undergoing traumatic events, it was noted that at the time of the experience, there was increased activity in parts of the right hemisphere of the brain involved in processing emotional states. In contrast, there was a decrease in Broca's area in the left side of the brain, a region that is significant in language and word processing (6). These facts support the idea that trauma memories are encoded differently than normal memories. Janet noted that 'traumatic memory consists of images, sensations, affective and behavioral states, that are invariable and do not change over time,' which helps to explain PTSD's, and DID specifically. In fact, it has been noted that in times of extreme stimulation of the Central Nervous System (CNS), permanent neuronal changes may occur (4). The extent of these neuronal changes in behavior and memory is not very well known, though one researcher writes, 'Chronic exposure to stress affects both acute and chronic adaptation: it permanently alters how an organism deals with its environment on a day-to-day basis, and it interferes with how it copes with subsequent acute stress' (7). One potential manifestation of this interference could be, of course, DID.

In particular, the stress response is notable on a hormonal level. While many aspects of the psychobiology of stress are not understood, research has allowed for some conclusions concerning hormonal responses. In times of intense stress, researchers have noted the release of endogenous, stress-responsive neurohormones, such as cortisol, epinephrine and norepinephrine (NE), vasopressin, oxytocin and endogenous opioids. These stress hormones help the organism mobilize the required energy to deal with the stress, ranging from increased glucose release to enhanced immune function. NE, for one, is known to affect memory consolidation, a function thought to be related to PTSD's (7).

The actual existence of the disorder, however, has remained questionable despite its consistent historical use and the above biological support, as can be seen by the recent book published by Nicholas P. Spanos, Multiple Identities and False Memories. Spanos suggests that the diagnosis of MPD is cultivated through society and particularly by mental health professionals through their methods of forming diagnoses (1) . He writes

The rules for enacting the MPD role conveyed by this and similar interviews are as follows: (a) Behave as if you are two (or more) separate people who inhabit the same body. (b) Act as if the you I have been addressing thus far is one of those people and as if the you I have been talking to is unaware of the other coinhabitants. (c) when I provide a signal for contacting another coinhabitant, act as though you are another person. To the extent that patients behave in terms of these rules, the "classic" symptoms of MPD follow by implication and do not have to be taught through direct instruction or further suggestion . (2)

Others have concurred with this view, suggesting that the diagnosis has only become as prevalent as it is through appearances in best-selling movies and novels. Paul McHugh, a professor at the Johns Hopkins Medical Institutions, points out that methods utilized to diagnose DID are inherently flawed. As the director of a Dissociative Disorders Treatment Program comments, patients do not always readily reveal their alternate personalities, and therefore they must be elicited by the doctor (3). Once these personalities are introduced, it becomes increasingly difficult for the patient, as well as the doctor, to eliminate the suggestion of multiple personalities (3).

The implications of this debate over the existence of DID is truly significant on many fronts of human, and particularly American, life, ranging from scientific effects to impacts on the sociopolitical aspects of the culture. As Leigh Gettier discusses, 'Without free will, the concept of "responsibility" makes no sense, and legally, criminals should not be held accountable for their actions' (8). In considering the idea of exonerating those who suffer from DID and have committed a crime related to the manifestations of the disorder, it is not difficult to imagine the potential scope of the diagnosis as a legal tool. This thought is particularly frightening in conjunction with the above examination of the apparent simplicity of obtaining a DID diagnosis, and when one approaches the topic from the stand point that entering the mind of another human is physically impossible at this point in time, at least in terms of legally credible evidence. It would be impossible to either prove or disprove the fragmentation of the 'I-function' or mind in terms of violent actions and perceptions of truth, and in a larger sense, the mere existence of the disorder within humanity. The scope of the existence and use of these false memories could be devastating, as well as the idea that if the disorder actually does exist within a person who has committed a crime without awareness of having done so in their predominant personality.

In Nowhere, America, Suzy is facing trial, and she is acquitted for murder. As the episode comes to an end, the camera pans the crowd and then focuses in on her face. At first, all the audience sees is Suzy's family, smiling and crying with relief. Then, as the camera closes in on her face, an evil glint is noticeable in her eye, and the scene switches to credits, leaving the audience wondering'

WWW Sources and Works Cited

1)IPT Journal Book Review: Multiple Identities & False Memories: A Sociocognitive Perspective

2)Spanos, Nicholas. Multiple Identites and False Memories: A Sociocognitive Perspective. (Washington, D.C.: American Psychiatric Association, 1996).

3)Multiple Personality Disorder/ Dissociative Identity Disorder

4)What is Dissociative Identity Disorder?

5)Interactive Glossary: Dissociative Disorders

6)Dissociation and the Fragmentary Nature of Traumatic Memories: Overview Exploratory Study

7)The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress

8)Book Review: Multiple Identities and False Memories

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