We've all experienced a feeling of dissociation before, but typically under another name: daydreaming. We temporarily take leave of our senses and our surroundings and imagine ourselves to be somebody entirely different, who's leading an entirely different life. Now consider a less pleasant form of dissociation: a person drinking alcohol until reduced to a state of falling-down confusion. The person's actions, thoughts and words are seemingly not his or her own, and the events that transpired while in that state aren't remembered the next day.
People with dissociative identity disorder (DID) share some traits with both the daydreamer and those who drink until they black out. For them, the "daydreams" and surreal sense of place and time may last for weeks or months. They experience lapses of time, a loss of identity, severe memory issues and an adoption of new personalities that have their own unique traits, histories and perceptions. The person essentially becomes a helpless and sometimes unaware passenger in his or her own body.
For reasons not fully understood (though trauma plays a significant role), people with DID form alternate personalities (called alters) that take command of their body. The behavior, speech and thoughts of the alter are often radically different than those of the host, or original, personality. Instead of knowing who they are, people with DID find that identity has suddenly become a very slippery concept.
DID isn't the only disorder that disrupts memory, the senses and identity -- dissociative amnesia, dissociative fugue and depersonalization disorder fall under this same category. DID is, however, the most severe -- and the most likely to result in multiple personalities.
Life with DID
Many modern researchers and psychiatrists believe that DID (known as multiple personality disorder until it was renamed in 1994) develops as a coping mechanism that enables a person to separate his or her consciousness from the memory of a childhood trauma. Alters may form as a means of dealing with specific situations or emotions that the host personality simply can't handle.
There's no common timetable for these personalities to emerge or change -- they may appear many years after the trauma occurred. People with DID have different experiences and even awareness regarding their alternate personalities, but there are some common elements.
DID manifests in the form of at least two distinctly different personalities (usually two to four initially, but there can be dozens) that take over the wheel, so to speak, and affect a person's behavior and bearing. The alters have their own identity separate from the person's: their own voice, age, gender, personality, quirks and even physical gestures. Sometimes the alters aren't even human -- patients have been known to develop animalistic alters. Identities can switch back and forth, sometimes quickly, other times over a period of days. Identity can switch back to the host personality for any length of time or frequency, and the host is often unaware of other personalities, though the other personalities are often aware of the host and each other.
While depictions in the media (such as "United States of Tara") can make DID look like a zany romp where you get to act out other lives, it's a potentially life-wrecking psychological disorder.
In addition to the "alters," people with DID may also have other symptoms:
- Mood swings, depression and anxiety
- Substance abuse, suicidal tendencies and eating disorders
- Severe long- and short-term memory disturbances
So what does it feel like to have DID? Life might feel like a foggy or distant image that you're just observing. People with the condition may feel literally detached from their own bodies. Even when an alter isn't present, DID sufferers can go through altered states of identity, in which no single personality emerges -- they just seem to be observing themselves acting outside their normal behavior patterns. Sense of time can be radically distorted during these episodes, as well as sense of place and perception of the events that are occurring.
DID Through History
Many ancient reports of "demonic possession" may very likely have been misunderstood cases of mental illness, including DID. While DID is often thought of as a modern creation, there is a rich, documented history of the illness.
The symptoms of DID were first diagnosed in 1791. At that time, hypnosis (then known as animal magnetism) was quite popular, and a doctor who practiced hypnotism used it to treat a patient who was switching between two distinct personalities -- the normal personality of the German woman, and a personality of a French woman. Under hypnosis, the French personality could easily be drawn out, and at the conclusion of a session the German personality would emerge from the hypnotic state.
Until about 1880, a commonly held belief was that everyone had a background consciousness that was greater than the consciousness responsible for the primary personality. Mental illness occurred when this greater consciousness became ill. The greater consciousness could then be brought out and treated through hypnosis.
Around the same time, doctors began to make a connection between the symptoms of DID and early childhood trauma, and also to recognize that more than one distinctly different personality could develop as a result of the mind compartmentalizing the trauma -- its attempt to protect the host personality.
A 22-year-old French patient, Louis Vivé, and his six distinct personalities made an appearance in an account published by his doctors in 1888 -- "Variations de la personnalité." The personalities didn't have overlapping memories, but doctors viewed the alters as hypnotic variations of the host personality and not truly separate personalities.
Another doctor of the same time period, Pierre Janet, had a different way of thinking, however. He was working with patients described as hysterical, and he concluded that some of them did have different, distinct personalities, born of things they'd witnessed during traumatic episodes.
The first real cure to be documented was in 1905 by Morton Prince. He published his account of a pseudonymous patient, "Miss Beauchamp," who exhibited three distinct personalities. Prince attempted to and -- by his own account -- fully succeeded in re-integrating the personalities and forcing them back into the subconscious, resulting in a unified and permanent personality.
In the 1970s, a doctor named Cornelia Wilbur treated a patient named "Sybil" and subsequently was the subject of a bestselling book on the case by Flora Rheta Schreiber. The book was later made into a movie. As we'll see in the next section, this brought about changes in treatment, public perception and public scrutiny.
The Mass Media and Multiple Personalities
In 1957, a book written by two psychiatrists, "The Three Faces of Eve," detailed the case of "Eve White" -- in truth, a patient named Chris Costner Sizemore. The patient was referred to them for blinding headaches and periods of amnesia, and during her time working with them, two alters emerged. Over the course of treatment, the doctors were able to reintegrate the personalities into a single, unified host personality. And then they quickly wrote a book, which was soon made into a movie blockbuster.
"The Three Faces of Eve," along with other books and movies that came out shortly before and after its release, brought what was then called multiple personality disorder to the forefront of public consciousness. It was also the most highly publicized modern case of a DID patient having more than two personalities.
In 1973, another high-profile book, "Sybil," about a case involving psychiatrist Cornelia B. Wilbur, was published by Flora Rheta Schreiber. It told the story of a DID patient who had 16 personalities as a result of early childhood trauma of an almost unbelievably cruel nature. This root cause of the disorder was only discovered after intensive therapy and hypnosis.
"Sybil" was later turned into a major motion picture (and re-made as a made-for-TV movie) and had a major influence on Americans' perceptions of DID. The number of patients seeking help for the disorder increased dramatically, and the movie more or less established in the public consciousness certain dimensions of DID -- forgotten early-childhood traumas creating a split in consciousness, allowing numerous personalities to form. In the years since "Sybil" was released, it's not uncommon for doctors to see patients with dozens -- even hundreds -- of alters.
Some doctors have cast doubt on the validity of the case, the diagnosis and Wilbur's treatment of the patient. It was alleged by another doctor who took over sessions for a period of time while Wilbur was out of town that case notes and the patient's own statements indicated that the highly suggestible patient was made to believe she had DID in part to facilitate Wilbur's sale of the subsequent book and movie.
These doubts -- along with other DID-related cultural phenomena we'll discuss next -- created a backlash against DID diagnoses and the psychiatric industry that grew larger with each mass media account of a case.
Is Dissociative Identity Disorder Real?
Some people, doctors included, deride DID as a made-up disorder that came into consciousness specifically through mass-media portrayals such as "The Three Faces of Eve" and "Sybil." Before "Sybil" hit the screen, there were fewer than 200 diagnosed cases of DID, according to CBS Sunday Morning. Shortly after the movie was released in the United States, there were around 8,000 cases reported. But while there are dramatic liberties taken in both the book and the movie, Sibyl's case is similar to countless other accounts of DID, and questions surrounding the work shouldn't cast doubt on other research about the disease.
The satanic child molestation hysteria of the 1980s added to the perception that DID wasn't real, as wild accusations based on false "recovered memories" led to several mistaken convictions, media pandemonium, and a newly booming industry for doctors who assumed all problems were the result of repressed memories -- and who could seemingly also recover these memories in almost any patient through hypnosis and the power of suggestion. Largely because of this skepticism, the focus of treating DID switched from dealing with split personalities to addressing the root cause: dissociation of self.
Furthermore, if a clinically dissociative patient in a vulnerable state seeks help from a psychologist who specializes in DID, the psychologist may pre-suppose the form of the disease and, in anticipation of discovering hidden personalities and repressed memories, will actually coax the patient under hypnosis to "reveal" these personalities and memories -- which don't exist.
Dr. Paul McHugh, among other skeptics, believes that DID is a cultural and individual invention, that it's induced by the psychologist's own treatment, and that patients should be removed from DID treatment that facilitates or encourages the appearance of "alters."
Some mental health practitioners have undoubtedly behaved in dishonest and unethical ways, but many mental health professionals and professional associations recognize DID as a very real disease and are actively working to gain better understanding of it.
Did You Know?
Repressed memories do occur, but they're very rare, and the overwhelming majority of people remember traumatic episodes more clearly than any other life experience.