Bipolar 2 From Inside and Out

I had a friend, Hal, who had Dissociative Identity Disorder (DID). I never met any of his alters until once we went to the corner store. He giggled. He grabbed numerous bags of chips and other snacks. When we got home, I mentioned this to him, and he said, “You just met Julie. She’s a teenage girl.” Later, I met an alter known only as The Angry Man, which is part of why we’re no longer friends.

DID, as its name says, is a dissociative disorder, one of three different kinds – Dissociative Amnesia, Depersonalization Disorder, and Dissociative Identity Disorder. DID is the most severe of the three conditions. All involve symptoms such as memory loss, “out of body” experiences, emotional numbness, and lack of self-identity. DID is thought to be a reaction to the trauma of extreme physical, emotional, and sexual abuse that occurs usually before the age of six.

Some trace the history of DID to 1584, when the records of a French woman who was exorcised recounted symptoms that today would very likely be attributed to DID. It’s likely that more cases that were actually DID have over the years been attributed to demonic possession. Later, it was seen as a form of hysteria, another disorder with dissociative symptoms.

DID really hit the big time in the 1950s through the 1970s, when the books The Three Faces of Eve and Sybil became best-sellers and were made into movies. The books, written by Corbett H. Thigpen and Flora Rheta Schreiber, respectively, were accounts from psychoanalysts about the diagnosis and treatment of DID, which was at the time called Multiple Personality Syndrome, since the disorder was notable for “alters,” or separate personalities that appeared while the primary personality was unaware that they existed. “Eve” had three alters, while “Sybil” had 16.

Since that time, both of those cases have been controversial, with exposes purporting to reveal that neither Eve nor Sybil really had multiple personalities. The theories were that either the subjects were faking the disorder, or that the doctors suggested to them via leading questions and hypnosis that they had multiple personalities. (This was related to the “repressed memory” controversy in the 1980s to 1990s, which raised many of the same issues. Healthline recently reported that “the majority of practicing psychologists, researchers, and other experts in the field question the whole concept of repressed memories. Even Freud later discovered many of the things his clients ‘remembered’ during psychoanalysis sessions weren’t real memories.”)

Still, DID is real enough to have made it into the DSM. (We should remember, though, that diagnoses of “illnesses” such as homosexuality were present in earlier editions but later removed.) There are therapists who treat it with Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), medications, Eye Movement Desensitization and Reprocessing (EMDR), and/or hypnosis, which started to be a treatment in the 1830s and is said to lead to a rapid recovery. Although hypnosis for diagnosis or treatment of DID is still controversial, it may be useful for reintegrating the alters back into the primary personality.

DID has also been used as a potential criminal defense in legal cases over the past several decades, in cases that range from drunk driving to murder. It has been used to support a plea of “Not Guilty by Reason of Insanity” (NGRI). This defense is used in less than 1% of felony cases and is successful in only a fraction of them. The theory that a crime was committed not by the primary personality but by one of the alters has not always proved persuasive. It’s difficult to prove, for one thing, and there are professional witnesses and psychologists who testify that either DID does not exist or that even if an alter committed the crime, the primary person is legally responsible for it. The DID defense did work in 1977 for Billy Milligan, who was said to have 24 separate personalities, two of whom were claimed to be responsible for his crimes of rape.

DID is subject to a number of myths or beliefs. For example, many people believe that DID is either nonexistent or an overdiagnosed “fad” seen only in North America. Some believe that it is caused by the doctors who treat it rather than by childhood trauma, or that it is in reality the same as Borderline Personality Disorder (BPD). However, there have been neuroanatomical changes recorded by MRI in cases of DID: “The neuroanatomical evidence for the existence of DID as a genuine disorder is growing and the structural differences seen in DID patients’ brains…contribute to that growth.” So, although DID is believed by some to be nonexistent, there are studies that back up its reality.

As for me, I have experienced a few mild instances of dissociation related to my bipolar disorder, but nothing even remotely like what occurs in DID. But then, I didn’t have the childhood trauma associated with it. (During the “repressed memory” days it was said that the only truthful answer to “Have you experienced extreme childhood trauma?” is “Not that I’m aware of.”) Nonetheless, I find the subject fascinating, as well as dissociation in general. (This is not intended to diminish the experiences of people who have a dissociative disorder.) But I look forward to learning more about DID, particularly the neuroanatomical changes when they become available.

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