Dissociative Identity Disorder: Sense of Self, Social Stigmatization, and the Question of Definition

Anna Dela Cruz's picture

Senior Seminar in Biology and Society
September 29, 2009
Anna Dela Cruz

Dissociative Identity Disorder: Sense of Self, Social Stigmatization, and the Question of Definition
the three faces of evethe three faces of eve
Defined as the occurrence of two or more personalities within the same individual, each of which during sometime in the person's life is able to take control. This is not often a mentally healthy thing when the personalities vie for control.

Symptoms are of course somewhat self-explanatory, but it is important to note that often the personalities are very different in nature, often representing extremes of what is contained in a normal person. Sometimes, the disease is asymmetrical, which means that what one personality knows, the others inherently know.

  • The patient has at least two distinct identities or personality states. Each of these has its own, relatively lasting pattern of sensing, thinking about and relating to self and environment.
  • At least two of these personalities repeatedly assume control of the patient's behavior.
  • Common forgetfulness cannot explain the patient's extensive inability to remember important personal information.
  • This behavior is not directly caused by substance use (such as alcoholic blackouts) or by a general medical condition.

                                                                                            ~DSM-IV
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October 4-10, 2009 is Mental Illness Awareness Week. But what constitutes mental illness?
(Disclaimer: this blog post is not intended to offend persons clinically diagnosed with mental illness or who are undiagnosed but strongly believe they have a mental ailment.)

The Diagnostic and Statistical Manual (DSM), the psychiatrists’ handbook of mental illnesses, has long been used as an authoritative guide to identifying and categorizing perceived “odd” behavior. However, since there is no single objective test to determine mental illnesses, diagnosing such disorders are based on symptomatic evidence—a problem since symptoms can be cross-listed in two or more seemingly distinct mental illnesses. In addition, the manual is in constant revision. In fact, the fifth edition is anticipated for publication in 2012.

In defining mental illness, the condition referred to as Dissociative Identity Disorder (formerly Multiple Personality Disorder), has of late, been subject to criticism as to whether it is an actual mental disease. Hollywood portrayals of the condition such as The Three Faces of Eve, Sybil, and The United States of Tara have put forth conflicting views from unrealistic and comical to heart wrenching to likable and quirky, respectively.
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Media Portrayals of MPD/DID:

Multiple Choice - CBS Sunday Morning Program

TV's Split Personality- Newsweek

 

Basic Information:

DID on WebMD

 

The Defenders of MPD/DID:

A Physiological Case for DID- brain size in terms of hippocampal and amygdalar volumes differ significantly between mentally 

                                           healthy participants and those diagnosed with DID 

Identity Crisis- the voice of a former DID sufferer

 

The Skeptics:

Criticism from a Psychiatrist- problems with the current definition of mental illness in the DSM-IV (the current version) such as

                                          burden of proof, determining causation, tautology, and vague language pose the question on

                                          whether DID is even a disease

Sense of Self:

The Ever Elusive "I"- "We can all attest to feeling internally divided at some point in our lives. It's not that hard to pinpoint such an experience; most instances of indecision are good examples, and so are displays of "uncharacteristic" behavior under the influence of drugs, and times of internal rationalization for things we do that "feel bad." Have you ever heard of an athlete prepping himself for a critical moment in a game, or of a student telling herself to calm down before an exam? Who is prepping the athlete, and who is being prepped by him? Likewise, who is calming the student, and who is being calmed by her? It really isn't that foreign a notion that there really may be a 'jostling crowd of "I"s' within us, and the workings of the nervous system seem to provide a rather convincing manifestation of this notion of multiple "I"s"-- What if, in reality, our notions of self for even normal, mentally healthy people incorporate multiple personas? 

 

 

 

 

      

 

 

 

 

Comments

about depression's picture

In Dissociative identity

In Dissociative identity disorder you will find unexpected alternations in between 2 patterns of behaviour, each of which is forgotten through the individual when the other- is found. Dissociative identity disorder will be severe and chronic and may result in disability and incapacity. Its linked to a higher occurrence of committing suicide efforts and is considered to be very likely to result in suicide compared to every other psychological disorder. more info

Paul Grobstein's picture

dissociation and integration

Lots of intriguing bits to this conversation, as in comments below.  My own particular foci of thought ...

The notion that DID is not a discrete condition but rather one end of a spectrum of brain states beginning with dissociation as a quite general and normal/adaptive characteristic of brain organization and extending into realms where it may become non-adaptive/pathological.  I'm intrigued by the possibility of focusing less on dissociation as the problem and more on failures of integration.  When/why/how do these occur?  And how can integration be promoted?  There are some interesting parallels to Temple Grandin's characterization of both autism and the minds of animals (see her Animals in Translation) and, curiously enough, to the immune system and the problem of auto-immune disease.  The DID memoir I mentioned is First Person Plural. 

DID in turn is an instance of the more general problem of "categorizing" in the mental health realm.  An account of the history and future of the DSM might make a very interesting senior paper along these lines.  For more about the general problem, see Exploring Mental Health and Models of Mental Health

ttruong's picture

Integration of conflicting information

After reading about the experiences of people with DID, I am leaning more towards the possibility that the disorder does indeed exists. I think that there may be degrees of severity of the condition, but it is a condition nevertheless. For a person to periodically do things that they have no recollection of, and in ways that are completely different from what a person feel is herself is very much a condition. The idea that it's a possibility that they are unable to integrate conflicting feelings and thoughts into a coherent pattern of behavior or a single personality makes alot of sense to me. I think a possible a direction of research would be to explore whether there are certain pathways in the brain are utilized when people are processing conflicting information.

jrieders's picture

Why do we realize that some

Why do we realize that some "mental illnesses" are socially constructed, and yet include gender identity disorder as a mental illness and even describe it in terms (category 2 and 4) that enforce the societal aspects of it?

jrlewis's picture

What if we characterized the

What if we characterized the presence of multiple personalities or identies as a spectrum.  The idea that it is not necessarily a pathological condition.  Walt Whitman claimed to contain multitudes.  In our discussion several people were able to formulate examples of experiencing different identities in a non-detrimental way. 

RachelBrady's picture

Exactly! Also, Including

Exactly! Also, Including gender, and other aspects of personality, in a manual of disorders implies that individuals that fit the criteria need to be treated/'cured', which in turn indivates that that there is a discrete norm for all of these behaviors, which is not defined (probably because it doesn't exist)

RachelBrady's picture

A few thoughts

 

     I have a lot of conflicting feelings on these issues, but mostly on the use of DSM itself. First off, I understand the importance of creating a general manual for mental disorders, or for any great body of knowledge. It serves as a diagnostic tool, and not only for individual treatment, but also for things such as child custody disputes, discrimination cases, court testimony, education and such. This diagnostic tool is invaluable in an otherwise non-measurable, quantitative analysis.
    Ok, now that that’s over, onto the dislikes. All of these attributes don’t leave me feeling comfortable with the fact that there is no scientific or medical validity to the disorders, but it is still used by some professionals as a sort of ‘bible’.
Whenever I think of DSM, the first thing that comes to my mind is the insertion, and subsequent removal, of homosexuality as a form of gender identity disorder. This immediately raises many questions:
1)    Gender identity disorder assumes, a priori, that there is a normal standard of what we call gender in the first place. In fact, this entire manual is assuming that there are discrete ‘normal’ states for all of these physiological phenomena, which they then fail to define.
2)    The case of homosexuality it only one instance of classification in DSM facilitating discrimination. I’m sure with a deeper look into the manual you’d find many more examples of this, even outside the gender identity section.
So with this I went to look up the DSM diagnostic criteria for gender identity disorder, to add more fuel to the fire.

 

"A. A strong and persistent cross-gender identification
   (not merely a desire for any perceived
   cultural advantages of being the other sex.)
   In children, the disturbance is manifested by
   four (or more) of the following: 1) repeatedly
   stated desire to be, or insistence that he or
   she is, the other sex; 2) in boys, preference for
   cross-dressing or simulating female attire; in
   girls, insistence on wearing only stereotypical
   masculine clothing; 3) strong and persistent
   preferences for cross-sex roles in make-believe
   play or persistent fantasies of being the other
   sex; 4) intense desire to participate in the stereotypical
   games and pastimes of the other sex;
   5) strong preference for playmates of the other
   sex. B. Persistent discomfort with his or her
   sex or sense of inappropriateness in the gender
   role of that sex. C. The disturbance is not
   concurrent with a physical intersex condition.
   D. The disturbance causes clinically significant
   distress or imPairment in social, occupational,
   or other important areas of functioning. (APA,
   2000, p. 581)"
 

 

By now, I’m sure you can all imagine the rant that would follow my own reading of this absurd piece of work. So I’d like to hear your thoughts on the matter.

 
Lisa B.'s picture

"Remove Gener Identity Disorder from DSM"

Richard Isay wrote, in “Remove Gender Identity Disorder from DSM,” that the category of psychiatric illness known as Gender Identity Disorder (GID) in children implicitly labels homosexual boys as mentally disordered (Psychiatric News, 1997). Isay also said that although the American Psychological Association (APA) removed homosexuality from DSM-III in 1973 and ego-dystonic homosexuality from DSM-III-R in 1987, GID is a remnant of those earlier diagnoses. He asked the APA why they continue to label a mix of gender traits found in the normal development of homosexual boys disordered if the APA admitted in DSM-IV that, “By late adolescence or adulthood, about three-quarters of boys who had a childhood history of Gender Identity Disorder report a homosexual or bisexual orientation, but without concurrent Gender Identity Disorder.” According to Isay, because the APA categorizes “feminine” traits in boys as undesirable, these children could become adults that have “lost contact with their emotions.”

 

 

 

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