Inside the Narrative System: Dissociative Experiences

Dissociative Identity Disorder (DID), formerly called “multiple personality” disorder, is one of the more unusual conditions in the spectrum of mental health. It is relatively rare, affecting only about 1.5% of people in the world over the course of their lives, and despite its intense and distinctive symptoms it is frequently misdiagnosed as one of several other behavioral conditions such as schizophrenia, bipolar disorder, or depression. The prior name "multiple personality disorder" (MPD) was confusing because DID was never considered to be a personality disorder -- those are a cluster of problems related to people's interactions with others or the world, which tend not to be distressing to the patient but are often distressing to those around them. DID, by contrast, is often confusing or frightening to the person experiencing symptoms. The disorder's key characteristic is "disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession." Besides being possessed, people often describe DID as an experience of two different people sharing the same body, most commonly by toggling back and forth between two different identities at different times. People with long-term experiences of DID sometimes report achieving "co-consciousness" where their various personalities (also called "alters") are aware of one another and can cooperate or coordinate activities. 

During my initial clinical training in the 1990s, a significant number of mental health professionals believed that there was no true physiological basis for DID, and instead talked about culturally-based "identity enactments" that could be considered as goal-directed social behaviors rather than as symptoms of illness. Some even suspected that clinicians specializing in dissociation caused DID by teaching their patients how to act as though they had multiple selves. However, later research has largely disconfirmed this notion. For instance, multiple studies have shown that people instructed to "act like" they have multiple personalities are unable to replicate key aspects of DID's symptom presentation -- many of the symptoms are simply hard to fake. Two of the most consistent unique characteristics of DID are identity-switching (i.e., a discrete "flip" from one sense of self to another) and amnesia (i.e., one alternate self not being aware of what the others have done or said). At one time the only accepted clinical goal in treating DID was to produce integration of the person's various alters, so that a single unified personality was always in control. Over time, patient advocacy efforts and increased clinical knowledge have led to the recognition that co-consciousness may be a more appropriate goal, in which people are able to avoid the disruptive effects of amnesia and involuntary switching, and gain greater cooperation where their alters can be appropriately or even strategically deployed to meet life's various challenges in a range of different contexts.

The modern view of DID generally rejects the idea that alters are social enactments, and instead connects DID to the experience of trauma, in particular to severe or recurrent trauma in childhood when the person had fewer cognitive or psychosocial resources available to help them escape from the traumatic situation. DID is just one example of a broader set of experiences, collectively referred to as dissociation, that affect a much greater number of people at some point in their lives and that are often linked to trauma. This perspective on DID is based in the idea that dissociation can serve as a "mental escape" from traumatic events when a physical escape is not possible. Bessel van der Kolk's popular book The Body Keeps the Score suggests that dissociation results from unprocessed memories, and indeed memory disruptions are a common feature of trauma. These can manifest as flashbacks (all-encompassing memories that seem like "reliving" a situation), flashbulb memories (particularly vivid and impactful memories that retain their power over time), or repressed memories that are no longer accessible to the conscious mind. Indeed, some neurological evidence suggests that this type of memory is stored differently from ordinary memories, so the brain's index of information can't call them up in the same way as it calls up normal memories. In this interpretation, dissociative experiences (particularly those connected to amnesia of events) may be the result of traumatic memories that are cut off from the main flow of a person's experiences. I have previously written about the various effects of trauma at the level of the Intuitive mind.

Although the neurological basis of dissociation may originate in the Intuitive mind (i.e., as an instinctive escape hatch from overwhelming fear or suffering, or in split-off memories that are difficult to access), DID alters themselves are clearly a disruption of the usual processes of the Narrative mind. The experiential reality of alters is that one of interruption to one's self-narrative, with holes or gaps where a continuous experience ought to be. For the alter who is present during those periods of missing time, the "primary" alter's experiences may be inaccessible or cut off from the sense of self. (Sometimes, one alter will have access to the other's experiences, but not vice-versa. And often, there is more than one alter, with some appearing more frequently and for greater periods of time than others). Some recent research suggests that dissociative feelings can actually be stimulated experimentally, by establishing a particular rhythm in the posteriomedial cortex. This section of the cortex (and by extension, the Narrative mind) appears to be particularly important to a person's sense of self as a continuously experiencing entity, rather than a series of unrelated physical and emotional states. 

Based on my own clinical experience meeting a few people with DID, I can confirm that the switch between alters is sudden and dramatic, where you are initially speaking to one person and then momentarily you are clearly speaking to someone else. The person's posture, mannerisms, tone of voice, vocabulary, and emotions all can change. Some alters may have abilities that others do not, including measurable things like athletic skill, ability to speak a foreign language, or visual acuity. Anecdotal evidence even suggests that some people's eye color can change when they switch from one alter to another, that some alters can have scars that others do not, and that certain alters might have a medical condition such as diabetes while other alters do not have physiological markers for the same illness when they are inhabiting the same body. These extensive physiological changes don't occur in all cases of DID, but they do show how a deeply-felt narrative can change many things about the body. The Narrative Mind may not be able to control behavior directly, but it does make a difference in how we experience and relate to the world around us.