“Fight Club”, “The Mysterious Case of Dr. Jekyll and Mr. Hyde”, “Black Swan”, “Secret Window” - and this is not a complete list of works that touch on the topic of split personality. Dissociative disorder (or in common parlance “split”, even if there are more personalities) can be called one of the main trends in pop culture of the 20th and 21st centuries. It enchants, excites, and gives many new ideas. But like all psychiatric phenomena that have gained unexpected popularity, it gives rise to questions and misconceptions. Let's look at them in more detail.
Does multiple personality disorder really exist?
The question is paradoxical, but does not lose its relevance even now, when the disease is included in the International Classification of Diseases. And not only ordinary people who do not interact with psychiatry ask this question - even many scientists, psychotherapists and doctors doubt the reality of this diagnosis [1, pp. 163-167]!
Daniel Keyes, the famous writer, in The Mysterious Case of Billy Milligan, about a man exonerated on the grounds of multiple personality disorder, quotes from a newspaper article from 1981:
“He [Milligan] is either a deceiver who fooled the public and got away with terrible crimes, or a real victim of a disease such as multiple personality disorder” [2, p. 11].
In order to deal with the question of truthfulness and answer it at the end of the article, it is necessary to arm yourself with the most complete and reliable information.
Treatment
The main treatment is psychotherapy. A person needs to be convinced that the problems happening to him have not external, but internal roots. When the patient agrees that he is the cause, he can be helped in the following ways:
- To teach how several personalities can coexist within his “ego” without causing harm or discomfort.
- Learn to recognize situations that most often provoke a change in these identities.
- Give a feeling of support and security, this may reduce the frequency and severity of episodes of dissociation.
It is important to involve relatives and close friends in the patient’s adaptation: they must react correctly and help a person suffering from personality dissociation cope with themselves.
Drug therapy relieves anxiety, aggression, depression and other conditions associated with this mental disorder.
What is multiple personality disorder?
Dissociative identity disorder is a defense mechanism (namely, failed repression of traumatic events), which has acquired proportions that threaten the integrity of the self. This makes it similar to psychogenic amnesia, that is, memory loss without organic disorders of the brain. The main function of dissociative spectrum disorders is the isolation of negative experiences [4, pp. 65-66]. The manifestation of the disorder occurs in adolescence or childhood; according to statistics, women predominate among those affected [5, p. 214].
As we understand, split personality is not a diagnosis that can be made in a conversation with a friend, passing 1-2 comic tests or under the impression of the plot twists of “Shutter Island”. This disease can only be diagnosed by a qualified doctor. In addition, a person may forget birthdays or the faces of acquaintances, behave strangely and unusually, and when angry or shy, may not look like himself at all. However, this diagnosis cannot be made until the patient’s complaints meet the following four criteria put forward by ICD-10:
- There are two or more personalities - but only one is capable of seizing control over a person’s thinking and activities at a given moment in time.
- Individuals have their own individual characteristics, memories, preferences.
- A person may not be able to remember some important information, but this is much more than simple forgetfulness.
- All of the above symptoms are not a consequence of organic lesions of the central nervous system or the use/withdrawal of psychoactive substances [3, p. 126].
Examples of behavior from life
In life, it can look like this: an adult suddenly begins to speak and behave like a child, the manner of speaking and judgments change. Another example: a person may not understand where he is, who surrounds him, or finds new things in his home environment, the appearance of which he cannot explain.
In the worst case, a person can commit a crime (kill, rob, cause bodily harm) during the period of activity of one of the individuals, and then not understand what happened and deny his involvement.
Film "Glass" (Glass, 2019)
There is a well-known example from life when two personalities within one person competed for the love of a girl. If one person wants the death of another, everything can end in suicide if you do not intervene in time.
It's still the same person. Can personalities be so different?
As a rule, individuals have different names, ages, gait, manner of speaking, and facial expressions. They are also diagnosed with different EEG indicators, and IQs can range from retardation to genius. In addition, differences are found in nationality, sexual orientation, and religions professed by individuals [2]. D. Keyes, in a book about Milligan, describes the characteristics of each of his personalities: a strong Slavic accent (Ragen), lack of initiative (Mark), a tendency to cheat (Allen), composure (Arthur). The latter also tends to connect his fingers with a “spire” - a gesture by which Arthur is recognized in the videos by many fans of the book.
Despite the layering of “new kids,” the original personality (usually still calling herself by her real name) remains among them, although not always in a dominant position.
Clinical picture
Usually in such situations, all pronounced symptoms are in full agreement with how the patient imagines the process of the disease. Medical diagnostics, as a rule, do not give a clear answer about the presence of any neurological diseases or physical disorders.
In such situations, it becomes obvious that the loss of mental functions is a consequence of the unmet emotional needs of the patient or a serious mental conflict caused by the corresponding trauma. Often, the existing symptoms have a gradual development associated with the patient being in a stressful state for a long time, and are followed by a sudden manifestation, since the tension is cumulative.
This may include types of disturbances associated with physical condition and functions that are normally controlled in a healthy state, as well as dulling of sensitivity.
Types of dissociative disorders
There are 5 main types of disease:
- Dissociative movement and sensation disorders are motor or sensory disturbances in the absence of somatic disorders.
- Dissociative amnesia is partial or complete loss of memory as a result of mental/psychological trauma.
- Dissociative stupor is a movement disorder resulting from a traumatic situation.
- Dissociative fugue - loss of memory of oneself after a sudden move as a desire to escape and start a new life.
- Ganser syndrome is a factitious disorder in which people behave as if they have a mental illness. It manifests itself in “past speech” (a ridiculous answer to a question) and “past action” (erroneous actions in response to a simple request) [4, P. 66].
Memantine and Intelligence
Memantine improves intelligence after brain radiation therapy (https://www.ncbi.nlm.nih.gov/pubmed/23956241).
There is evidence from a large study where memantine showed positive properties in the treatment of opioid addiction, in particular, it will improve overall well-being and intellectual abilities. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437025/).
In Down syndrome, memantine works better than placebo, although in a study on mice, although it is far from the performance of normal animals (https://www.ncbi.nlm.nih.gov/pubmed/20363261).
There is a study that shows improvements in working memory in rats (https://www.ncbi.nlm.nih.gov/pubmed/24385956).
There is little data regarding the possible improvement of intellectual abilities in healthy people. I'll tell you more about one experiment.
40 healthy volunteers were divided into 2 groups, some took memantine 30 mg, others took placebo. Then they were shown 20 photos of people they didn’t know and 20 building objects. They waited 80 minutes and asked them to choose from 80 people/buildings what they remembered. Results: both groups remembered people almost equally; with regard to buildings, the group with memantine was slightly worse. (https://www.ncbi.nlm.nih.gov/pubmed/11160760)
A couple more studies indicate either memory impairment or neutral data for HEALTHY people. (https://www.ncbi.nlm.nih.gov/pubmed/16423331 https://www.ncbi.nlm.nih.gov/pubmed/9132691)
Is dissociative identity disorder a symptom of schizophrenia?
This is one of the most common misconceptions about multiple personalities. Although Doctor of Medical Sciences, Professor Yu. V. Popov emphasizes that it is not always easy to distinguish schizophrenia and multiple personality disorder from each other, this can be done based on symptoms that are not characteristic of dissociative disorders. Basically, patients with schizophrenia tend to perceive the symptoms of the disease as the result of external influences [5, P. 217].
In addition, in the case of schizophrenia, a process of a more primitive nature occurs - the splitting of individual mental functions, without the formation of new, complex and different personalities within one. Logical thinking is also impaired, emotions are dulled - these symptoms are not symptoms of multiple personality disorder.
Reason for confusion
First, let's try to figure out why two different diseases began to be perceived as one. This is mainly due to the etymology of the word “schizophrenia”. From Greek it is literally translated as “to split” or “split” the “mind”, “thinking” or “thought”. This causes confusion among people who do not understand medicine and psychiatry.
But for an experienced doctor, differentiating these diagnoses is not so difficult. In short, with a split personality, it is as if a person has several people in one body. In schizophrenia there is no such split or split; the patient simply inadequately evaluates himself and the surrounding reality. The differences between these diseases will be more obvious if you look at their symptoms. Let's start with split personality.
I want to be different from others. Can I also split into three personalities?
Very doubtful. Splitting occurs, of course, always at the request of the patient - but not by the wave of a magic wand, but by unconscious desire. Basically, as emphasized earlier, this is the desire to isolate oneself from extremely strong negative memories. Not every sad or disturbing event in life can provoke this kind of “crack” in the self. For example, the most famous person with multiple personality disorder, Billy Milligan, was subjected to repeated physical and sexual abuse as a child [2]. Therefore, for such a strong defense mechanism to work, the trigger must also be very serious.
Speaking about simulation, it is worth emphasizing that a psychiatrist is easily able to determine where the illness is real and where it is being played out. Yu. V. Popov notes that during simulation, personality disorders are hypertrophied, polarized, and primitive. When playing them, an experienced expert may notice a lack of differentiation between individual personalities and the presence of internal inconsistencies in them. Unlike malingerers, patients with RML tend to hide their violations (the simulation of offenders trying to avoid punishment is especially striking) [5, p. 217].
In addition, having a complete, comprehensive understanding of this disease, it is unlikely that anyone will really want to have it. Of course, it will be possible to stand out from the crowd - but it is unlikely that any individual will strive for this.
In general, dissociative identity disorders are a large-scale topic that continues to be studied and discovered from new angles to this day. There are still some blind spots and riddles, mysteries and unanswered questions here. Researchers are still arguing about the reality/falsity of the disease. It is all the more interesting in these debates to hear a third, completely different point of view, expressed by a proponent of the relativity of personifications, American psychologist James Hillman: “Multiple personality is human nature in its natural state” [6]. And from this point of view, which is not devoid of rational grain, norm and pathology easily change places.
Films about mental dissociation
Famous film about dissociation: “The Three Faces of Eve” (1957, directed by Nunnally Johnson), based on real events. Three personalities coexist within a woman; her husband and psychiatrist are trying to help her cope with the different “I”s within herself. The series “Sybil” (1976, Daniel Petrie) is also about a real woman who experienced sexual abuse as a child and throughout her life feels alternately like completely different people. You can also call Frankie and Alice (2009, Jeffrey Sachs), Psycho (1960, Alfred Hitchcock).
Who is at risk?
Research suggests that the cause is most likely a psychological reaction to interpersonal and stressors, especially in early childhood when emotional neglect or abuse can interfere with personality development. Up to 99% of people who develop dissociative disorders learned personal histories of repeated, overwhelming and often life-threatening disruption or trauma during a sensitive stage of childhood development (usually before age 6).
Dissociation can also occur when there is persistent neglect or emotional abuse, even if there has been no overt physical or sexual abuse. Research findings suggest that in families where parents are unpredictable, children may become dissociative. Research suggests it affects about 1% of the population.
