I've been venturing into more random subjects lately, like reviewing the perspective of foreigner Youtubers living in China on how evil China is, or more recently discussing how social media group subculture adjusts members' perspectives. This is about dissociative identity disorder (DID), formerly known as multiple personality disorder. To be clear I wrote this out as a draft two months back and am just getting back to sharing it, a bit longer for adding changes to perspective.
I'll try to keep the context framing and disclaimer part moderate; it would be easy to write a 1500 word description of how my own perspective is limited, explaining all the scope not covered. In a sense it could be regarded as disrespectful to read up a bit on a mental health related subject, watch some videos, read and interact a bit in some related social media groups, read a book and a few papers, and then summarize it. Of course that oversimplifies the topic, and isn't true expertise, or not even personal contact grounding. An explanation of my background with the subject will help, what caused me to drift into it.
A social media contact posted something about this subject, and I asked for clarification in a message, and we went on to discuss it. The subject was more interesting for another tea related contact explaining schizophrenia prior to that, and a second offering a very different account of that condition, based on their own experiences. Schizophrenia is not necessarily closely related, but it did bring up an interest in a range of subjects that I'd never considered. I didn't understand a lot of the topic range in comparison with what I did catch in that discussion (for either disorder, really, but I mean the one about DID), but I didn't want to press too far for more and more details; it was nice hearing what that person was open to sharing. Youtube brought up the subject in recommending videos about it some time later; apparently it has become a topic of interest.
That's where things take an unusual turn. There are lots of channels about DID on Youtube, people posting about their experiences. They are all quite different, related to what they communicate, and the condition itself does vary. It's amazing how open the people sharing ideas can seem, how genuine and clear, and how many will have "alters," other internal personalities, join the video session to discuss their background or outlook on things. Usually that's not in the form of an on-camera switch, as tends to come up in social media content, which probably could be valid or just performance in different forms.
Amazing descriptions of complex internal realities also come up. It's easy to see why this could become a trendy topic, beyond the occasional movie promoting it (but I didn't see Split, and don't remember ever seeing Sybil). A few of those details in some videos or movies don't match up well with what people who identify themselves as having the condition describe. I won't really get into level of likelihood that some people are misdiagnosing themselves in this, or using false claims to have a condition to get attention. Some of that would come up, but in general I think it works best to set it aside, and try to take in what is communicated without that as even a potential factor.
I did ask that first contact (who experiences DID) about some of the more extreme portrayals, of switching out alters on cue on camera, and elaborate inner reality descriptions (of relationships between alters, or internal physical spaces), or degree of openness and shared awareness of all the alters. Many of those forms don't match her experience. Even for her that's hard to place, since the condition varies in different people, or in any given one over time. Tik Tok portrayals of the most dubious and rapid persona switches are flagged as least likely to be valid in online discussion, but I've not looked into those [I did later, between initial draft and revising the earlier notes, but it still seems as well to skip talking about that part].
I'll mention what I've ran across by subtheme here, breaking this subject up into some relatively arbitrary parts, to avoid the problem some people have with reading one large block of text.
Writing context and disclaimers
First, why summarize it at all? In part I write to collect ideas for myself, as I do in a workspace blog that I don't even online, mostly about Buddhism, but also about other ideas (2 Monkeys Buddhism). I've put this is in my "main blog" because somehow it makes sense to me add some other themes here too. The basic reasoning here is that anyone could gain the topic exposure that I already mentioned but it would take some doing. Maybe after hearing a summary of that degree of contact others would want to explore more, as follow-up. Or it's possible that it could at least stand alone to offset the "intended as fiction" version of DID presented in Hollywood movies. Or initially I thought that I might never post this, just writing as an exercise, but I am re-editing the draft with the intention to share it.
Obviously almost no one experiencing DID has an evil alter who is a serial killer; that goes without saying. That actually did happen once, in real life, and I've heard that Hollywood is currently making a movie about it, but in a sense that's not a fair portrayal. It builds on a number of fictional narratives to imply a conclusion that's the exact opposite of true, that people with DID would be likely to be dangerous. They wouldn't be, related to what the condition is all about. I'll get to that.
I'm no expert; I've already expressed that. This shouldn't be used as a guide to understand a friend who may have a similar condition or a means of understanding your own experiences. I'll mention other support groups that serve as a resource at the end, or of course in most related contexts getting professional help would make sense. The intention here is to portray nothing negative at all about this medical condition, in terms of judging people with it, or with related experience, or even people who claim to have it who may not. At some point that kind of exploitation and appropriation would be negative, but it wouldn't be easy to judge where any one person is coming from, or why, related to their communication about their own inner reality. The point here is just to share some interesting ideas, which don't apply much to people without the condition, but then inner reality probably isn't as consistent across different people than it might seem.
Background on the condition
There is a very consistent explanation of DID that people who experience it express. I'm going to assume that most people in the discussion groups really are experiencing it, and just drop out the concern that some might not from that content, only summarizing generalities reinforced by many. It would be possible to cite lots of summary explanation posts by people in those groups but I'm not sure they would prefer that, and it's messy to ask them, since they then might have mixed feelings about it. Keeping this really basic also works.
The basic theme: early childhood trauma interrupts a natural process of a normal and broad range of personality integrating into just one experienced persona in early childhood, maybe by the age of 7 or so. Instead one or more secondary personas are essentially created to serve in a protector role. I don't mean like Batman, that an abused 5 or 6 year old might seek out justice; it's almost always described as just a persona better adjusted for enduring trauma, or at a minimum the partitioning isolates one main personality from that contact. The other conscious experience personality range, the main or other personas, might then not even have access to memory of that range of experience, or per my understanding most typically wouldn't.
It's best to hear multiple descriptions of personal experience about variations of such conditions, instead of accepting one account as normal, or even less so one person's third-person input summary. Again the idea here is that if Hollywood movies are going to portray obviously false variations of these themes then it's as well for others to discuss the reality, even though a dozen other accounts would be much clearer in identifying a normal range than any 2 or 3. Initially I tried to find one good, long, detailed summary but the "first page of a Google search" approach failed. Reading academic papers is a relatively easy next step, I just didn't go there [two months ago at time of writing this draft that was true at least; I have read a book on DID and a couple of good research papers, and lots more social media group posts, and I'll add some references at the end].
One might wonder if people would necessarily know if they experienced this, and a consistent theme in descriptions of experiencing it is that many don't (maybe most, at a certain age or stage of experience). Amnesia is a main early indicator, not being clear on what happened in blocks of time. That "early experience" part might not be clear; depending on the individual's circumstances not only would the condition vary but when or how it becomes apparent also would. One counterintuitive part of how the experience often goes is that although the condition is caused by trauma in youth, well before the age of 10, it's normal for the effects to not fully manifest and be recognized until late teens or early adulthood.
Over and over people describe how the condition is formed and arranged in such a way to not be obvious to others, or even to personalities in "the system" (the main way people describe the set of personalities, a terminology use that could easily vary, but that social groups shared experience discussion causes to be more consistent now). That makes perfect sense, when you think through that primary origination context. Additional personas created to help protect the person in early childhood--a little more complicated, since person, persona, and personality often tend to be equated--wouldn't ordinarily be positioned to stand out as being "someone else." But internally that framing could be possible, and related to what is communicated it is quite common, to see the other personas / alters as completely different, independent others. People don't only experience alters with the same gender or sexual orientation. Again, that complexity adds up.
Is there usually a central self?
This seems to fall into the range where individual accounts vary. Many people do identify one personality (alter) as a host, as a primary personality, but it is also commonly communicated that the whole set is the person, not just one of them, and others report a more opposite experience, that there is no main one. For someone considering inner reality experience that's only based on one internal, distinct personality--as it's interpreted, at least--all of this can be hard to grasp.
It seems likely that everyone isn't as internally consistent as they might seem to themselves. Not just people on a DID spectrum of some sort, I mean, but in general. It's not only that our work and private life external images vary, or that habits and forms of interaction can be local to lots of other context, we seem to be a lot more context-specific than it's easy to notice at first. Any number of examples can work in different ways but I'll cite one that's probably easiest for everyone to relate to.
When you "go back home" and visit your parents, assuming that you've moved to a different area, that earlier location and setting context ties to a personal perspective range, which it's easy to adjust right back to. You kind of become that person who you were before. For some that would be a really bad experience, but for me it's comfortable and familiar, and grounding, just a bit strange. I'm not that different than who I was at 18 but still it's been awhile, and I'm in a much different place, so the experience of the perspective shift stands out.
The opposite experience can happen when you find yourself in an absolutely new set of circumstances, with next to no baseline for placing what is going to happen next, or how you should react. Travel isn't like that, typically, because we travel for a reason, and the context is set before any trip, often based around an exploration theme. For vacations even if you did no basic Trip Advisor review and had absolutely no idea what was outside your hotel (assuming you had that reserved, although it could start one step before that) the context of just looking around you would've already set.
Twice in my life I've moved and have been immersed in areas and cultures I just couldn't place, in grad school in Hawaii and moving to Bangkok. I don't want to go too far with that, to waste space on it, but the feeling is completely different than vacationing, or a planned move with work and housing details set up, to a familiar culture. When you first try to talk to someone who doesn't speak English it's disturbing on an unusual level (which happened right away in Hawaii, so it was more normal here later on, not an example of a brand new context). A context that's not just "somewhere else," that is actually set up to be completely different from normal life experience, to impose strict external rules and processes, is something else altogether. It's probably as disorienting a thing as one could experience, because there would be no internal patterns set up for interacting in that environment. Military experience comes to mind as an example. I had an interesting experience once in an ROTC camp that I could discuss, but it's too much of a tangent, and it was a lot more isolated in extent than that subject theme would normally imply.
Back to DID. Everyone's experience seems to be slightly different related to the number, types, connections, and "main personality" theme, so it's as well that I don't try to place that further. Some do describe one personality as a host and for some that's not how it works at all. Some discuss a lot of interrelationship between alters and for others they seem to barely be aware of each other, and tend to rarely "co-front" (be present at the same time). For people interested in hearing more about that, which is fascinating, I would recommend scanning online discussion groups more than Youtube videos. It's faster, and a lot of accounts turn up one after the other. Organized in Quora answers a number of people would address the same point, and a Reddit sub discussion isn't so different. Maybe more than one Facebook group is as helpful, but those other two source areas clicked best for me.
It's tempting to try to guess which accounts must be real or would be likely to not be. It's probably not possible for someone without direct experience to do that, and I don't have a clear feel for how someone having DID leads to relating to the entire span of other forms of experience. It seems as well to just set aside input that seems potentially less helpful. As far as the most extreme forms seeming most interesting, people describing radically different personalities, or complex internal interactions, it's probably useful to approach the subject as shared unique life experience and not so much as entertainment, although I suppose the two could overlap. Fictional accounts of other fantastic experiences can better fill that other role, or extreme everyday life stories, mafia history or ghost stories or the like. To me the difference and the attraction of learning more about DID is that it indirectly informs us about conventional life experience. Drug addiction stories are like that, just different in form, not atypical internal experience but instead accounts of what life is like when normal supporting conditions fail.
Range of types of alters
No generalities turn up here either; described personalities span the broadest possible range. Alter ages are described as varying a lot, along with gender, and a tendency to age or not.
That makes sense, given the general context. It's as well to keep in mind that whatever people experience isn't about intuition informing that as likely or valid, it's just what happens. Then this line of thought also leads to an edge; what if someone describes having an alternate personality that is an animal, or alien, or has superpowers? It's possible to just set that aside.
Unconventional range may not seem to violate common sense expectations--which again would only apply so far, not related to making judgments, but as a map of how far from personal experience context range one is considering--for personalities to extend beyond the bounds of ordinary experience, for example to be a "fairy." It's probably a short step from developing a personality experienced as having that atypical a character to developing even more extreme range, maybe back to the "alien" concept. It's interesting considering how this kind of experience could've been interpreted as demonic possession in the past, if someone experienced a second persona taking control of their life experience.
One might wonder how this is possible, for a range of personalities to be sustained by one mind (in the broadest sense). Really this leads back to considering how it's possible for people to develop a broad range of differing context-bound experiences within a conventional, integrated self experience. It wouldn't be hard to imagine someone experimenting with sexual identity and preference and developing a new social circle and set of personal practices tied to that, or even a somewhat different persona (just in a different sense; not really as an independent and separate personality).
This is absolutely not what I take people with DID to be experiencing, only other "imagined selves;" there are real separate "people," in the sense of personalities, having a shared body experience in that case. The point here is that your mind can adjust to a range of completely novel experience, and that doesn't seem odd, to maintain a new external persona and collection of response patterns. Memory being partitioned is harder to relate to; there is just no corollary or way to imagine that, seeing DID experience from a non-DID perspective. Or of course the "switching" experience, and probably other parts, like being conscious of more than one "present" personality at a time.
It's hard to relate to the experience of separate personalities being much younger, the "littles" theme. It's not regarded as unusual, in relation to a normal range of experience, and other first person accounts would describe it best. Since the trauma that causes DID almost universally occurs in early childhood it's normal enough that some degree of personality fragmentation would result in the experience of younger personalities, or one that doesn't experience aging. Intuitively the central self protected from trauma by personality separation would be a main one, and would continue to age normally, but again intuition only goes so far in identifying these patterns.
Switching, co-consciousness, internal communication
Really all these parts could've just been a sentence at the end of the last section, about how it doesn't work to relate to them, or map to a more universally familiar inner reality experience. I can add a short summary of what other people say, but it's one more part that gets described very differently by different people. All of the parts are sort of like that, which is why I was initially not sure I would ever publish this.
Beyond practicality and the capacity issue part of what makes it hard to relate to is why there even are different personalities. Not the root-trauma original cause, but why someone wouldn't expect and desire life to be structured within the context of a singular identity and personality, and why re-integration wouldn't naturally occur over time (with the opposite experience communicated more often, increasing degrees of internal fragmentation). Maybe some alters would see this as positive and some wouldn't, so it's back to the issue of them actually being real internal components of a broader system. A denial phase is described as very normal for many people, in initially discovering their condition. In some accounts or discussions many people describe the experience as very positive, as a functional, normal for them way of experiencing reality. Surely others struggle with it too, and ongoing rejection is an issue.
I wasn't exposed to enough accounts of how integration works out, in terms of that being an experience following a range of typical patterns, or to what extent choice was a factor. Discussion of people discovering additional personalities comes up a lot more than integration, of re-combining them.
Co-consciousness, internal communication, and specific forms of inner reality also vary a lot, and are hard to relate to. Often people will talk about some personalities being in contact with others, while the whole set is not interrelated in the same way. In some accounts it's the opposite, not at all different than a set of roommates living together, who can be closer or not as close, but definitely very aware of who is living in the same apartment. Even discussions of physical representations of inner mental space come up. It's around a point like this that accounts vary so widely that either valid experience takes a very broad range (which must be true in some range of senses), or some accounts are extrapolations of how someone without DID interprets it.
It seems best to set aside a mapping of accounts of these experiences back to how people experiencing one continuous personality experience things. Factors like internal dialog vary by individual; some people don't experience that in an internal voice form, as most do. Internal conflict would take a more "vocal" form for some, and others wouldn't "get" that. Finer points, like how alters communicate, and to what degree different personas are aware of each other, is very inconsistent in accounts of DID experience, with only some basic patterns standing out as most typical.
Oddly that's where I had stopped writing in the draft. Due to gaining a good bit more input the range of how DID is experienced seems more clear to me now than then. But I've also let exploration mostly drop in the past month. Reading back through that earlier draft a lot of those discussions add a lot about the experience of multiple personalities, or contact between alters, and how their own awareness of the condition evolved, and the experience changed over time, but it's all too much to get far with. It doesn't help that every person's account is presented as their own individual experience, which only applies to one potential form, not to DID in general.
An academic definition of DID, in contrast with the standard DSM IV criteria
That last sentence includes a lot that never gets filled in by this paper. It seems to be the main explanation for why some psychologists see DID as "not real," as I take it, as a condition that develops as a learned interpretation of other underlying conditions that are objectively real. Google's definition of iatrogenic: "relating to illness caused by medical examination or treatment."
I don't think that line of thinking is necessarily limited to the claim that mental health treatment is a main cause of DID being experienced in a developed form, as it is interpreted, since it would seem that an experience of hearing voices could develop into an internal mapping of separate personalities even without formal treatment, based on the expectation that was the condition being experienced.
Let me be clearer, at the risk of adding too much in interpretation: the claim here seems to be that it's a standard, accepted starting point for some people to hear multiple internal voices, but then that only develops into an identified experience of multiple personalities when that interpretation is encouraged by a mental health practitioner, or perhaps the same thing could potentially happen through self-diagnosis and review. I accept that DID is "real" instead, and that ongoing internal interpretation of the experience would change the form, but that people experiencing it go through the basic conditions prior to ever consciously identifying or interpreting it, within the context of treatment or on their own.
I can't get far with this since it's not something I've experienced, or have learned enough to weigh in on, but one example from a discussion can explain what this probably means. One social group participant explained how he came to transition from not realizing that he had DID, or experienced any other internal personalities, to that being very developed in form, to the other personalities having names and developed characters. At first he experienced the dissociation effects, memory loss and such, and later came to associate internal parts of his personalities as connected to life experiences or circumstances, eg. a somewhat separate persona related to experiencing anger, or at least a very distinct mode of being. Then over time he came to associate those modes of being more as distinct personas, and developed an internal mapping of persona details, which included separate names, which weren't initially part of his experience. It didn't sound like the interpretation process caused the divide in any way, only that it may have played a role in developing the form.
From this sketch it's easy to see how from a field of psychology perspective this could be seen as a completely different experience than depression and such, with conscious interpretation playing a causal role, and changing what is experienced. But that doesn't mean that his experience was "not real" (in that example). He experienced an atypical separation of internal experience and the dissociation / amnesia aspects prior to connecting it with any interpretation at all.
The other two models, the DSM IV version ("official" description) and the broader one proposed seem to vary along some of the same lines I've described in relation to how DID cases and experiences vary. It's a strange subset of the DID range of ideas how mental health treatment, related professionals' perspectives, and academic perspective (described in that paper, as one example) all vary.
DID experience in relation to Buddhist model of self
I wrote a separate draft about how I see these experiences and this framework for reality relating with that of ideas from Buddhism. Buddhism rejects that the ordinary experienced internal self is real, with "real" being used in a specific sense, and that assertion serving a specific functional purpose. That's not a model for reality, as I take it (so the subheading is actually slightly wrong). Instead it's a very functional perspective that needs to connect to a process of introspection and lead to specific forms of internal experience change to serve an intended purpose. It works to also reject that all multiple internal experienced selves are not real, in a limited sense, even the "primary / host" version, it just requires some mapping out. "Real" is being used in a very special and limited sense here. One has to be careful with interpretation; it's a short step from grounded, functional, safe practice of Buddhism to more wonky Scientology range claims, shifting to a psychological "going clear" internal re-programming theme. Or maybe Scientology isn't really wonky, but if you read Dianetics it seems likely that it is.
In hearing accounts and talking to people in groups--a little; it seems odd to join their space out of curiosity, so I'm reluctant to add much, even questions--how it works out for them seems clearer. It's still not easy to place how the experience of multiple personalities would support a continuous and functional life experience. Life can be hard enough to deal with when every experience is linked within one context of internal self-response, and within one memory stream. I guess it's all relative.
Since the end of that first exploration phase I've asked my kids if they've ever experienced any internal voices as external, in any form, and one of them said that they sometimes do. That's not DID, for sure, but it may relate to a limited experience of schizophrenia, probably far enough into the normal spectrum that he wouldn't be diagnosed with that. It turns out that on the order of 10% of everyone experiences some form of "hearing voices," as it's described. If nothing else this exploration has led to a very personally relevant scope to keep an eye on, and to keep exploring.
I'll get around to writing more about how I interpret DID in the discussion of the condition in relation to Buddhism, which I already mentioned (revising an existing draft).
Hopefully it has come across that I see this condition as atypical instead of abnormal, that I intend to pass on no negative judgment in relation to people experiencing this. It seems a bit of a stretch to say that it's just a part of the spectrum of normal life experience, but in a broad sense that's actually how I see it. It seems unusual, but then all of our life experience circumstances represent only one isolated instance of how human reality might play out. There isn't as much of a broad, consistent normal range as there might seem, or at least that's my take.
I'll link to a few of the references and groups I've mentioned here, and close this without really drawing any further conclusions. The idea here was to share some initial review of an interesting subject, not to develop my own interpretations on how to model it, or to critique any other interpretations.
References / groups
Multiplicity Space on Quora: one of the best groups I've ran across; the people discussing the subject there are open and helpful, and very genuine
Dissociative Identity Disorder Space on Quora: another good option; Quora's typical group culture environment seems positive for this kind of topic range
Discuss DID sub on Reddit: also positive and open. Because different sites / platforms have a different audience base the context is slightly different, not necessarily just better or worse.
DID/OSDD Support And Experiences: different DID groups are more or less open to discussion or questions from people who don't experience it, and this one is more focused as a support group than for general discussion (it seems). But it's open for people to join and view, or even contribute, but it's best to be mindful of group purpose and scope when asking questions or posting.
Internet Archive links (papers, videos, podcasts, etc.): a good reference source for all sorts of materials
Internet Archive references, the Open Library section: a great source for free texts on DID and other subjects, and some research materials (papers)
Auditory verbal hallucinations and the differential diagnosis of schizophrenia and dissociative disorders: Historical, empirical and clinical perspectives: an example of research oriented work (not the full paper though).
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