Multiple personalities?

“Multiple personality disorder,” now known as dissociative identity disorder (DID), is one of the most controversial diagnoses in the field of psychiatry. While dissociation – feeling like you’re not in your body or that you’re not “yourself” – is a recognized psychiatric symptom, some mental health professionals have questioned whether a person can truly experience themselves as having multiple identities. While only a few colleagues in my thirty-plus years as a psychologist have had a client that they believed had DID, I’ve known other clinicians who’d diagnosed it in several clients they’d worked with. Psychodiagnosis, as I’ve said before, isn’t rocket science.

In my opinion, multiple personality disorder was a “fad diagnosis” for a while, influenced by the popular book and movie, The Three Faces of Eve (Joanne Woodward won an Oscar for her portrayal of Eve), and subsequently the TV movie Sybil, with Sally Fields as a woman with multiple personalities. In my career I only had one client that I treated for DID. Some of my colleagues had doubts about my diagnostic impression, because they were skeptical about “multiplicity” as a phenomenological state. But my clinical supervisor validated the diagnosis and helped me to work strategically in my treatment.

My one client with DID – I’ll call her Susan – had corresponded with Chris Sizemore in her quest to understand her experiences of blackouts, and subsequently finding evidence of having done things she had no recollection of doing. Chris was the “Eve” of The Three Faces of Eve, and she’d written a book titled I’m Eve in which she revealed that the psychiatrist who’d written the book about her hadn’t, in fact, cured her of the disorder as he’d claimed. She’d discovered that she had more than the three personalities described in the book, and it took her years of additional therapy with another therapist to resolve the issue and experience herself as a single, integrated person.

With Susan’s permission, I initiated a correspondence with Chris, who validated the therapeutic strategy I’d described to her. Each of Susan’s personalities served a distinct function in her life, and she’d come to unconsciously rely on “them” to do things she didn’t think she was capable of doing, herself. Her “core personality” wasn’t initially aware of all the other personalities, and didn’t grasp that she’d unconsciously created them. Once she understood what was happening, she was terrified at the prospect of facing the world as a single, integrated person, but deeply troubled by her frequent dissociative episodes. She knew she couldn’t go on living that way.

The primary metaphor I used in therapy was that people are like oranges. We all have different aspects of our personalities, just as an orange has multiple sections. (I’ve labeled some of mine: the lieutenant, the teacher, the player, the host, etc.) Most of us, I said, have permeable boundaries between our sections. Each section is aware of the other sections, and is aware that it’s part of a single entity – an orange. I suggested to Susan that people with DID have impermeable boundaries between (at least some of) the sections. Each “personality” was aware of the core personality, but not necessarily aware of all the others, or the complex web of selective interactions among personalities. Some of the personalities that “came out” in sessions seemed open to the notion of eventually integrating with the core personality; others feared extinction. The method of integration was to make the boundaries between the sections permeable: to help each personality to be aware of the others, the function that each served, and the fact that they were all part of the whole person that was Susan.

Over time Susan gained the insight she needed, comprehending that DID wasn’t something that had happened to her, but rather something she was unconsciously doing – and could stop doing. But first she needed to learn to trust that her core personality had all of the capabilities that she’d attributed/distributed to the “others.” She eventually achieved her goal of integrating the splintered parts of herself. We kept in touch for a while after I was transferred to another satellite office of the regional mental health center, and she maintained her awareness of herself as a single personality with multiple facets. Like the rest of us. When she tried to give me credit for her breakthrough, I said what I always said in that circumstance: “You did the work; I just helped.”

I later met Chris Sizemore, who had become an active mental health advocate and public speaker. I saw her again a few years later and got to spend some time with her. She remembered me from our first meeting and “hugged my neck,” as we say in the South, when we met for the second time and when we parted. She was a highly intelligent, warm and generous person, and did a lot to promote awareness of mental illness. I feel privileged to have encountered her.

I still believe DID is a valid diagnosis, but think it’s very rare. I never worked with another person with the diagnosis again. My therapy with Susan was one of the most complex in my career, and I never needed good supervision more than then. I felt like I was walking a tightrope between not invalidating Susan’s experience of having more than one personality, while not validating her belief that the “others” were truly separate from her core personality. I think that my study of phenomenology in grad school really helped me to help Susan to integrate her “split personality.”

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