Remember that quiet, little lady in the movie, the one who bats shy eyelids and blushes every time a car drives by? “Doctor, I keep losing time, waking up in strange places and no idea how I got there. I think there’s something wrong with me.”
The psychiatrist records the session. They always do in the movies. The next scene is just as predictable. We hear the patient’s interview. The psychiatrist is alone, of course, thinking about what he’s heard, a perplexed look on his face, and you see his finger jump from button to button on the recorder… PLAY, REWIND…PLAY, REWIND… This is where the cinematography gets cool. Colors drift into black and white. Shadows appear. You don’t know what you’re looking at, but you hear everything. Quiet, little lady’s voice takes on a masculine edge. Educated vocabulary slips into street-talk, lots of F- and B-words. Then it happens. A harsh cry, choking sound, maybe a whimper or two, then a calm voice, much too calm: “So, Doctor, you’ve been looking for me? The others say you have a few questions for us.”
So, Doctor, what’s your diagnosis? If you guessed “multiple personality disorder” (dissociative identity disorder (DID), if you want to get technical), you got it. DID is one of several psychiatric conditions that falls under the umbrella of dissociative disorders.
What is dissociation? The word “dissociation” is used to describe a disturbance in one’s experience of reality. This might be as simple as the absence of pain while doing something that would usually hurt (seen in drugs like Ketamine or PCP). Alternatively, it might be experienced more broadly, as a mismatch between the different, normally integrated functions of a person’s consciousness; i.e., problems with identity and perception of the world around them. Except for substance-induced dissociation, these dissociation is almost always an after-effect of severe, repetitive trauma.
What are the types of dissociative disorders? There are four types:
- Dissociative amnesia (also called “psychogenic amnesia”) occurs when a person suddenly has difficulty recalling important personal information – like his name or date of birth. Usually this is a result of personal stress or mental trauma. An example might be a man’s sudden inability to remember the recent death of his child. Often these types of memories come back in time.
- Dissociative fugue (also called psychogenic fugue) occurs when a person suddenly and unexpectantly travels away from his life and, during the fugue state, doesn’t remember who they were prior to the episode. Many times the patient “comes to” after the event; he wakes up in a new place and become aware that he’s “lost” time. An example might be a college student who suddenly disappears for three days, only to show up in a city one hour away unaware of where he has been during that time.
- Dissociative identity disorder (also called multiple personality disorder) is a very rare phenomena defined by the presence of two or more distinct personalities inside one person. Often these personalities have different names, characteristics, accents, even gender. Most individuals with this disorder have suffered severe and catastrophic abuse as a child. Of interest, many experts argue this illness doesn’t exist.
- Depersonalization disorder is described as persistent or recurrent experiences of feeling detached from one’s mind or body. The person experiences reality as something foreign to himself. This experience feels like a dream, but it is terrifying and interferes with the sufferer’s ability to live and function well. Imagine feeling déjà-vu for hours or days at a time, as though your world is off-kilter.
Dissociation in other syndromes. Many patients experience dissociation as part of other syndromes. One example would be post-traumatic stress disorder (PTSD), as flashbacks. Flashbacks are to wakefulness as nightmares are to sleep. Like nightmares, the flashbacks are extremely distressing to the sufferer. They’re experienced as though the sufferer is living through the trauma again. Flashbacks may last minutes to hours.
Alex Natalian is a penname for psychiatrist KRR.