Dissociative identity disorder

“ The facts are trite enough; but, because they are of common experience, it is well to formulate them and so, as far as possible, give precision to our conception of the psychological relations which have a distinct bearing on the principles of dissociated personality and other psychoses, on character and psycho-therapeutics. When, at a later time, we take up for study the subject of dissociated personality [147] we shall find that the dissociation of consciousness sometimes takes its lines of cleavage between systems of complexes of this kind. ”

“ At all events there exists an identity of I. and II., but it does not lie in the region of the personality under discussion; it lies in the basis common to both; that is, in the personality of the patient which in deepest essence is one and indivisible. Here we come across the characteristic of all hysterical dissociations of consciousness. They are disturbances which only belong to the superficial, and none reaches so deep as to attack the strong-knit foundation of the ego-complex. ”

“ What is needed is to get at the dissociated mental states—the forgotten, disease-creating memories—and reassociate them with the upper consciousness, or root them out completely by means of “suggestions” skillfully applied.
This is no fanciful theory. It is the solidest kind of fact, repeatedly tested and verified. Time and again, patients pronounced incurable by competent physicians have been taken in hand by the psychopathologists and, once their disease has been definitely traced to some dissociation, have been restored to perfect health. ”

“ Through the defense mechanism of dissociation, the victim may escape the horrors of reality by inaccurately processing that reality. In a dissociative state, a young child who ordinarily would know the difference might misinterpret a film or video as reality. ”

“ When the inhibiting or repressing force that induces dissociation ceases to be effective, that is when the dissociated systems come again into activity and repress the temporarily dominant systems, then the individual returns to his normal condition (in which he may or may not remember the dissociated state) , just as a person returns to his habitual character after the passing of a mood. We may speak of the two phases—the normal and the altered one—as constituting together multiple personality. ”

“ And you have replaced your knowledge by an awareness of dreams because you are afraid of your dissociation, not of what you have dissociated. When what you have dissociated is accepted, it ceases to be fearful. ”

“ When the alteration is slight and affects few systems it may be easily overlooked; 546or when it is accompanied, as it often is, by physiological disturbances, it may be so masked by them as to be mistaken for so-called neurasthenia. It is when the dissociation is so comprehensive as to deprive the individual of memory of his previous phase of personality, or of certain acquired knowledge or other particular experiences that the personality is easily recognized as a dissociated one. ”

“ It has been found that under some unusual stimulus—such as an injury, an illness, or the strain of an intense emotion—there may result a disintegration, or, as it is technically termed, a dissociation, of personality, giving rise it may be to hysteria, it may be to hallucinations, it may even be to a complete disappearance of the original personality and its [Pg 75] replacement by a new personality, sometimes of radically different characteristics. ”

“ But even here the position would not be altogether satisfactory, for we should be driven to regard the process of suppression to which the paralyses and anæsthesias are due as itself a mode of activity of the suppressed experience. If, in place of regarding dissociation as a state of independent activity, we hold independent consciousness to be a necessary part of the concept of dissociation, it is evident that hysteria wholly fails to answer to the definition, for there is no evidence whatever of such independent consciousness. ”

“ But, after all, it is not necessary to insist on such extreme instances in order to demonstrate the essential instability and divisibility of that which we commonly have in mind when we speak of the “self.” Dissociation of personality is in evidence every day in the pathetic symptomatology of the various insanities, and in the chronic, if often masked and unrecognized, memory lapses universal among sufferers from the manifold affections of hysteria, such as we dealt with in the chapter on “Dissociation and Disease.” ”

“ In other words, that he was, like other historic [Pg 170] personages whom we have already encountered, a victim of dissociation. There is no gainsaying the fact that he was of a distinctly nervous temperament; and it is equally certain that he chose a vocation, and placed himself in an environment, which would tend to make a dissociated state habitual with him. But this is bringing us to the consideration of a psychological problem which would itself require a volume for adequate discussion. ”

“ This power of switching from one set of interests to another may perhaps be regarded as a kind of epicritic dissociation in which Man has utilised the instinctive property of, or tendency to, dissociation, in which he has brought it under control and to a large extent graduated it to meet the special needs of the developed mental life. At the least we seem to have here a feature of normal mental process, with certain points of resemblance to morbid, or, as it may be called, protopathic, dissociation, which may help us to understand its nature. ”

“ Fundamentally, dissociation of consciousness means the same thing as Gross's disintegration of consciousness. By accepting the idea of sejunction we have only a new term of which psychiatry has certainly enough. Dissociation according to the French school is a weakness of consciousness due to the splitting off of one or a series of ideas. They separate themselves from the hierarchy of the conscious ego and begin a more or less independent existence. [77] The hysteria doctrine of Breuer and Freud was developed on this foundation. ”

“ The depths and extent of dissociation of mental systems may be regarded as variables of vividness. Dissociation varies inversely as vividness. When vividness is at its minimum, dissociation is at its maximum. The phenomena of functional psychosis having their origin in states of dissociation may thus be regarded psychologically as functions of vividness, the most characteristic attribute of representative elements. ”

“ Usually in all such cases the neurograms are isolated, etc., by dissociation. They still, however, may be strongly organized and conserved as an unconscious complex and sometimes may be excited as a subconscious process by an associated stimulus. In such conditions it very frequently is found that the dissociation is due to conflict between the emotion belonging to the complex and another emotional complex. The impulsive force of the latter dissociates the former complex which then cannot be voluntarily reproduced as memory, nor awakened by any association under normal conditions. ”

“ Where the hysterical dissociation becomes so extreme as to eventuate in amnesia in one state for another the different systems of complexes are easily recognized as so many phases of multiple personality. ”

“ When a mood or system of complexes drives out all other moods, one becomes "a different person." But if this normal dissociation is carried a step farther, we may lose the power to put ourselves together again, and then we may truly be said to be dissociated. Almost any part of us is subject to this kind of apparent loss. In neurasthenia the happy, healthy complexes which have hitherto dominated our lives may be split off and left lying dormant in the subconscious ”

“ The most characteristic example of dissociation is the fugue in which a person shows behaviour, often of the most complicated kind, and lasting it may be for considerable periods of time, of which he is wholly unaware in the normal state. The fugue usually comes into being owing to the fact that some unpleasant experience has become unconscious by the unwitting process of suppression or is tending to pass into the unconscious through the agency of the witting process of repression. ”

“ As a matter of fact there is no need for us to establish hypothetical, intermediate, unconscious or physiological links. The "unconscious" brain-processes are problematic entities and there is no way of getting at them. What we need to discover in cases of mediate association, and especially in cases of psychopathic diseases, is whether the intermediate links, or the original experience that brought about the trauma, or the state of dissociation is present, consciously, or subconsciously, or coconsciously. ”

“ The conclusion to which I am tending is that the definition [p. 79] of dissociation, which will make the term of most service to psychology and pathology, is: one which lays special stress on the feature of alternate consciousness. ”

“ The first possibility which occurs to us is that we should connect the term "complex" with the process of dissociation as so defined. A complex would then be a body of suppressed experience with an activity independent of the behaviour of normal life and accompanied by consciousness dissociated or separated from the consciousness which accompanies that behaviour. ”

“ Recessive states, becoming marginal and subconscious, lapse from voluntary control, they cannot be recalled deliberately and consciously by the activities of voluntary, recognitive, associative memories, constituting the mental life of personality, and hence may be regarded as mental systems in a state of dissociation. The lapsed states are present subconsciously when not completely blurred and obliterated by the process of decay or regression. ”

“ In whatever way the hysteria arises the developed symptoms are the result of a mental activity which is powerful enough to overcome for a long time the desire for recovery. There are two streams of thought—the one desirous of cure and the other engaged in keeping up the symptoms—and we recognise an extreme example of continuous dissociation, in which the main stream is not only unaware of the existence of the other and unable to control it, but in which the results produced by the dissociated stream are antagonistic to the desires of the main personality. ”

“ Instead of assuming that some hereditary disposition, or a toxaemia, gives rise directly to organic processes of disease, I incline to the view that upon the basis of predisposition, whose nature is at present unknown to us, there arises a non-adaptable psychological function which can proceed to develop into manifest mental disorder; this may secondarily determine organic degeneration with its own train of symptoms. ”

“ Whatever the symptoms, the mechanism of the puzzling malady is always the same. There has been an abnormal dissociation. The ideas connected with the original shock, although submerged beneath the threshold of consciousness—in a word, forgotten—remain vividly alive in the subconscious, to act as perpetual irritants of the [234] nervous system and in time to give rise to the appearance of the symptoms of which the sufferer complains. Often, indeed, the dissociation is instantaneous, and the appearance of the disease symptoms equally rapid. ”

“ Gerald Balfour, whose writings on Psychical Research deserve the closest and most attentive study, discussed in the Hibbert Journal ten years ago the problem of dissociation, “whereby an element of the normal self may be supposed to become [Pg 92] in a lesser or greater degree divided off from that self, and to acquire, for the time being, a certain measure of independence.” ”

“ In order to allow the emergence of the transmitted ideas into the field of conscious knowledge, there seems to be always necessary some form of psychical “dissociation”—as in a trance, dream, reverie, or moment of absentmindedness. Such states of dissociation are not always easy to bring about voluntarily; and when they are brought about, whether voluntarily or involuntarily, it by no means follows that ideas received telepathically [85] will forthwith and rapidly rise above the threshold of consciousness. ”

“ The pathological liar, who becomes involved through his phantasies, behaves exactly like a child who loses himself in his play, or like the actor who loses himself in his part. [76] There is here no fundamental distinction from somnambulic dissociation of personality, but only a difference of degree, which rests upon the intensity of the primary auto-suggestibility or disintegration of the psychic elements. The more consciousness becomes dissociated, the greater becomes the plasticity of the dream situation, the less becomes the amount of conscious lying and of consciousness in general. ”

“ The dissociation is apt to involve a certain number of acquired traits and certain innate dispositions and instincts, while other outlived and repressed traits and innate dispositions and instincts are apt to be reawakened and synthesized into an altered abnormal personality. ”

“ Amnesia alone, however, does not constitute alteration of personality strictly speaking; for a person may have complete loss of memory for certain specific experiences without true alteration of character. It is of important significance, as we shall see, that the dissociated or inhibited [265] systems may include emotions, instincts and innate dispositions.
548Examination of recorded cases shows too that besides mental memories, physiological functions may be involved in the dissociation. ”

“ Any one may readily work out for himself the application of the theory to the explanation of the power of the operator’s suggestions to control movement, to induce anaesthesia, hallucinations and delusions, and to exert on the organic processes an influence greater than can be exerted by mental processes in the normal state of the brain. But the positive evidence of the occurrence of dissociation is a matter of great psychological interest and its nature must be briefly indicated. The phenomena of automatic speech and writing afford the best evidence of cerebral dissociation. ”