Response to The New Yorker

by PEM

#2 Multiple Personality

I want to first give some philosophical analysis of whether multiple personality (now called Dissociative Identity Disorder in the psychological literature) or any disease can be described in terms of some objective reality that we can discover or whether our description of it is always subjective (the approach called “social construction”). Since I believe it is always subjective I believe that the relevant question is not whether multiple personality is objectively real, but whether it is a self-description/diagnosis that leads to healing.

Please be aware that I am writing on two levels here: from the philosophical point of view I am arguing that our description of any disease or disorder is never simply a description of objective reality, but when I write from my own subjective point of view, I do believe that multiple personality is real (what I mean by that would require a separate essay). That is why I choose to use the term multiple personality (as the article does) rather than using the name DID that has replaced it in the psychological literature. Dissociative Identity Disorder implies that the person with that disorder has a distortion of thinking that causes her/him to believe that s/he has multiple identities, but that those multiple identities are not real.

First, the philosophical issue. I do believe that multiple personality is socially constructed--that I experienced myself that way because I lived in a society where that is a fitting metaphor and I was exposed to those ideas. And to some extent because I chose that metaphor, which perhaps goes beyond social construction. However, I don't see that as a problem with the diagnosis--menstrual cramps are socially constructed too and I don't think that consumption as experienced in the 19th century was in any substantive sense the same thing as tuberculosis experienced today. There is some underlying reality, but the metaphors that we put on our illnesses are the larger part of their reality.

This is particularly true for a metaphor like multiple personality, which is a representation of what is going on in my unconscious. The unconscious cannot be fully known; our descriptions of it are always metaphors. What is in my unconscious can never fully be captured by the pattern by which I understand it.

Therefore, the relevant question is not whether multiple personality is real but whether it is a useful metaphor. Like any metaphor, any social construction of illness, any paradigm, it can be constricting. I was amused that the author of the article thought that a case of multiple personality was proved to be fake because the woman couldn't remember the names of her alters and had to carry index cards to remind herself. First, to answer from inside the paradigm, it is hard for many host personalities to believe in the alters and sometimes alters didn't want anyone to know their names. But more broadly, it seems to me an unreasonable constriction of the processes of the unconscious to say that multiple personality can only involve fixed alters with unique names who take turns in complete control of the body. I also had trouble keeping track of the names and characteristics of my alters; I believe that was because what was going on in my unconscious was something more diffuse than the model of fixed alters.

The relevant question, then, is not whether multiple personalities are real, but whether the metaphor of multiple personalities is a good path to healing. I don't think that alternative diagnoses like borderline personality disorder or depression are any realer, any less socially constructed (that is not to deny a biological basis for some mental illness, but to say that we can experience the consequences of that biological basis in very different ways and that is what matters most). In fact, it is quite clear that at least according to some definitions borderline personality and multiple personality are different metaphors that can be applied to the same group of people (see for example: Richard A. Moskovitz, Lost in the Mirror: An Inside Look at Borderline Personality Disorder (Dallas TX: Taylor Publishing Co., 1996.).

Which metaphor gives the best path towards healing? It might even be that for people with more ego strength, multiple personality defines the better path, while for people who lack basic coping skills, a borderline personality diagnosis might be the more productive approach (at least if they can avoid those therapists who believe that borderlines are untreatable or should be treated harshly).

I am convinced that, for me, multiple personality was the best path towards healing. To talk about this let me leave aside social construction and talk about ways of understanding an underlying reality (which is also socially constructed, but I don't experience that). I do believe that in some real sense I had parts of myself who felt like they were not me, and that those parts had existed since childhood.

When I decided I was multiple, I chose to crystallize that pattern in a particular form. I chose to see those cut-off parts of myself as separate people: to listen to them, to try to meet their needs, to encourage them to grow stronger and express themselves in the world, and to learn to love them. This was a wonderful experience.

It was much easier to love a wounded child, who I conceptualized as another person, than it would have been to love myself as a wounded, contaminated child. By conceptualizing the parts of myself as separate people, I was able to learn to listen to them and meet their needs, and I found that the more I did that the less separate they became. I believe that seeing my parts as separate people was the path towards healing and integration, because it would have been much harder to learn to acknowledge and accept them if I had insisted on conceptualizing them as me. And once I acknowledged and accepted them then they were part of me.

In other words, I am acknowledging that my multiple personalities were something I encouraged. (My therapist did not encourage them; he took a neutral yet accepting role.) And I am very glad I did; it has already led me towards more healing than I had ever thought possible. For some reason, the process by which multiples get to know themselves after they accept that they are multiple gets defined as choosing to get sicker. Certainly many people have trouble coping with life as they unpack the old patterns of childhood pain and learn to care for the wounded children inside (though many of them were in clinical depression before they started, so their lives haven't necessarily gotten worse).

It doesn't seem to me that it should be that hard to accept that it is valuable to take apart the old structure and look at the pieces one-by-one in order to rebuild a more stable structure. That requires a lot of therapy, but it has the potential to transform the person, while cognitive and behavioral therapy just papers over the pain inside.

I don't have figures on outcome studies, but the popular books on multiple personality and DID usually state that it has one of the best success rates for treatment of the mental disorders (though they also say that that takes on average 5 years of therapy). That certainly suggests that it is a good path towards healing.

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