Multiple Personality Disorder, Demons, and Me

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I once met a man who believed he had another person, a soul, living inside of him. It brought him comfort—a psychological construct. I didn’t take it literally, but I took it seriously. I once attended a charismatic church, for a class that I was taking, where I watched the preacher “casting out demons.” Again, I didn’t take it literally. Yet it was transformative for those in attendance. We live in our stories. We live in our constructions of the world. We see the world we expect to see—not the literal world.

I’ve watched people marry, believing in the union where two become one, and that is a powerful process. Yes, I watched the recent Royal Wedding. It was beautiful for many reasons—racially and culturally. In life, people need meaning. As a physician, I have stood with family members as their loved ones die. Facing death is powerful. Examining our own mortality is meaningful. I do it daily.

So, when it comes to the idea of Multiple Personality Disorder (Dissociative Identity Disorder). I take it quite seriously, but not literally, for I believe that self is an illusion—a necessary illusion, but not a true and independent thing that is static and unchanging. Nothing about us is static. That is precisely why therapy can and does work; because we can change.

Recently, a colleague of mine, a psychiatrist, said to me that he believes that people can have multiple personalities (dissociative identity disorder). He takes a literal approach to this idea of self—as if we are just plopped down into our heads, navigating an avatar of a body where apparently, like a professional tag-team wrestling match, someone else can be tagged in to finish the event. I’m familiar with this research, but I listened as he explained with excitement how there are studies demonstrating that as these individuals switch between personalities they may exhibit EEG changes (measures of coherence) and psychophysiological changes—biological correlates that suggest that we have measurable differences between alters. These differences have been demonstrated, in some studies, between DID patients as they switch alter but they were not seen in matched cohorts—actors pretending to switch between different personalities. Yes, on the surface, very compelling data!

However, the immediate criticism that people typically levy against did is that there is strong evidence that the rise and fall in the prevalence of this disorder, like many of our disorders, strongly mirrors the psychological trends of the day. It’s simply not as popular these days, like it was in the '70s and '80s, but Hollywood, and some TV doctors, will still present this disorder as a viable form of entertainment for us—a psychological roadside accident where we slow down to gawk and thereby drive up their ratings.

The crux of the opposing argument is that this disorder is the creation of well-intentioned therapists. In medicine, we use the term iatrogenic to explain conditions or disease states caused by medical providers. Many people consider did to be iatrogenic.

Allen Frances, in 2014, expressed this position by writing, “I was convinced that it was an iatrogenically inspired diagnosis inappropriately inflicted on vulnerable patients by the poorly trained therapists who came away from their silly weekend workshops armed with an MPD hammer that seemed to fit every patient nail. My own inclination was to wise up dumb therapists and protect vulnerable patients by simply omitting MPD from the DSM.” Ouch, that’s pretty harsh, but a fairly popular opinion by many psychiatrists. I have heard this position often.

So, what do I believe? I think both positions are right and wrong, but there are much nicer ways of framing things. Stay with me. I believe that the brain is a dynamic interconnected network, capable of plasticity and adaptation, designed to meet the changing needs of our lives. I also know that self is not a real thing, it is a persistent illusion—yet a necessary illusion for our survival. If self is an illusion so isn’t the idea of multiple selves or shared selves or oneself. Dementia patients will eventually lose orientation to this thing that we call "self." I have watched this thing called "self" arise in children and disappear in the elderly.

This sense of self is created by our biological potentials, traits, and shaped by parents, culture, and experiences. But there is no you sitting in your brain. It feels real, but I know that if I were to remove certain brain structures like portions of your frontal lobe, you would be drastically changed. Self is a dynamic process. It is not an unchanging thing.

Nevertheless, people can experience constructions of self that are interconnected with life, self and others—healthy, adaptive, and securely attached—oriented toward love, compassion, and gratitude. People can also have constructions of self that they experience as fragmented—divided--and under attack. One is more adaptive and one is filled with great suffering. Some see themselves as victims; some see themselves as heroes. But hero and victim only live within the constructions of a network—in the roles that we are playing—manifested in the narratives of our lives. I'm not saying bad things won't happen to you, but to carry it with you for the rest of your life is a choice.

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The next question is why do we see changes in things like EEG coherence in patients with did when compared to actors. It’s simple. Self is a non-conscious process. Most of what we do is non-conscious. Trained meditators will show clear physiological, and EEG changes, when shifting into a meditative state. Belief changes biology. If I gave you a pill and said it would make you healthy or sick, you’d switch into a state of panic or relief, and show immediate physiological changes. People with this DID, for the most part, are not acting. It’s a believed state of being. It’s a construction. Shifting states of being happens to all of us, all the time. While driving on the highway, we often dissociate and miss our exits. We are not static beings. We are dynamic and changing in a moment. That is to keep us safe.

Now, taking on the idea of it being iatrogenic, caused by therapists, is also easy to explain. Self is constructed through the rituals of our culture and families. We have explicit rituals like Bar Mitzvah. The military creates the ritualized process of building soldiers, special forces. They will be forever a soldier until they die. Medical school makes doctors. Gangs have rituals. Religious communities, being “Born Again,” a baptismal process, is a ritualized transformation of a sense of self for many people. They will talk about being filled with the "spirit of God.” Ask them if they are changed and they will tell you that they have been created anew. This is not a critique of religion or if there is a God. I'm simply stating that the belief in anything lives in the brain. Apples may live in the real world, but your knowledge about apples lives in your brain. Categorizing them as red, sweet, and fruit is the work of the brain.

The psychology of transformation is guided through our practices. Psychotherapy is a ritualized process where multiple personalities can be born and also more integrated personalities can be forged. It goes both ways. It depends on the therapist. Her orientation. And his skill set. A therapist, unwittingly, might ask a client questions that are leading and suggestive like: "When you were angry yesterday, did you feel like you were someone else? Has your partner ever said to you that sometimes you seem like a totally different person?" Eventually, you might even hear, "Maybe that other person has a name." Yes, people are vulnerable and highly suggestible. In fact, false memories can be created in all of us. It happens all the time. These false memories can be filled with details and be just as emotionally laden as actual memories. People have confessed to crimes they never did; but nothing about self is static--not even our memories. The '80s were overflowing with stories of therapists filling clients with false memories of things like satanic ritual abuse. Daytime talk shows had hours of riveting programming at the expense of hurting individuals.

In sum, people with incomplete or poorly formed attachments during their first couple of years of life and who have had early developmental traumas are very vulnerable. They carry trauma in their minds and bodies. They are at risk for a whole host of sicknesses including Complex PTSD. They are impressionable and waiting to be rescued. Their sense of self is tenuous and it doesn't take too much to influence them. False selves can be created. False memories can be created. And they continue to suffer.

Therefore, both perspectives are right and wrong. We have constructions of self that can be varied and broken or integrated. There is even a case report of monozygotic (identical) twins with a shared sense of self. There is no true self. There is no ideal self. There is not a self-waiting to be born. There is no child within. You can hug your so-called child within by wrapping your arms around yourself. You can talk to it. Eat a popsicle. Do play therapy. But it's not real. It's just the power of imagination—the activity of the brain. I'm not saying that it's not therapeutic. If your construction of self is still young, seen as vulnerable, and you nurture this construction into a more adult-like way of being—then great. Many adults haven't learned to sit with their feelings and they often regress in the setting of stressors. But self is still an illusion—built upon a highly adaptive neural network. It's also a necessary illusion that we must take seriously.

And the best self is born out of a family that fosters a secure and healthy attachment to a primary caregiver. This self has the potential to become adaptive, interdependent, and connected to life, self, and others. That's the goal of therapy. Ideally, self is constructed through a process of allowing an individual to face age-appropriate challenges of living as they become more competent in this world--where they learn to survive in the absence of their parents. This self has what we call an internal locus of control—which means that they believe they have the capacity to shape and influence the circumstances of their life. They are psychologically flexible. Resilient. And they suffer less in this world; because they hold a belief that life has meaning.

In the end, my assertion is that there can be no multiple selves, because there is no such thing as “self.” Nevertheless, the people that experience this disorder are suffering greatly. They have not acquired the tools to navigate this world as a healthy adult. They often have unresolved trauma. These symptoms are real for them, as real as a person experiencing a religious conversion, as real as a solider graduating from boot camp. Hypochondriacs have symptoms that are real and they suffer every day from a variety of aches and pains—it’s not organic, but it still hurts.

As a child, you had little say in your construction of self. Your culture, your beliefs, religion, and stories were given to you. Some serve. Some limit. Today, with this awareness, and with a willingness to face your fears, you can change your construction of self. You're not stuck. You're not static. It's all an illusion. You're actually a dynamic process. Build the you that you want to be.