Dissociative Identity Disorder

Shaili Jain's The Unspeakable Mind (2019) is an impressive examination of the stress experienced by a veteran community that too often is handled with a sense of clinical sterility that borders on inhumanity, or a that of pandering condescension. However, what is striking about Jain's text is the lack of analysis of how trauma manifests in what Heidegger would refer to as average everydayness. This, to me, seems like a missed opportunity, especially as it pertains to trauma-based ethics since all (...) too frequently manifestations of trauma do not occur as they are portrayed to in popular culture, but in the day-to-day and moment-to-moment living of those who deal with trauma. In this article I interrogate everyday manifestations and ideal manifestations of trauma using a comparative lens. My hope is that by focusing my analysis on my process of engagement with traumatic experiences I can help develop new discussions about trauma that will both allow for the discovery of new modes of thinking-about trauma as well as illuminate more nuanced methodologies of healing for those effected by post-traumatic stress in future research. (shrink)

The Quest for Physical Theory (QPT) comprises the eight Lowell lectures that Kuhn gave on Tuesdays and Fridays in March 1951 in the Lecture Hall of the Boston Library. He was 28 years old at the time, a member of the Harvard Society of Fellows, a recent Harvard PhD in Physics (1949), and an instructor in the general-education course on science set up by James Conant, Harvard’s President. Kuhn seized the opportunity of the Lowell Lectures to present his new, and (...) ground-breaking at the time, take on science which was shaped by Kuhn’s forays in psychology, philosophy, history, and logic. It is obvious from reading the lectures that Kuhn was very confident of his views and was aiming to jolt the public with his revisionary account. To a complacent audience, accustomed to the standard, textbook picture of science, he hurled the provocative claims that there are no pure facts, that prejudice plays a decisive role in scientific practice, that the then-current history of science fabricated mythologies about past science, that perception is not passive, and that the overthrow of a theory does not add to previous knowledge. All these claims more than foreshadow the basic elements of Kuhn’s model in The Structure of Scientific Revolutions (SSR). It is not just that the lectures speak to the emergence of Kuhn’s ideas that were later refined, as George Reisch, the editor of QPT, says in his introductory essay. The lectures show that Kuhn had conceived his model, almost in its entirety, very early on, which means that the much-debated influence exercised on him by later works, such as Toulmin’s, Hanson’s, or Polanyi’s in the 1950s, was secondary to the exploratory readings of his youth. These later influences must have solidified his early conception. (shrink)

ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ-20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to (...) interpretative phenomenological analysis. Five main themes were identified: endorsement and identification with the diagnosis. The notion of dissociative parts justifies identity confusion and conflicting ego-states. Gaining knowledge about DID affects the clinical presentation. Fragmented personality becomes an important discussion topic with others. Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided. (shrink)

Deutsche Krankheit: eine Diagnosestellung mit Rückblick und Ausblick auf Krankheitsverlauf.

This essay explores the topic of Dissociative Identity Disorder (formerly called “Multiple Personality Disorder”) with special attention to such Quadrophenia masterpieces as “Dr. Jimmy” and “The Real Me.” A number of major philosophical questions arise: Can two or more “persons” really inhabit the same body? How can we hold Dr. Jimmy morally responsible for the reprehensible actions of Mr. Jim? Wouldn’t it be wrong to do so if they are really different people? What is it to be the “same” person (...) over time? Does Dr. Jimmy really have free will? The focus is on the much discussed and important notions of personal identity, free will, and moral responsibility. (shrink)

The Who was one of the most influential of the 1960s British Invasion bands—not just because of their loud and occasionally destructive stage presence—but also because of its smart songs and albums such as “My Generation,” Who’s Next, Tommy, and Quadrophenia, in which they explored themes such as frustration, angst, irony, and a youthful inclination to lash out. This collection explores the remarkable depth and breadth of the Who’s music through a philosophical lens.

While many theorists have argued that dissociative identity disorder is a case of multiple selves or persons in a single body, I maintain that DID instead should be understood as involving a single self who suffers from significant disruptions to self-consciousness. Evidence of overlapping abilities and memories, as well as the very logic of dissociation, supports the claim that DID results from internal conflict endured by a single self. Along these lines, I will maintain that alter-formation should be understood as (...) the result of extreme emotional ambivalence. While it is true that subjects with DID exhibit volitional conflict, as Frankfurt [1988. The Importance of What We Care About. New York: Cambridge University Press; 1999. Necessity, Volition, and Love. New York: Cambridge University Press] maintains, I argue that these incompatible volitions have a deeper source: conflicting desires and affective stances concerning basic emotional needs that are not easily abandoned. A single subject turns to... (shrink)

If someone with dissociative identity disorder commits a wrongful act, is she responsible? If one adopts the Multiple Persons Thesis, it may seem that one alter cannot be responsible for the actions of another alter. Conversely, if one regards the subject as a single person, it may seem that she is responsible for any actions she performs. I will argue that this subject is a single person, but one who suffers from delusions of disownership and therefore does not fulfill ordinary (...) requirements for responsible agency. This is because she suffers from extreme ambivalence: her deep-seated needs and desires conflict, and she forms alter-personalities as a way to cope with inner discord without abandoning any of these contradictory impulses. However, although the ability to exercise autonomous agency is eroded in such cases, the capacity for autonomous agency is preserved. The subject with DID is weakly responsible for her wrongful acts. (shrink)

This groundbreaking volume of original essays presents fresh avenues of inquiry at the intersection of philosophy and psychiatry. Contributors draw from a variety of fields, including evolutionary psychiatry, phenomenology, biopsychosocial models, psychoanalysis, neuroscience, neuroethics, behavioral economics, and virtue theory. Philosophy and Psychiatry’s unique structure consists of two parts: in the first, philosophers write five lead essays with replies from psychiatrists. In the second part, this arrangement is reversed. The result is an interdisciplinary exchange that allows for direct discourse, and a (...) volume at the forefront of defining an emerging discipline. Philosophy and Psychiatry will be of interest to professionals in philosophy and psychiatry, as well as mental health researchers and clinicians. (shrink)

Gloria Ayob Begins her commentary with the main metaphysical and ethical motivations for including the personal perspective in psychopathological assessments. The metaphysical motivation: human actions are performed for a reason. Thus, from the personal perspective, explaining human actions amounts to justifying them by appeal to individual’s reasons. However, does it follow from this peculiarity that “explanations of human behavior that appeal to empirical generalizations and those that consist in justifying an action by appeal to reasons are of entirely different logical (...) orders” (Ayob 2013, 127) as she contends? I do not think so for two main reasons. First, in both cases, genuine explanations involve factual .. (shrink)

Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term “schizophrenia” in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework (...) for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of “split mind” may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration. (shrink)

One of the central problems of personal identity is to determine what we are essentially . In response to this problem, Lynne Rudder Baker espouses a psychological criterion, that is, she claims that persons are essentially psychological. Baker’s theory purports to bypass the problems of other psychological theories such as Dissociative Identity Disorder and the problem of individuating persons synchronically. I argue that the theory’s treatment of Dissociative Identity Disorder leads to untenable results, is invalid, and consequently fails to individuate (...) persons. (shrink)

This is a response to an article published inSociety & Animals in 2008 that argued for the existence of a “species identity disorder” in some furries. Species identity disorder is modeled on gender identity disorder, itself a highly controversial diagnosis that has been criticized for pathologizing homosexuality and transgendered people. This response examines the claims of the article and suggests that the typology it constructs is based on unexamined assumptions about what constitutes “human” identity and regulatory fictions of gender identity.

As witnessed by recent films such as _Fight Club_ and _Identity_, our culture is obsessed with multiple personality—a phenomenon raising intriguing questions about personal identity. This study offers both a full-fledged philosophical theory of personal identity and a systematic account of multiple personality. Gunnarsson combines the methods of analytic philosophy with close hermeneutic and phenomenological readings of cases from different fields, focusing on psychiatric and psychological treatises, self-help books, biographies, and fiction. He develops an original account of personal identity and (...) offers a provocative interpretation of multiple personality: in brief, "multiples" are right about the metaphysics but wrong about the facts. (shrink)

As witnessed by recent films such as _Fight Club_ and _Identity_, our culture is obsessed with multiple personality—a phenomenon raising intriguing questions about personal identity. This study offers both a full-fledged philosophical theory of personal identity and a systematic account of multiple personality. Gunnarsson combines the methods of analytic philosophy with close hermeneutic and phenomenological readings of cases from different fields, focusing on psychiatric and psychological treatises, self-help books, biographies, and fiction. He develops an original account of personal identity and (...) offers a provocative interpretation of multiple personality: in brief, "multiples" are right about the metaphysics but wrong about the facts. (shrink)

Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only after clarification of the diagnosis and consideration of (...) other treatment options. (shrink)

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The (...) second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)

Thomas Kuhn's celebrated work, The Structure of Scientific Revolutions revolutionized thinking in the philosophy of science. This book goes beyond Kuhn by explicating the non-deductive notion of paradigm shift in terms of the new concept of representati.

In the second edition of the Essay Concerning Human Understanding, John Locke argues that personal identity over time consists in sameness of consciousness rather than the persistence of any substance, material or immaterial. Something about this view is very compelling, but as it stands it is too vague and problematic to provide a viable account of personal identity. Contemporary "psychological continuity theorists" have tried to amend Locke's view to capture his insights and avoid his difficulties. This paper argues that the (...) standard approach fails because it takes Locke to be a memory theorist, and does not focus enough on his claim that we need continuity of consciousness for personal persistence. An alternative reading of Locke is offered, emphasizing the role of self-understanding in producing continuity of consciousness. This alternative overcomes the difficulties with the standard approach, and shows how it is possible to attribute unconscious psychological elements to a person, even when personal persistence is defined in terms of consciousness. (shrink)

In this paper we argue that dissociative identity disorder (DID) is best interpreted as a causal model of a (possible) post-traumatic psychological process, as a mechanical model of an abnormal psychological condition. From this perspective we examine and criticize the evidential status of DID, and we demonstrate that there is really no good reason to believe that anyone has ever suffered from DID so understood. This is so because the proponents of DID violate basic methodological principles of good causal modeling. (...) When every ounce of your concentration is fixed upon blasting a winged pig out of the sky, you do not question its species' ontological status. James Morrow, City of Truth (1990). (shrink)

Now that consciousness is thoroughly out of the way, we can focus more precisely on the kinds of things that can happen underneath. A contrast can be made between dissociation and repression. Dissociation is where a memory record or set of autobiographical memory records cannot be retrieved; repression is where there is retrieval of a record but, because of the current task specification, the contents of the record, though entering into current processing, are not allowed into consciousness. I look at (...) hypnotic amnesia and dissociative identity disorder in relation to this contrast. (shrink)

The article questions the assumption that conjoined twins are necessarily two people or persons by employing arguments based on different points of view: non-personal vitalism, the person as a sentient being, the person as an agent, the person as a locus of narrative and valuation, and the person as an embodied mind. Analogies employed from the cases of amputation, multiple personality disorder, abortion, split-brain patients and cloning. The article further questions the assumption that a conjoined twin's natural interest and wish (...) is separation. I first contend that separation is such a radical procedure as to render the post-separation person different from the pre-separation one. Therefore, it is not possible to benefit the pre-separation twin by the act of separation. The article concludes with a critical evaluation of the tendency in bioethics to regard ethical challenges as rivalry between individuals competing for scarce resources. (shrink)

KEYWORDS: dissociation; multiple personality, person, responsibility.

The condition known as Multiple Personality Disorder (MPD) or Dissociative Identity Disorder (DID) is metaphysically strange. Can there really be several distinct persons operating in a single body? Our view is that DID sufferers are single persons with a severe mental disorder. In this paper we compare the phenomenology of dissociation between personality states in DID with certain delusional disorders. We argue both that the burden of proof must lie with those who defend the metaphysically extravagant Multiple Persons view and (...) that there is little theoretical motivation to yield to that view in light of the fact that the core symptoms of DID bear remarkable similarity to the symptoms of these other disorders where no such extravagance is ever seriously entertained. (shrink)

Many philosophers say that two or more people or thinking beings could share a single human being in a split-personality case, if only the personalities were sufficiently independent and individually well integrated. I argue that this view is incompatible with our being material things, and conclude that there could never be two or more people in a split-personality case. This refutes the view, almost universally held, that facts about mental unity and disunity determine how many people there are. I suggest (...) that the number of human people is simply the number of appropriately endowed human animals. (shrink)

Many contemporary bioethicists claim that the possession of certain psychological properties is sufficient for having full moral status. I will call this thepsychological approach to full moral status. In this paper, I argue that there is a significant tension between the psychological approach and a widely held model of Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder). According to this model, the individual personalities or alters that belong to someone with DID possess those properties that proponents of the psychological approach (...) claim suffice for full moral status. If this account of DID is true, then the psychological approach to full moral status seems to entail that the two standard therapies for treating DID might, on occasion, be seriously immoral, for they may well involve the (involuntary) elimination of an entity with full moral status. This result should give proponents of the psychological approach pause, for most people find the claim that current treatments of DID are ethically suspect highly counter-intuitive. (shrink)

Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder) is a condition in which a person appears to possess more than one personality, and sometimes very many. Some recent criminal cases involving defendants with DID have resulted in "not guilty" verdicts, though the defense is not always successful in this regard. Walter Sinnott-Armstrong and Stephen Behnke have argued that we should excuse DID sufferers from responsibility, only if at the time of the act the person was insane (typically delusional); (...) otherwise the presumption should be that persons with DID are indeed responsible for their actions. We find their interpretation of DID and of the way in which the requirements for criminal insanity relate to this condition worrying and likely to result in injustice to DID sufferers. Our thesis is that persons with DID cannot be responsible for their actions if the usual features of the condition are present. A person with DID is a single person in the grip of a very serious mental disorder. By focusing on the features of DID which have, as we argue, the effect of deluding the patient, we try to show that such a person is unable to fulfill the ordinary conditions of responsible agency (namely, autonomy and self-control). (shrink)

The paper offers a conceptual and phenomenological analysis of the language of depersonalization. The depersonalization syndrome or disorder has no known common pathogenesis and shows no characteristic behavioral manifestations. A conceptual analysis of the key terms in the subjective complaints would therefore have consequences for clinical research into the phenomenon of depersonalization.

If personal identity consists in non-branching psychological continuity, then the sharp breaks in psychological connectedness characteristic of Multiple Personality Disorder implicitly commit psychological continuity theories to a metaphysically extravagant reification of alters. Animalist theories of personal identity avoid the reification of alternate personalities by interpreting multiple personality as a failure to integrate alternative autobiographical memory schemata. In the normal case, autobiographical memory cross-classifies a human life, and in so doing provides access to a variety of interpretative frameworks with their associated (...) clusters of general event memory and episodic memory. Multiples exhibit erratic behavior because they cannot access reliably the intersecting autobiographical memory schemata that permit graceful transitions between social roles, behavioral repertoire and emotional dispositions. Selves, in both normal and certain pathological cases, are best understood as semi-fictional narratives created by human animals to serve their social, emotional and physical needs. (shrink)

Beginning with classic Hollywood melodramas of the 1940s, cinema has maintained a prolific output of films with their own take on mental illnesses–none more so than the rare syndrome of dissociative identity disorder (DID). DID films are a popular and enduring genre, whose influence can be seen throughout mainstream cinema. Exploration of DID in cinema is a useful exercise in that it touches on issues in film studies, psychiatry and the mythology around mental illness. Despite “detective story” narratives and conformity (...) to the codes of the psychological thriller, DID representations correspond closely to contemporary thinking about its phenomenology and aetiology. That said, some films confuse DID with schizophrenia, and many reinforce two other misconceptions within film psychiatry: mental illness as violence and the belief that every mentally ill person harbours one “great dark secret”. Those sceptical about DID have suggested that popular written accounts increase its profile: so too, powerful cinematic images may suggest the possibility of DID to susceptible people, including clinicians. Recent DID films reflect the real debate within psychiatry about the diagnostic validity and scientific basis of DID. (shrink)

This article elaborates on Putnam's ''discrete behavioral states'' model of dissociative identity disorder (Putnam, 1997) by proposing the involvement of the orbitalfrontal cortex in the development of DID and suggesting a potential neurodevelopmental mechanism responsible for the development of multiple representations of self. The proposed ''orbitalfrontal'' model integrates and elaborates on theory and research from four domains: the neurobiology of the orbitalfrontal cortex and its protective inhibitory role in the temporal organization of behavior, the development of emotion regulation, the development (...) of the self, and experience-dependent reorganizing neocortical processes. The hypothesis being proposed is that the experience-dependent maturation of the orbitalfrontal cortex in early abusive environments, characterized by discontinuity in dyadic socioaffective interactions between the infant and the caregiver, may be responsible for a pattern of lateral inhibition between conflicting subsets of self-representations which are normally integrated into a unified self. The basic idea is that the discontinuity in the early caretaking environment is manifested in the discontinuity in the organization of the developing child's self. (shrink)