Louis Vivé
Multiple Personality Disorder (MPD) or Dissociative Identity Disorder (DID).
Dissociative identity disorder (DID) is a psychiatric diagnosis and describes a condition in which a person displays multiple distinct identities (known as alters or parts), each with its own pattern of perceiving and interacting with the environment.
In the International Statistical Classification of Diseases and Related Health Problems the name for this diagnosis is multiple personality disorder. In both systems of terminology, the diagnosis requires that at least two personalities (one may be the host) routinely take control of the individual's behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be the temporary effects of drug use or a general medical condition. DID is less common than other dissociative disorders, occurring in approximately 1% of dissociative cases, and is often comorbid with other disorders.
The "personalities" in Multiple Personality Disorder are different within the person. Each personality can have separate memories, behaviors, physical attributes, and even a different gender than the patient. For example, when remembering child abuse, a patient may have a personality to just remember those memories of abuse and will act violent or withdrawn even if the patient is someone who it outgoing. The personalities serve different purposes. The self-help personality acts as the self-confidence of the patient and gives the person self-esteem in high stress situations involving confrontation. The persecutory personality acts on the hate within the person with MPD. For example, if someone tends to self-mutilate it is the persecutory personality acting on the person's behalf. The hate within the person can be so great they relieve the stress with the persecutory personality.
Signs and Symptoms.
Individuals diagnosed with DID demonstrate a variety of symptoms with wide fluctuations across time; functioning can vary from severe impairment in daily functioning to normal or high abilities. Symptoms can include:
§ Multiple mannerisms, attitudes and beliefs which are not similar to each other
§ Unexplainable headaches and other body pains
§ Distortion or loss of subjective time ( a long time)
§ Depersonalization
§ Derealization
§ Severe memory loss
§ Depression
§ Flashbacks of abuse/trauma
§ Sudden anger without a justified cause
§ Frequent panic/anxiety attacks
§ Unexplainable phobias
Patients may experience an extremely broad array of other symptoms such as pseudoseizures that may appear to resemble epilepsy, schizophrenia, anxiety disorders, mood disorders, post traumatic stress disorder, personality disorders, and eating disorders.
Physiological findings.
Reviews of the literature have discussed the findings of various psychophysiologic investigations of DID. Many of the investigations include testing and observation in a single person with different alters. Different alter states have shown distinct physiological markersand some EEG studies have shown distinct differences between alters in some subjects, while other subjects' patterns were consistent across alters.
Neuroimaging studies of individuals with dissociative disorders have found higher than normal levels of memory encoding and a smaller than normal parietal lobe.
Another study concluded that the differences involved intensity of concentration, mood changes, degree of muscle tension, and duration of recording, rather than some inherent difference between the brains of people diagnosed with DID. Brain imaging studies have corroborated the transitions of identity in some DID sufferers. A link between epilepsy and DID has been postulated but this is disputed. Some brain imaging studies have shown differing cerebral blood flow with different alters, and distinct differences overall between subjects with DID and a healthy control group.
A different imaging study showed that findings of smaller hippocampal volumes in patients with a history of exposure to traumatic stress and an accompanying stress-related psychiatric disorder were also demonstrated in DID. This study also found smaller amygdala volumes. Studies have demonstrated various changes in visual parameters between alters. One twin study showed heritable factors were present in DID.
Causes.
This disorder is theoretically linked with the interaction of overwhelming stress, traumatic antecedents, insufficient childhood nurturing, and an innate ability to dissociate memories or experiences from consciousness. A high percentage of patients report child abuse. People diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially during early to mid childhood. Several psychiatric rating scales of DID sufferers suggested that DID is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.
Others believe that the symptoms of DID are created iatrogenically by therapists using certain treatment techniques with suggestible patients, but this idea is not universally accepted.
Development theory.
It has been theorized that severe sexual, physical, and/or psychological trauma in childhood by a primary caregiver predisposes an individual to the development of DID. The steps in the development of a dissociative identity disorder are theorized to be as follows:
1. The child is harmed by a trusted caregiver and splits off the awareness and memory of the traumatic event to survive in the relationship.
2. The memories and feelings go into the subconscious and are experienced later in the form of a separate part of the self.
3. The process reoccurs at future traumatic events resulting in more parts of the self to develop, each containing different memories and performing different functions that are meant to keep the child safe and to allow them to form an attachment to the caregiver. Sometimes abusers attempt to do this deliberately, as in the case of the more morbid abusive group practices of various sects, or torture variations.
4. Dissociation becomes a coping mechanism for the individual when faced with further stressful situations.
Diagnosis.
The proposed diagnostic criteria for DID in the DSM-5 is:
1. Disruption of identity characterized by two or more distinct personality states (one can be the host) or an experience of possession, as evidenced by discontinuities in sense of self, cognition, behavior, affect, perceptions, and/or memories. This disruption may be observed by others, or reported by the patient.
2. Inability to recall important personal information, for everyday events or traumatic events, that is inconsistent with ordinary forgetfulness.
3. Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning.
4. The disturbance is not a normal part of a broadly accepted cultural or religious practice and is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). NOTE: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
The "personalities" in Multiple Personality Disorder are different within the person. Each personality can have separate memories, behaviors, physical attributes, and even a different gender than the patient. For example, when remembering child abuse, a patient may have a personality to just remember those memories of abuse and will act violent or withdrawn even if the patient is someone who it outgoing. The personalities serve different purposes. The self-help personality acts as the self-confidence of the patient and gives the person self-esteem in high stress situations involving confrontation. The persecutory personality acts on the hate within the person with MPD. For example, if someone tends to self-mutilate it is the persecutory personality acting on the person's behalf. The hate within the person can be so great they relieve the stress with the persecutory personality.
Personality Types.
Clinicians working with multiples have identified various types of personalities. The categories describe behavioral manifestations and attitudes, which are driven by memory banks of unique personalities. In general, personalities manifest differences is cognitive and executive abilities. Some personalities are strong-willed and in charge of other personalities. Others are submissive and do not challenge the leaders. The leading personalities may often fight between themselves for control over the body. One personality type, known as the host, has been identified by clinicians and recognized for its dominant control over the body most of the time.
By identifying the host personality type, experts have created a false impression in the minds of the public or less knowledgeable doctors. The host personality is no different than other personalities are, and is controlled by the same neural mechanisms as they are. The host is neither the core of the patient nor the true person, who happens to have additional cognitive parts in the form of the other personalities. Every personality is a cognitive system (a person) in its own right. The personalities and their interactions as a group are the individual perceived by an observer.
The significant trait of the host is that it naturally fits the everyday environment best of all personalities, and that is why the host is in charge of the body most often. However, some people can have several major personalities that are active about equal amounts of time. These personalities could be considered co-hosts, but it is best to avoid the label "host," because it only creates confusion. The host is simply the dominant personality. Changes in daily routines (illness, vacation, business trip, seminar, relocation, etc.) may cause that other personalities emerge as dominant and stay in charge for days or weeks. During these times, the host personality controls the subject's behavior only sporadically. When daily life returns to normal, the host personality usually resumes its prominent role. It would require major disruption in lifestyle to dramatically reduce the participation of the host over a long period or permanently. The situation could occur if the need for the function of the host were abolished
Clinicians working with multiples have identified various types of personalities. The categories describe behavioral manifestations and attitudes, which are driven by memory banks of unique personalities. In general, personalities manifest differences is cognitive and executive abilities. Some personalities are strong-willed and in charge of other personalities. Others are submissive and do not challenge the leaders. The leading personalities may often fight between themselves for control over the body. One personality type, known as the host, has been identified by clinicians and recognized for its dominant control over the body most of the time.
By identifying the host personality type, experts have created a false impression in the minds of the public or less knowledgeable doctors. The host personality is no different than other personalities are, and is controlled by the same neural mechanisms as they are. The host is neither the core of the patient nor the true person, who happens to have additional cognitive parts in the form of the other personalities. Every personality is a cognitive system (a person) in its own right. The personalities and their interactions as a group are the individual perceived by an observer.
The significant trait of the host is that it naturally fits the everyday environment best of all personalities, and that is why the host is in charge of the body most often. However, some people can have several major personalities that are active about equal amounts of time. These personalities could be considered co-hosts, but it is best to avoid the label "host," because it only creates confusion. The host is simply the dominant personality. Changes in daily routines (illness, vacation, business trip, seminar, relocation, etc.) may cause that other personalities emerge as dominant and stay in charge for days or weeks. During these times, the host personality controls the subject's behavior only sporadically. When daily life returns to normal, the host personality usually resumes its prominent role. It would require major disruption in lifestyle to dramatically reduce the participation of the host over a long period or permanently. The situation could occur if the need for the function of the host were abolished
typical traits is profound loss of emotional intelligence and with it associated consequences:
- tendency to believe in the supernatural
- inability to recognize the existence of other personalities despite their obvious presence
- strong feeling of responsibility, even for things over which she has no control
- no interest in improving personal well-being despite overwhelming lifestyle
- low interest in personal relationships of all types (mild Asperger's syndrome)
- low factual understanding of jokes, irony, false pretenses, figurative speech, guilt, embarrassment, emotion, or affection
The second most influential personality is usually the worker personality. It is not bothered by strong negative emotions and is mainly joyful, optimistic, and isolated from personal issues. In fact, many worker personalities have no understanding of interpersonal relationships. They may lack all ability to receive, express, or understand affection. The host and the worker are largely asexual, but other personalities may express their sexuality through the host or the worker.
Another influential personality is the representative. She goes to events, meetings, and reunions to represent the multiple outside the family. This personality may go out with her friends and also tends to emerge during interactions with members of the extended family. She tends to be asexual, but may engage in sex if it is perceived as a form of social interaction.
In sexually abused multiples, strong sex drive is usually expressed by a unique personality that may naturally complement the frigidity of the above personalities. This personality, the sexual one, is an adult who engages in sex responsibly and considers it a normal part of life. By contrast, many multiples also have one or more highly sexualized personalities that live for nothing but sexual adventures. These personalities are often accompanied by the seductive one. She is flirting, smiling, pleasing, provoking, and is seemingly asking for sex, but is asexual. Next to these influential personalities, a common multiple has numerous other parts, but their cognitive scope, purpose, and control over the body are very limited.
Another influential personality is the representative. She goes to events, meetings, and reunions to represent the multiple outside the family. This personality may go out with her friends and also tends to emerge during interactions with members of the extended family. She tends to be asexual, but may engage in sex if it is perceived as a form of social interaction.
In sexually abused multiples, strong sex drive is usually expressed by a unique personality that may naturally complement the frigidity of the above personalities. This personality, the sexual one, is an adult who engages in sex responsibly and considers it a normal part of life. By contrast, many multiples also have one or more highly sexualized personalities that live for nothing but sexual adventures. These personalities are often accompanied by the seductive one. She is flirting, smiling, pleasing, provoking, and is seemingly asking for sex, but is asexual. Next to these influential personalities, a common multiple has numerous other parts, but their cognitive scope, purpose, and control over the body are very limited.
Every multiple seems to have child personalities. They may be needy and longing for love and attention. Other child parts are angry troublemakers. Some of them have narrow interests and try to satisfy their desires whenever possible. Child personalities contain most of the traumatic experiences that produced the subject's MPD.
The great paradox of personalities is that the most powerful and most frequently activated personalities usually have no knowledge of traumas that resulted in multiplicity. Such personalities are able to handle everyday tasks, but have no ability to restore the personality system and form a single mind anew. By contrast, less significant personalities possess enormous destructive power and are able to harm or kill the subject. Some of these infrequently activated personalities hold the traumatic memories of the past
experiences of multiples can be easily recognized based on the number of the voices involved and based on their interactions. If two or more voices talk among themselves or include the subject in their conversation, the voices manifest MPD. If an individual voice instructs the subject to do something, and the voice comments about the personal qualities or faults of the subject, and if the voice emerges repetitively and has something new to say every time, this also reflects MPD. Almost universally, the voices of multiples get emotional when their requests, ideas, orders, or suggestions are ignored. In some cases, the voices can be accompanied by visual hallucinations. The other personalities are "seen" (in the mind) as real persons who talk to the subject. If the visualized persons interact among themselves or with the subject, the case typically manifests MPD. Interaction does not mean pursuit of a common goal. Interaction involves exchange of ideas, looks, gestures, feelings, and consideration of the viewpoint of the other personality.
Differential diagnoses
Conditions which may be present with similar symptoms include borderline personality disorder, and the dissociative conditions of dissociative amnesia and dissociative fugue. The clearest distinction is the lack of discrete formed personalities in these conditions. Malingering may also be considered, and schizophrenia, although those with this last condition will have some form of delusions, hallucinations or thought disorder.
Figures from the general population show less diversity:
Dissociative identity disorder is diagnosed in a sizable minority of patients in drug abuse treatment facilities.
Comorbidity
Dissociative identity disorder frequently co-occurs with other psychiatric diagnoses, such as anxiety disorders (especially post-traumatic stress disorder-PTSD), mood disorders, somatoform disorders, eating disorders, as well as sleep problems and sexual dysfunction. Dissociative identity disorder has been found to more commonly occur with particular personality disorders including Avoidant Personality Disorder (76% co-morbidity), Self-defeating Personality Disorder (68% co-morbidity), Borderline Personality Disorder (53% co-morbidity) and Passive-Aggressive Personality Disorder (45% co-morbidity). Schizotypal Personality Disorder also had a 58% crossover with dissociative tendencies.
History
Before the 19th century, people exhibiting symptoms similar to those were believed to be possessed.
An intense interest in spiritualism, parapsychology, and hypnosis continued throughout the 19th and early 20th centuries, running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings. Hypnosis, which was pioneered in the late 18th century by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puységur, challenged Locke's association of ideas. Hypnotists reported what they thought were second personalities emerging during hypnosis and wondered how two minds could coexist.
The 19th century saw a number of reported cases of multiple personalities which Rieber estimated would be close to 100. Epilepsy was seen as a factor in some cases, and discussion of this connection continues into the present era.
By the late 19th century there was a general acceptance that emotionally traumatic experiences could cause long-term disorders which might display a variety of symptoms. These conversion disorders were found to occur in even the most resilient individuals, but with profound effect in someone with emotional instability like Louis Vivé (1863-?) who suffered a traumatic experience as a 13 year-old when he encountered a viper. Vivé was the subject of countless medical papers and became the most studied case of dissociation in the 19th century.
Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation. It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation. One of the first individuals diagnosed with multiple personalities to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp; American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a Personality. Fowler went on to marry one of her analyst's colleagues.
In the early 20th century interest in dissociation and multiple personalities waned for a number of reasons. After Charcot's death in 1893, many of his so-called hysterical patients were exposed as frauds, and Janet's association with Charcot tarnished his theories of dissociation. Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma.
In 1910, Eugen Bleuler introduced the term schizophrenia to replace dementia praecox. A review of the Index medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia became popular, especially in the United States
Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports. Bleuler also included multiple personality in his category of schizophrenia. It was concluded in the 1980s that DID patients are often misdiagnosed as suffering from schizophrenia.
Exorcism
Exorcism (from Late Latin exorcismus, from Greek ἐξορκισμός, exorkismos - binding by oath) is the religious practice of evicting demons or other spiritual entities from a person or place which they are believed to have possessed. Depending on the spiritual beliefs of the exorcist, this may be done by causing the entity to swear an oath, performing an elaborate ritual, or simply by commanding it to depart in the name of a higher power. The practice is ancient and part of the belief system of many cultures and religions.
Requested and performed exorcisms occurred rarely until the 1900’s where the public saw a sharp rise due to the media attention exorcisms were getting. There was “a 750% increase in the number of exorcisms performed between the early 1960s and the mid-1970s”.
Exorcism and Christianity.
In Catholic Christianity, exorcisms are performed in the name of Jesus Christ A distinction is made between a formal exorcism, which can only be conducted by a priest during a Baptism or with the permission of a Bishop, and "prayers of deliverance" which can be said by anyone.
The Catholic rite for a formal exorcism, called a "Major Exorcism", is given in Section 13 of the Rituale Romanum. The Ritual lists guidelines for conducting an exorcism, and for determining when a formal exorcism is required. Priests are instructed to carefully determine that the nature of the affliction is not actually a psychological or medical illness before proceeding.
In Christian practice the person performing the exorcism, known as an exorcist, is often a member of the church, or an individual thought to be graced with special powers or skills. The exorcist may use prayers, and religious material, such as set formulas, gestures, symbols, icons, amulets, etc. The exorcist often invokes God, Jesus, a litany of saints, and/or several different angels and archangels to intervene with the exorcism. It may take several weekly exorcisms over several years to expel a deeply entrenched demon.
In general, possessed persons are not regarded as evil in themselves, nor wholly responsible for their actions. Therefore, practitioners regard exorcism as more of a cure than a punishment. The mainstream rituals usually take this into account, making sure that there is no violence to the possessed, only that they be tied down if deemed necessary for their own protection and that of the practitioner.
Scientific View.
Demonic possession is not a valid psychiatric or medical diagnosis recognized by either the DSM-IV or the ICD-10. Those who profess a belief in demonic possession have sometimes ascribed the symptoms associated with mental illnesses, such as hysteria, mania, psychosis, Tourette's syndrome, epilepsy,schizophrenia or dissociative identity disorder, to possession. In cases of dissociative identity disorder in which the alter personality is questioned as to its identity, 29% are reported to identify themselves as demons. Additionally, there is a form of monomania called demonomania or demonopathy in which the patient believes that he or she is possessed by one or more demons.
DID and Exorcism: can a personality be exorcized?
Personalities are complex neuropsychological entities. Some parts of these entities can be banned from reaching consciousness. The usual way to do this is through hypnosis. The mechanism does not work in a healthy conscious mind. Dissociation of some sort, either temporary (hypnosis) or permanent (MPD), is required to enable the suppression of an inconvenient segment of a personality structure. The approach only works with certain types of personalities, particularly those that are incomplete and fragmented. Suppression of the undesirable personality can be achieved through direct appeal to the personality to stop interacting with the world, with others, or with the mind, and stay forever dormant. This approach works even when the hypnotist makes the request in religious terms. The fragment does not care whether God, Satan, President, or the patient's dog wants him to disappear and never come back. The factual meaning of the request, and not the supernatural overtone, is what suppresses the personality. Similarly, the suppressed personality fragment can be reactivated in the future by an appeal to become active again. But the personality cannot be erased from the records of the memory forever. This would require destruction of the neural substrates that host the personality. The corresponding neuropsychological entity can only be banned from participation in mental processes or it can be combined with other cognitive parts of the brain. DID and Exorcism: can a personality be exorcized?
Some personality fragments are difficult to ban after a simple order or request. In such a case, other parts of the brain can be recruited to block the unwanted personality fragment. The blocking can be done by other personalities or by the Internal Self Helper.
Psychotherapists working with MPD patients routinely meet adult patients who have several adult personalities, child personalities, and some doctors even report personalities of the opposite gender. Exceptionally, the reports about the types of personalities also include animals, God, Satan, stuffed animals, and people thousands of years old or from another dimension.These claims immediately arouse laughter and disbelief in laymen with zero clinical experience in MPD and zero understanding of how the brain works. The laymen do not accept the possibility that the claims might be true and that a personality might sincerely believe to be an animal, alien, 1000-year-old man, God, Satan, or person of the opposite sex. But if such beliefs are genuine — and clinical experience indicates that — then it is important to explain how the entities are generated and what they represent in the neuropsychological sense..
However, it is useful to consider a similarly striking condition of anosognosia. The patients may deny that their left arms belong to them and confabulate some irrational explanation why they have dysfunctional left limbs attached to their bodies.These are also cases of false claims and unbelievable behaviors, but the conditions can be readily tested by seeing the patients' limbs and hearing the irrational confabulated answers. It turns out that both multiple personality and anosognosia share some neural substrates that are responsible for such "internal realities."
