The Problem of “otherness” in dissociative
disorder
The unity of the primary personality remains unchanged; nothing breaks away, nothing is split off. Instead, dissociated experiences (…) were always, from the instant of their occurrence, assigned to, and associated with the second system within. （Pierre Janet, 1889)
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The appearance of a
second personality is often presented in the most deceptive manner.
(Sigmund Freud (Breuer & Freud, 1985,
p287)
Where does “The Problem of otherness” stand?
Although our understanding of dissociative phenomenon and its
pathological manifestations have made a significant progress for the past
couple of decades, there are many crucial problems to be further explored and
understood. One of them that I discuss in this article is what I would call “the
problem of otherness” in
dissociative disorder, particularly among parts of personality in dissociative
identity disorder (DID). How much do we recognize them as individual
personalities which are distinct from each other, with their high enough level
of “emancipation” (Janet, 1907) and autonomy as well as independence? Do we
grant a status of an independent and distinct personality to each of them, or
regard them as different “parts” of a whole personality?
Although there might
not be a definitive answer to this question, I consider that our general trend
in these days seems to be to choose the latter more than the former. We no
longer use the term “alter” (which is Latin for other), at least not as often as before, to describe different
parts of personality in DID. We abandoned the traditional term “multiple
personality disorder” in order to avoid an implication that there are different
and independent personalities in an individual’s mind (as exemplified by
DSM-IV, DSM-5 and ICD-11). It appears that the “problem of otherness” in
dissociative disorder is at least temporarily settled among experts in the
direction of not fully granting it. But how much does this trend reflect the
clinical reality including patient’s subjective experiences?
A patient of mine,
Ms. A, one day talks about her recent experience.
“The other day I was
driving a car and waiting at a traffic light. When it turned green, a car ahead
of me didn’t start for a moment and I heard a voice on the back of my head
yelling ‘Gee, weren’t you goofing off ? Get started, silly!’ I said to myself
‘My goodness, can’t he be more patient?’ Of course I was driving by myself and
it was B, one of my alters, who yelled”.
In this example, it
seems obvious that Ms. A has a very different perception and emotional reaction
compared to “B”. For her perspective, B is someone else, another subject, if
not altogether another person. The question is whether or not we recognize B’s “otherness”
from Ms.A, in such a way that Ms.A feels understood by us her subjective
experiences.
If we are not sure
about how we can answer this question, just think about another example in a following
thought experiment.
Ms.C is at a traffic light, in a
same way that Ms.A was. When the light turned green and a car ahead of her was
inattentive in a same situation, she heard a voice from her back. “Gee, aren’t you goofing off ….” Ms.C said
to herself, “Gee, can’t he be more patient??” But in this case, it was her
husband in the back seat who yelled.
How many of us are
sure that we acknowledge Ms.A’s perception of B’s otherness on a comparable
level as Mr.C’s of her husband, another real person? Perhaps not many of us
are. I believe that it is partly due to the fact that we tend to consider
multiple existences of subjects in Ms. A as sort of a fantasy, or something
pathological and temporary that needs to be fixed with some kind of therapeutic
effort. This belief is eloquently expressed in the description of DID by a
reliable diagnostic system.
“Dissociative
Identity Disorder reflects a failure to integrate various aspects of identity,
memory, and consciousness.” (DSM-5, American Psychiatric Association, 2013).
As I suggested, current
literature appears to be on the side of not granting a full “otherness” to the part
of personality of an individual with DID. However, quite often each of them
should be regarded as having their own personality, or at least be treated as
so, despite the fact that their level of elaboration and emancipations differ greatly.
The purpose of this
article is to propose that individuals with DID’s perception of their parts of
personality as “others” is not altogether pathological but rather a reflection
of the healthy aspect of their cognitive function, from theoretical as well as
neurocognitive viewpoints. When a PP subjectively experiences “otherness” in another PP, they are
structurally separated in a bio-psychological sense. The degree of that
structural separateness corresponds the strength of the sense of “otherness.”
In this article
hereafter, I will use the abbreviation “PP(s)” (parts of personality, van der
Hart, et al, 2006) in order to connote what has been referred to as “alter”,
“other personality”, etc. in individuals with DID, partly for the sake of
simplicity and in order to temporarily bypass the issue of how appropriately we
can call them, which is actually the very point that this study is addressing
to.
