“The more we tolerate the idiosyncrasy in our fellow man, the less we mistake it as mental illness – and the less mental illness there will be. Look for the sanity of the people in your life, and you will find it” (The Wandering Mind: Understanding Dissociation from Daydreams to Disorders by John A. Biever, Maryann Karinch )
The movie depiction “Split” was presented 2 cases of complexly traumatized persons with severe dissociation (dissociative presentation) (trauma-related altered state of consciousness) and nondissociative distress (normal waking consciousness).
Kevin, a victim of childhood abuse, diagnosed with dissociative identity disorder with 24 personalities in the body. When Kevin was a toddlers (3 years old), he was abandoned his father and have physically and emotionally abused and punished (e.g. for being untidy) by his mother, who probably suffered from OCD and other mental disorder. However, it wasn’t presented clearly has whether abuse started since infant years or later, did it include torture (presumably, caregiver have used a metal hook to punish naughty child) and did it have persistent character. In general, the more severe the precipitating trauma, the more alters will be created. Most of the personalities function like a remedy against the pain of physical abuse. All Kevin’s memories about childhood was presented as short recollection which appeared at the stressful moment. So, even childhood wasn’t shown in detail, but based on numbers of alters his mind had created we probably can assume he had experienced ongoing extreme abuse. Capacity to dissociate allow him to survive all horrors of his childhood.
Kevin met all four criteria for dissociative identity disorder, i.e. :
– The presence of 24 distinct identities, where each with its own pattern of perceiving the environment and self. Attitudes, outlooks as well as personal preferences about dress and activities have suddenly shifted from one alter to another and then shift back. Their bodies also have feel different, i.e. like a child Hedwig, the woman Patricia, or the huge and muscular “beast.” Kevin as truly himself is a pretty quiet, timid, unassertive and, as other alters have described, weak and miserable. Barry as previous overseer of the alter’s system, extraversion leader and cloth designer with positive attitude towards the world, exhibit assertive and gracious side of the Kevin’s consciousness. Whiles his anxiety and depression was getting worse, another alters, Dennis, Patricia and Hedwig, who probably contain most memories of abusive experience and childhood in generally, become the hosts most of the time when it came to dealing with the outside world. Hedwig, a 9 year old child, alter with memories about overwhelming painful mistreatment, was terrified be hurt or abused again as well as be bullying by peers due to his socialization problems. Patricia represents feminine, confident and smart personality, that can be created to play a role ‘real’ mother, a provider of love and care, that needs not only childs, but every adults as well. And Dennis – strong, disciplined, and precise, who has obsession to keep everything perfect (a symptom of OCD) as adapted pattern of perverted mother’s behavior. The Beast – exaggerated personalities, manifesting superhuman strength, speed and emphasized overwhelming aggression and anger. Despite the fact that the beast is a fiction toward the real world, the personality still make sense relatively issue of whether exposure to any form of violence can later lead to murder or abuse. Various studies have shown children, exposed to continued abuse and ongoing violent acts, can then copy the behavior and characteristics of abusers. However, it must be pointed out that it’s just a possibility, not a rule and not all children turn out to be abusers in adulthood. Infancy and early childhood define the most important period in child’s developing of nervous system. Whilst these times are developing, exposure to abusive environment and circumstances can lead the child to believe that what their sibling or parent is enacting is absolutely normal and afterwards alter the way in which the child brain will functions in life. Another hypothesis includes an assumption the consciousness of traumatized children that have known both love and abuse, splits on one personality that experiences the good part and another that embodies the bad like a parent will be very loving and supportive one moment, then suddenly switch in a monster.
– Kevin didn’t lost memory of his personal life events at the stressful period of childhood and adolescence, but while some of personality states have recurrently taken control of the Kevin’s behavior, he wasn’t able to recall any life events since September 18, 2014. According DSM-5 amnesia in individuals with dissociative identity disorder is not limited to stressful or traumatic events; these individuals often cannot recall everyday events as well.
– All exhibited symptoms caused significant impairment in social and other areas of life. Kevin lives in the basement of the zoo, present explicit social isolation with comorbid depression, anxiety, feeling of deep loneliness and needless to the world.
– The symptoms are not attributable to the physiological effects of a substance or another medical condition.
Casey, 13 years teenager-outsider, was exposed such traumatized event as sexual abuse by her uncle for 10 years, who adopted her after father’s death (another stressful event). Her mother was also absent for an unknown reason, but whatever reason is, it’s impair the clinical picture even more.
Exposure to parent’s death and sexual violence caused persistent negative emotional state, markedly diminished interest or participation in significant activities and negative alterations in cognitions and mood such as chronic emotionless, inability to experience positive emotions, (e.g., happiness, satisfaction or loving feelings). Recurrent, involuntary, and intrusive distressing memories dreams of the traumatic event, dissociative reaction like a flashback weren’t clearly presented, thought abduction worked like a trigger and caused some distressing memories of the traumatic events. On the Casey’s body we could see many scars. The infliction of physical pain commonly help to relieve negative experience and reduce emotional pain so we can assume that it could be a self-injury (cutting and scratching). This clinical presentation match criteria for PTSD with anhedonic or dysphoric mood states and negative cognitions as most distressing.
While other kidneped girls, Claire and Marcia, have tried to find any possible way to get out, Casey reaction on abduction was passive and obedient which can indicates a sign of internalizing posttraumatic psychopathology and interpersonal maladjustment.
She was sexually abused by her uncle since 3 years, did she try to resist to violence? If yes, what ways of resisting or fighting back she has used? This information can be crucial on the way of developing individual program and psychotherapy to overcome the negative consequences of the disorder. Another childhood events, that must be taken into account in the work with this case is Casey’s experience of hunting on deer in the very early years. Can we consider it as exposing children to some type of violence? And what is the consequences of this exposure?
Thus, depiction exhibit common case with a childhood physical abuse in men and childhood sexual abuse in women, where psychopathological dissociation, according the studies, has emerged more often among men.
Obviously Kevin has both posttraumatic stress disorder (PTSD) and dissociative identity disorder, while Casey hasn’t presented explicit dissociation. DID will probably always coexist with PTSD, whereas even PTSD can contain dissociative symptoms, such as amnesia, flashbacks or depersonalization/derealization, but will not match criteria for DID.
Dissociative identity disorder is a dramatic phenomenon that has fascinated psychologists, scientists and all society as well. The statement that dissociation is due to childhood trauma is still doubtful. Many people who were abused as children never develop such symptoms. There is no direct relationship between abuse in childhood and dissociation. Plenty psychiatrist have never made diagnoses of DID and even have never seen any case. It is an argument why existence of DID is still questioned and some of researchers consider as mythical. While dissociation is a frequent symptom in many other mental disorder, the main element of a DID is that it’s not an episodic symptom, but a chronic dysfunction that begins early in life and it become very difficult to change and treat.
Unfortunately, the depiction exposures audience to stereotyping, stigmatization and prejudice toward DID that leads to negative actions and discrimination toward people with dissociation and any mental illnesses in general. DID is one of the most misunderstood mental disorders, and that makes individual’s life even more difficult than it is already for them.
The movie “Split”, created to entertain public and motivated by billions of dollars from the film screening around the world and high rating, enhances misunderstanding, controversy and the wrong stereotypical conception surrounding the relationship between individuals with DID and their highly dangerousness to society. However, it’s concerns not only entertainment media, but psychiatrists as well who continue diagnose based on observation, personal intuition and guided by DSM-5 which is actually just a simulacrum of scientific document, the result of consensus of psychiatrist’s organization and researchers, whereas the consensus is the start of most medical errors (if we can consider a mental disorder as a medical diagnoses at all).
DID is much more complicated and there are no black and white, no generalizations and rules. It’s very specific disorder which, at the same time, exist in various of ways and it’s extremely important for accurate diagnosing process to continue gathering reliable information and epidemiological data of it.
“Split” is not just false picture of disorder, which lead to misunderstanding , it cause significant impairment in personal life of people, who have suffered in the childhood and continue struggling with dissociative self in adulthood, individuals with a crippled past, broken heart and dismembered consciousness. When it comes to trauma in your personal life, it hard talk about no matter what type of personality you have (e.g., introvert, extrovert) or kind of mental illness. One of the first steps is to notice weirdness in your consciousness, gaps in your memories, then start to seek help without shame and fear, establish stable open relationship with a psychotherapist, to share your painful experience. Next step is be diagnosed with DID. Unfortunately, one of the main ways in which DID works, is that it’s created to be hidden even from yourself. This allows you live your life for long time without any clue of existence the different part of your consciousness until you receive the diagnosis. However, the hardest one and crucial on the life way is an acceptance and reconciliation with yourself. Building relationships with alters is hard work, it’s takes time and patience, ability to accept each alter’s specific needs and develop co-consciousness between them. Formatting a cohesive team with dissociative self, your numerous altars, can help better manage them, live a normal life, have a job, friends, family and moving through the word with peace, happiness and satisfaction.
To talk about DID openly and honestly is a vital part of therapy. A better understanding of DID will help patient better understand yourself, deal effectively and easier with diagnosis. Acceptance of general public will change perception of mental illnesses and DID in particularly and allows victims of extreme violence, that comes from the side where the birth and live start, overcome their own fear, shame and denial, talking honestly with psychotherapist, sharing their experience and receive a healing treatment that they deserve.