There are many mental health conditions that have captured the public's imagination, but few rival the pop culture phenomenon that is Multiple Personality Disorder — or Dissociative Identity Disorder, to use its current correct term. And it's easy to see why, as the idea that one person could secretly contain many different personalities is a fascinating one.
Although this phenomenon was only designated as a mental health condition in the mid 1800s, the notion of many personalities living in one body has been around for centuries in different cultures, giving rise to legends of demonic possession, speaking in tongues, and other mysterious unexplained behaviors.
As occurs whenever a new movie is made about it, Dissociative Identity Disorder has come to the forefront of the public's mind again thanks to M. Night Shyamalan's controversial movie #Split, which seems to stigmatize DID (and demonize those who struggle with mental health conditions) as its main antagonist juggles multiple personalities. But how much of Dissociative Identity Disorder is fact, and how much is fiction?
Society's Fascination With Split Personalities
To say that DID is a controversial condition really is an understatement. Ever since the first reported cases, doubting psychiatrists have published papers and conducted studies to debunk the diagnosis. Multiple scams and reports of iatrogenic (therapist-induced) cases have only clouded the issue further. Despite the fact that many people have been diagnosed with DID in varying intensities, there is still a lot of debate about the disorder, what it entails, and whether distinct personalities can really exist.
It doesn't help that the case which helped define the disorder — that of the infamous "Sybil" — is shrouded in suspicion thanks to the doctor's administration of Sodium Pentathol (a drug which induces the patient to talk without thinking, and with a great degree of confusion)... not to mention the fact that the doctor, the patient, and their associates all made a lot of money from the bestselling non-fiction book based on the case.
Despite the controversy — or maybe because of it — the Sybil book and live action adaptations gave rise to a huge resurgence in Multiple Personality Disorder cases in the late 20th Century. MPD, as it was called then, is usually caused by extreme childhood trauma, causing the subconscious mind to split the personality into several different "alters." Different experiences can trigger the appearance of these "alters" in a dissociative episode, in which the person cannot remember what they have said or done during this time.
Such is the classic diagnosis of MPD, but more recent studies have refined the condition — just as others have sought to disprove it. The influence of pop culture has invited a lot of doubt as to whether the condition actually exists, because every time a new movie or book comes out about the disorder, psychiatrists are inundated with new cases. Of course, this could have a lot to do with the impact of representation — it's no myth that seeing someone like you in a story helps you understand yourself.
But the exaggerated portrayals of MPD / DID in fiction might be exactly why there is such controversy, mystery, and misunderstanding surrounding the disorder.
Myth vs Reality: The Influence Of Pop Culture
Many movies bring the idea of multiple personalities to life, and almost all of them lean heavily on dramatic license rather than psycho-scientific accuracy. In Fight Club, the narrator doesn't just have an alternate personality, he also interacts with the persona of Tyler Durden. Alfred Hitchcock's Psycho features a similar version of the condition, while Split showcases its antagonist's 23 personalities in all their deliberately distinct glory.
It would be easy to label the fictional portrayals of DID as just that — fiction — while reality stands apart. But many psychiatrists have pointed out the relationship between the representation of multiple personalities in popular fiction and the manifestation of the condition in real life people. In fact, even the first psychiatric cases of "multiplex personality" in the late 1800s came to light after the publication of Robert Lewis Stevenson's Dr. Jekyll & Mr Hyde.
The relationship between apparent psychiatric fact and popular fiction caused a lot of contention in the 1990s, when Multiple Personality Disorder reached its height. While some psychiatrists specialized in the condition, treating patients by holding sessions with each of their "alters" and seeking to unify the personality again, others descried MPD as a myth created by therapists and patients who were either confused or deliberately manipulating one another. Needless to say, the debate was fraught, and it fractured the psycho-scientific community.
The diagnosis was later altered and refined — going from Multiple Personality Disorder to Dissociative Identity Disorder. This new definition neatly avoided the argument about whether alternate personas could be proved, and focused on dissociation as the root issue of the condition.
Refining The DID Diagnosis
Dissociation is quite easy to understand. Ever get in a car and then find yourself at your destination, unable to fully remember how you got there? That's like a mini-dissociation. Of course, in pathological terms dissociation is far more extreme — people can lose vast chunks of time, mis-remembering details, and sometimes missing years from their memory. In this way, dissociation is both a symptom of multiple conditions (Acute Anxiety, Depression, Schizophrenia, etc.) and is also the main identifier of three conditions: Dissociative Amnesia, Depersonalization-Derealization, and DID.
Dr. Bethany Brand, Ph.D, who specializes in the treatment and research of dissociative disorders, seeks to dispel the apparent myth of multiple personalities that is perpetuated by pop culture. She argues that, while in a dissociative episode, people aren't manifesting alternate personalities but are merely operating in a different "state" in which their behavior can be erratic:
"[They] have different ways of being themselves, which we all do to some extent, but people with DID cannot always recall what they do or say while in their different states."
Categorizing these dissociative states as completely separate personalities may be an effort by the patient — and at times, the therapist — to understand the condition. However, the jury is still out on whether the mind is capable of manifesting several distinct personalities at once — and whether these personalities can actually interact and have a relationship with each other, as in Split and other movies, is definitely up for debate.
Of course, despite the current definition of DID, many people still believe they have manifested separate personalities — and there are many psychiatrists who specialize in multiple personalities specifically. As with any discussion of mental health, at the end of the day we cannot know what's inside a patient's mind. But in the case of MPD, exaggerated portrayals seem to have lead to many misunderstandings, and the condition itself has become a social construct.
Further study on this phenomenon is ongoing, and thanks to the nature of mental illness we may never know for sure if the psyche can indeed split into different personas. But for the time being, the current specifications of Dissociative Identity Disorder have moved away from the idea of "alters," and the focus on dissociation itself seems to allow therapists to better help their patients. In the meantime, movies like Split may only perpetuate misunderstandings — both in the minds of the general public, and the minds of the patients themselves.
Tell us in the comments: Do you think Split is a good portrayal of mental illness?
[Sources: Psychology Today, The Guardian, CNN, Multiple Identities & False Memories: A Sociocognitive Perspective by Nicholas Spanos, International Society for the Study of Dissociation, Dr Brand via PsychCentral, Dr Charles Raison via CNN.]