A friend of mine sent me an e-mail recently which raised a question that I believe goes right to the heart of being a Buddhist psychotherapist. "Would you as a psychotherapist say that most people have a very mild form of Dissociative Identity Disorder? Or is it just me!!!" In order to answer her question, I think we need to examine it in some depth and the obvious place to begin is by defining the three terms dissociation, identity, and disorder, each of which come fully loaded with questions that disallow any simple answers. I realise that psychotherapy--and certainly psychiatry--tends to be defensive about its nomenclature. But sometimes it is necessary to subject diagnostic terms to close analysis in order see how much conceptual weight those terms are able to bear. I do not doubt the reality of dissociation or question that it can constitute a major problem for people who suffer from it. But as a therapist, it seems to me that psychotherapy is both morally and intellectually responsible for the diagnostic terms that it employs. Moreover, those terms should be as accurate as possible in the interests of our clients, if for no other reason.
The term dissociative identity disorder, which is more widely known as Multiple Personalities Disorder, has a rather questionable status due in large part to popular stereotypes which many people seem to have about it. Unfortunately, the idea that someone might have multiple, distinct personalities, all vying within one person in a desperate struggle for dominance, lends itself all too easily to an operatic understanding of how the disorder affects people. But dissociation is seldom, if ever so clearly demarcated and therapists usually prefer to speak of separated personality states rather than of distinct personalities. Moreover, what usually characterises this disorder, apart from dissociation, is pervasive depression, a state which commonly provides the affective ground for so many other psychological maladies, as well. In DID, the movement from within a depressive disposition, going from one personality state to another, is always an abrupt and disjointed transition which leaves the sufferer with a bewildering feeling of discontinuity. I have dealt with clients who have suffered from extreme dissociation and I can confirm that their experiences of dissociation did indeed leave them feeling deeply destabilised, which affected both their sense of identity and self presentation and led them to act in ways that they later found bewildering, out of character and even mad. Yet, in my admittedly limited experience, their experiences of dissociation did make a certain skewed sense when seen within the contexts of the pressures they experienced themselves to be under. Therapeutic work, as I understood it, consisted in large part of discovering what those pressures were.
But let's return to the three terms that constitute the description of the disorder. Dissociation means to split off or disconnect, which does seem an appropriate term for the essential dynamic of DID. But it should be remembered that we all dissociate whenever our focus wanders away from its intended object of attention. Perhaps more to the point, to dissociate by losing attention through daydreaming or trying to abstain from focussed thinking before going to sleep, is entirely normal and even necessary. Even so, to dissociate from one's actual identity may represent a dangerous self abdication which negates the possibility of achieving meaningful self understanding, as well as truthful interaction with other people. But it should also be remembered that everyone has multiple identities which are meant to accord with the various roles we each have to adopt in society and in our relationships with others. It is only when there is a severe disjunction between an individual's multiple identities and core sense of self that his or her identity would become dissociated and deserve to be called a disorder. But an important question still remains: what do we mean by core sense of self?
Much like David Hume, Buddhism has always argued that there is no core self, though it does concede that there is and should be a core sense of self. But if there is no self than how would it even be possible to develop any sense of it? And if this is possible, isn't it rather like saying that we need to cultivate a certain sort of self illusion? But what is essential to Buddhism's argument is that the illusion of self thrives on its attachments---indeed, the attachments themselves constitute the illusion. A fixed or rigid sense of identity is certainly a kind of attachment, in fact one of the strongest attachments that anyone can have. Yet, paradoxically, it can also be understood as a form of dissociation, though not dissociation from any sense of self. On the contrary, for if we are only looking for objects that sustain or interfere with our sense of self we would overlook anything that would appear irrelevant to our prior self interests. The dissociation, then, would consist of withdrawing our attention whenever an object or situation failed to stimulate our self interest. Of course, such a broad definition as this would make dissociation into such a general phenomenon that it could hardly be called pathological. And as we noted before, everybody does it just by daydreaming or fading off before going to sleep. But viewing dissociation in this way, as a form of ignorance or avidya, may still be useful in helping us to understand DID.
"Who am I?" is one of the most potent questions that anybody can raise and has always featured prominently in both spiritual and philosophical enquiry. But the question can evoke terror when it disturbs a person's core sense of self, even if it arises from a spiritual or philosophical interest. Although the philosophical or spiritual question of identity would seem to have little in common with psychopathology, the crucial issue of the indeterminacy of the self may be fundamentally the same. My friend notes, for example, that two contemporary mystics, Eckhart Tolle and Byron Katie, both suffered prolonged suicidal depressions before experiencing their mystical awakenings. Whatever we might make of these figures, their experiences certainly agree with reports of other mystics throughout history. The Dark Night of the Soul that St John of the Cross had to endure appears to be a peril for anyone who embarks on a spiritual quest, no matter what their religious orientation happens to be. But can these experiences be compared to what people undergo when they suffer something like DID?
Although the comparison should not be pressed too far, I do think there is more than a passing similarity between the ordeals of the mystic and the torments of people suffering from conditions like DID. But perhaps the more important question is how do they differ? This is something I would like to discuss in a future post.
One of the hottest debates in philosophy these days concerns the nature of consciousness. What is consciousness? How did it originate and what purpose, if any, does it serve? Although the present controversy about consciousness has been enlivened by recent scientific research, these questions have always been with philosophy and in fact, actually preceded it. For consciousness itself is like a great root of wonder from which religion and magic arose, well before philosophy and science blossomed afterwards. Even so, the questions of consciousness sometimes seem to fall into retirement as its apparent mystery appears to be solved by plausible explanations. God, for instance, though himself considered far beyond human comprehension, was once seen as the source of all consciousness and explained everything from the movement of the stars to the thoughts and moods in our heads. But those explanations no longer carry the authority they once did and the idea of God's role in creation increasingly appears to be the product of the human imagination fabricating explanations for mysteries that were once believed to be forever closed to human understanding. We now know, of course, that the sun, moon and stars do not wheel around a stationary earth. And the solar system itself is an infinitesimal speck in an unimaginably vast universe that contains billions and billions of galaxies. Although some people still maintain that a divine hand is responsible for the cosmic order, science would have never advanced without first removing God as an explanatory principle. The same appears to be true of our understanding of consciousness. The divine spark that was once thought to explain the light of consciousness has now been superseded by the complex structures of the brain that modern neuroscience has just begun to reveal, but with dramatic results. The brain, many investigators now believe, is merely an organic computational device that blindly follows the biological instructions that are hard-wired into it. We are simply "the clumsy robots of our selfish genes", as Richard Dawkins puts it. Moreover, for all of the brain's undoubted complexity, many scientists and philosophers do not regard consciousness as an unfathomable mystery, but instead see it as a problem that is just about to reach a conclusive explanation. "Consciousness Explained" is the title of one of the books by the materialist philosopher Daniel Dennett which brazenly expresses this view.
Yet it is possible to be dazzled by what science has to tell us about the brain and its processes without believing that consciousness has been completely explained by these revelations. It would be more accurate to say that many of the mechanisms of consciousness are becoming better understood though scientific investigation, but important questions about consciousness still remain. Perhaps foremost among these questions concerns subjectivity. What is it to be a conscious person, not just considered archetypally, but what is to be a "me", that is a self reflective subject with a unique history and point of view, whose experience must, in principle, be unique? Although there are metrics for virtually every physical and mental human characteristic--height, weight, intelligence, temperament, sexual orientation and so forth can all be fit into pre-determined categories--none can fully illuminate human experience without reference to self consciousness, indeed, to being a self. To say the self is an illusion, as Dennett does, does nothing to dislodge the illusion of selfhood or begin to dispel the problems of being a conscious person. Still, in some respects Dennett is clearly right. We are often mistaken about the truth of our actual condition as we inevitably hold false beliefs about ourselves and the world. In fact, our understanding of both the self and the world must be flawed by the necessarily provisional knowledge we form about both. But in the darkness we inhabit, perhaps we may be forgiven for sometimes mistaking the dim fires of consciousness for the bright light of truth.
Yet, no matter how much we overestimate the veracity of our understanding, we all recognise that that there are matters about which we will always be ignorant. Much of our ignorance is general and collective and is so remote from our affairs that it scarcely seems to impinge on us. Nobody could possibly know what might exist beyond our sensory and cognitive capacities to apprehend them. Wondering, for example, what happens in those billions of distant galaxies that we will never be able to explore would seem a pointless question because there can be no intelligible way for us even to imagine it. But even the most immediate and commonplace items of experience become subject to unanswerable wonder if we ask why they--and we--exist at all. In truth, why known things exist is far more mysterious than what unknown things might exist. For the mystery of known things presses in on us by their very presence as soon as their mystery is admitted into our awareness of them. And from any experience of wonder it is just a small step to wondering about wonder itself. What enables us to wonder and why is it so compelling once it claims our attention?
For some people of a strongly rational disposition, these questions may seem frivolous and pointless. Wonder is useful to such people only insofar as it can be converted into active curiosity about knowable things. As for mysteries that can't be investigated by rational methods, hardened rationalists believe that such things are best ignored and should be treated as virtually nonexistent. Yet some mysteries can be neither dismissed as trivial nor investigated by rational methods as we discover whenever we find ourselves in a state of suspense about concerns for which there can be no clear predetermined answers and no way of regarding them as unimportant. Such questions as "Will he/she love me?" or "Am I going to recover from my potentially fatal illness?" may never rock the epistemic foundations of scientific knowledge. Yet, if forced to confront such questions personally, each of us would be held transfixed in a state of anxious wonder. For we can never solve such mysteries, but can only live them out with the understanding that our fate depends on how our concerns will unfold. Of course, seen objectively as examples of perennial phenomena, falling in love and falling ill may be taken as nothing more than biological processes, as natural and as unmysterious as leaves falling off trees. But as individuals living out our lives we are compelled to wonder whenever such things happens to us, as we experience them as mysteries that endow our lives with emotional meaning.
Mysteries are not always enchanting. They can sometimes be agonising, as the example about serious illness shows. They can also be merely vexing, as when we wonder when the traffic jam we are stuck in is going to clear so that we can be on time for an important appointment. Mysteries can also arise out of factual confusions. No gods ever caused the sun to disappear behind the moon at midday, even if a tribe's misdeeds would seem to have angered them enough to do it. And though we can now easily see past such a confusion with our superior understanding of astronomy, it would be arrogant to suppose that we are no longer be liable to similar misunderstandings. For our understanding of things can only be provisional and must be revised whenever new discoveries inform our ideas about them. But the notion that we as individuals will always be in a position to wait patiently for all the facts to come in is to misunderstood the human situation. For we are always in danger of being worried about being late for important appointments, to say nothing about finding love and dying too soon. Our lives always depend on eventualities whose outcomes we can never know in advance.
This is where psychotherapy can be helpful. Not by providing answers for unanswerable mysteries, but by enabling people to deal with them, which is something that no scientific theory of consciousness will ever be able to do. Buddhism tells us that the law of impermanence infiltrates all things and offers a path of escape from the flux of existence. Therapy helps us negotiate the mysteries in our lives within which that path lays concealed.