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.