When Sybil first came out in 1973, not only did it shoot to the top of the best-seller lists — it manufactured a psychiatric phenomenon. The book was billed as the true story of a woman who suffered from multiple personality disorder. Within a few years of its publication, reported cases of multiple personality disorder — now known as dissociative identity disorder — leapt from fewer than 100 to thousands. But in a new book, Sybil Exposed, writer Debbie Nathan argues that most of the story is based on a lie.
Like all other mental difficulties, dissociation runs a spectrum from normal to extremely pathological. In my clinical experience it is very common for traumatized and/or very mentally ill people to manifest high rates of dissociation. People who dissociate a lot have conscious experience that is like Swiss cheese: full of holes. But unlike sadness, anger or clear psychosis, it is not usually readily apparent, so it gets less attention than it should. People who suffer with this rarely complain about it, because almost by definition, their fragmented conscious awareness makes it very difficult for them to even notice that they are missing things and/or not aware.
It is generally accepted that DID results from extreme and repeated trauma that occurs during important periods of development during childhood. The trauma often involves severe emotional, physical or sexual abuse, but also might be linked to a natural disaster or war. An important early loss, such as the loss of a parent, also might be a factor in the development of DID. In order to survive extreme stress, the person separates the thoughts, feelings and memories associated with traumatic experiences from their usual level of conscious awareness.
Many biological psychiatrists who base their practices around medication management will tell you the condition doesn't exist, or that if it exists it is "iatrogenic," meaning it is caused by therapists training their patients to interpret their symptoms as if they have a whole set of distinct personalities. On the other hand, there are clinicians who specialize in the condition and they take the presence of multiple personalities so seriously that they will separate therapeutic meetings with each of a patient's "alters" (i.e. individual personalities).
Dissociative amnesia. The main symptom of this condition is memory loss that's more severe than normal forgetfulness and that can't be explained by a medical condition. Amnesia that comes on suddenly following a traumatic event, such as a car accident, is rare. More commonly, you simply can't recall traumatic periods, events or people in your life, especially from childhood.
Dissociative identity disorder. This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress. In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head. Each of these identities may have a unique name, personal history and characteristics, including obvious differences in voice, gender, mannerisms and even such physical qualities as the need for corrective eyewear. There also are differences in how familiar each identity is with the others. People with dissociative identity disorder typically also have dissociative amnesia.
What used to be known as Alternate or Multiple Personality Disorder and is now called Dissociative Identity Disorder has been misunderstood almost since its first diagnosis, often getting confused with schizophrenia. This is largely due to semantics: The word "schizophrenia" literally means "split mind," but the split is with associations, not personalities. Schizophrenics may have delusions or hallucinations but do not have multiple identities.