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Sarah Paterek is a 21-year-old writer based out of New Jersey. She is a student of English and linguistics. Her work is largely influenced and informed by her experiences with various forms of psychiatric treatments and institutions; as a child, she fell into a period of catatonia, and struggled to get a stable footing with her mental health as she entered adulthood. Through her work, she hopes to frankly discuss the many ills prevalent in the west’s treatment of the mentally ill and shed light on the abuse and mistreatment that many in the field of psychology do not openly admit to. Creatively, she is influenced most deeply by the likes of Franz Kafka, Marina Abramović and Anne Carson. Her worldview is informed by thinkers such as Simone Weil, Søren Kierkegaard and Thomas Szasz. More of her work can be found online at sarahpaterek.wordpress.com. 

ESSAY: 

 

From Witches to Madmen: The Western World’s Treatment of Dissociative Identity Disorder

 

The past few decades have presented a significant shift in the public’s attitude regarding mental health. More and more, people are less afraid to admit they are suffering from some sort of depression or neuroses, making the prospect of seeking mental health services much less scandalous. As the Western world is frequently making great strides in the effort of broadening the conversation surrounding mental health and decreasing the stigmas associated with such afflictions, there remain a number of disorders which are too “taboo” to be readily accepted by the general public. Perhaps the most stereotyped and least understood of these disorders is Dissociative Identity Disorder, or DID, formerly known as Multiple Personality Disorder.

To accurately present a portrait of those afflicted with DID, we must first understand the basic terminology that clinicians and patients use in identifying the disorder. Those afflicted with DID experience within their psyche the prevalence of at least two distinct, separate personalities; these personalities are referred to as “alters.” According to Psychiatry MMC, each alter can attain executive control over the body. They “their own identities, involving a center of initiative and experience, they have a characteristic self representation, which may be different from how the patient is generally seen or perceived, have their own autobiographic memory, and distinguish what they understand to be their own actions and experiences from those done and experienced by other alters” (Gillig). Other terms for alters include “parts,” “fragments” and “alternate personalities” (Gillig). Dissociation is often understood as “an attempt by the individual to prevent overwhelming flooding of consciousness at the time of trauma.” Thus, the disorder develops in childhood, before a person’s personality is fully formed. When “switching” to another personality, patients may alter their appearance via a change of hairstyle, makeup or clothing choices and may alter their speaking patterns (Gentile et al).

Diagnosis of dissociative identity disorder requires extensive psychiatric evaluation which takes into account the patient’s social history and physical symptoms as well as psychological. Lived experiences that may result in the development of a dissociative identity include sexual, physical and psychological childhood abuse, childhood membership in cults, and a history of neglect (McDavid). Those with dissociative identity may exhibit self-injurious behaviors, disordered eating, or substance abuse (McDavid). This indicates that dissociative identity disorder can exist comorbidly with other known mental illnesses. 

Historically speaking, the mentally ill have faced a long history of persecution, mistreatment and abuse in the United States and across the globe, even in recent times as treatment methods have become more and more humane and effective. The earliest case of suspected DID (suspected because diagnostic psychiatry did not exist this early in time) dates back to a woman named Jeanne Fery in 1584 (Hart et al). She was “treated” with an exorcism, as for the greater part of history, those exhibiting signs of mental illness were deemed possessed and handled by the Church. Fery recorded her own symptoms as well as her exorcism in great detail; she had multiple alters with their own distinct names, personalities, and purposes, such as fulfilling the behaviors of disordered eating and self-injury. She could hear these distinct personalities inside her head (Hart et al). 

The origin of psychiatric treatment in religious institutions is one that greatly contributed to the historical oppression and fear of the mentally ill. Unfortunately, those suffering from dissociative identity disorder, what with the multiple personalities they possess, present symptoms that too conveniently fall under what people consider demonic possession. Erratic behavior, bouts of self-injury and starvation, and the presence of voices inside one’s head are merely fuel to the fire of persecution on religious grounds. To be labelled as “possessed,” and then to endure the traumatic experience of an exorcism carried out by the ones the sick are supposed to love and put faith in, naturally further stresses an already delicate and unstable psyche. And because for most of Western history, the Church doubled as the government, there was no other authoritative body to look to for relief from systematic oppression and violence.

In The Manufacture of Madness, Thomas Szasz posits that Western psychiatry and society’s “othering” of those who are mentally ill is a direct progression from the persecutory witch trials. Anyone who acted outside of the norm, or who was simply disliked by those with greater social status, could have their identity manipulated into that of a witch; to be a witch is to attempt to disrupt God’s will, and is therefore to be one with the Devil. It follows, then, that the mentally ill, who were improperly identified as witches, would be persecuted via the same mentality that burned and exorcised alleged witches of history prior. Once Western history began to absolve those who were accused of witchcraft, society needed new grounds on which to persecute and subjugate those whose behaviors were outside the norm. As the influence of the Church fell, the existence of witches was eradicated. Science replaced the Church as the intellectual guiding principle; the mentally ill were science’s witches (Szasz).

One can never truly escape one’s history. If any group, regardless of who it is, has experienced any kind of systematic derision, this oppressive thought does not simply cease to exist once equality is established from any influential source. Just as racism persists in the United States long after laws forbidding it on a systemic level were put into place, so does the marginalization of those afflicted with mental illnesses, especially particularly severe ones. Once intolerance is embedded into a culture, it can only grow or decrease in its severity. The fact is that the mentally ill were immediately locked away and oftentimes tortured for the greater part of history; in essence, they were treated no more humanely than criminals, and so society’s opinions of these people formed accordingly. Though the average American would not necessarily believe a mentally ill person to be possessed by a demonic force, any fear or unease they feel towards this person is a byproduct of the stigmas attached to such illnesses in eras prior.

Given the mistreatment that people afflicted with dissociative identity disorder have experienced, and their history of being locked away and treated as demonically possessed, it is important to communicate with someone of this disorder in a way that is unbiased and nonjudgmental. In a 2003 article published by peer-reviewed journal Innovations in Clinical Neuroscience, a typical therapy session between a psychologist and patient afflicted with dissociative identity disorder is described. The main goal of the therapeutic process is to “listen, empathize and provide validation that the patient is currently safe, particularly when the emerging ‘alter’ represents a person who is much younger than the person’s current age” (Gentile et al). 

Mental health activist Chloe Wilkinson, who is diagnosed with dissociative identity disorder, states that some of the stereotypes those with this illness face include being considered murderous, demonic and dangerous to others. One way in which her lifestyle differs from others is that when she has plans, she needs to put absolutely everything she needs to get ready in the same spot before those plans take place, because she cannot know ahead of time whether her personality will switch to another alter who then will not be able to recall the plans ahead of him or her and what is needed to get ready. She will also leave a note for herself explaining the plans and what she needs to do (Wilkinson 01:10-02:20). 

Though most people who aim to communicate with someone diagnosed with dissociative identity disorder are not doing so under the premise of therapeutic treatment, one can look to the aforementioned therapeutic approaches as a way to understand the individual with which they are communicating. Even though someone who exhibits multiple personalities does not literally occupy the bodies of several people, it is important not to invalidate their experiences, as the objective reality they experience is unique from that of someone who does not have the disorder. If a personality, or alter with which one is unfamiliar is fronting for the individual, one should take special care not to question, corner or make any accusations of manipulation. If there are physical manifestations of the illness that are jarring, such as scarring from self-injury or malnourishment, one should not comment on them or inquire unless explicitly appropriate given the subject matter of the conversation. Similarly, if someone with dissociative identity disorder undergoes a switch and becomes disoriented or forgetful, one should objectively and calmly reaffirm the person of their surroundings and safety and help remind them as to where they are and what they are doing. As those with dissociative identity disorder are accustomed to the idea that society views them as crazy, and as they may feel ashamed of their own illness, it is important to recognize that they are rational, functioning human beings just like anyone else. It is unfair to immediately judge statements or behaviors of theirs as being byproducts of their illnesses. 

Given society’s historical treatment of those with mental illness, particularly ones such as dissociative identity disorder, which are perceived as “scarier” or “more taboo” than more well-known mental illnesses, it is important to look deep within oneself and examine any biases one has towards those afflicted with the disorder. Any negative presumptions or feelings of unease are the evolutionary progression of how generations before us viewed and treated people with this illness. To effectively communicate with anyone who exhibits dissociative identity disorder, there must be a concerted effort to educate oneself on the disorder and understand that the afflicted are equally valid and worthy as everyone else. 

 

REFERENCES:

Hart, Onno van der; Lierens, Ruth; Goodwin, Jean. “Jeanne Fery: A Sixteenth-Century Case of Dissociative Identity Disorder.” The Journal of Psychohistory, vol. 24, no. 1, 1996. 18, www..proquest.com/openview/3ff371b577995143d47ebce317bf3687/1?pq-origsite=gscholar&cbl=1816657.

Gentile, Julie P., et al. “Psychotherapy and Pharmacotherapy for Patients with Dissociative   Identity Disorder.” Innovations in Clinical Neuroscience, Feb. 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615506/.

Gillig, Paulette Marie. “Dissociative Identity Disorder: A Controversial Diagnosis.” Psychiatry MMC, Mar. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2719457/.

McDavid, Joshua D. “The Diagnosis of Multiple Personality Disorder.” Jefferson Journal of Psychiatry, vol. 12, no. 1, ser. 7, 1994. 7, jdc.jefferson.edu/cgi/viewcontent.cgi?article=1370&context=jeffjpsychiatry.

Szasz, Thomas Stephen. The Manufacture of Madness; a Comparative Study of theInquisition and the Mental Health Movement. Harper & Row, 1970.

Wilkinson, Chloe, director. Travelling with DISSOCIATIVE IDENTITY DISORDER.  Travelling with DISSOCIATIVE IDENTITY DISORDER, YouTube, 11 Aug. 2019, http://www.youtube.com/watch?v=Oq_BTkpGe-U.

 

 

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Death Comes in Small Bursts

a ward of robotic vessels seek respite

 

in technicolor bleached white,

 

mouths entangling the wires in their beds.

 

all sterile and motionless,

 

there is no god in these halls -

 

only white, Holy white -

 

and the incessant hymn of footstep and clipboard.

 

i beckon benzodiazepine and, lying,

 

lose myself in nausea and fluorescence

 

as my veins course through medical equipment.

 

somehow, a unit of silence, cotton and psychosis

 

seems no place for comfort.

 

but between our marrow and crooked limbs

 

Death comes in small bursts

 

prodding like an incessant dog.