Ison 1

Sireana Ison

Professor Rebecca Morean

English 1201-515

23 March 2020

Dissociation: A Psychological Experience Plagued by Social Stigma

Introduction to Dissociation

Think back for a moment, have you ever experienced a disconnection from your

thoughts, feelings, or your sense of identity? If the answer is yes, you may have experienced

something called dissociation. If you have not, it is an important mental health topic to learn

about, as mental health has been on a decline in the United States, and “over the past two

decades mental illness has become the second most common cause of disability in the U.S.”

(Higgins) The more societies, communities, and individual people understand and work to de-

stigmatize mental health, the more they can provide aid and support for those affected. While

dissociation is one of the lesser known mental health topics spoken about today, it has the

ability to expand into multiple disorders that are heavily stigmatized and are more common

than one might be aware of. Dissociation occurs as a result of anxiety, depression, or trauma

and is used by the brain in order to protect and relax the body. Though the symptoms of

general dissociation and dissociative disorders (furthermore DD’s) vary, social stigmatization

and poor mental health portrayals in the media negatively affect each variant of this category

of disorders and the individuals who are also affected. This papers purpose is to educate the

reader about the five recognized dissociative disorders along with their history, ways to cope,

prospective treatments, and the presentation of a social argument regarding the ill affects’

media has on them. It also touches on the negative controversy regarding the research
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accompanying the disorders and how it is dangerous to the individuals diagnosed or seeking

diagnosis.

Understanding Dissociation and Dissociative Disorders

Before one can understand the different disorders categorized by dissociation, an

understanding of dissociation itself along with its history must be reached. According to Mind,

a mental health organization based in the U.K, dissociation is a natural coping mechanism

employed by the mind when there is too much stress or during a particularly traumatic event.

(Mind) Dissociation usually consists of a disconnection from one’s thoughts, feelings, identity

(more so with depersonalization), or memories (dissociative amnesia). Dissociation is a natural

response and is sometimes unable to be controlled. The more often a person dissociates, the more

likely that individual is to develop a dissociative disorder, especially when at a younger age. This

response, while natural, can be concerning to someone who is first experiencing it. Dissociation

can be a symptom of a mental health disorder, or a side-effect of alcohol, medication, or

medication withdraw. The most common instance where a person may dissociate is due to a

mental health disorder, illness, and repeated trauma, though it should be noted that not

everybody with a mental illness will experience dissociation in their lifetime if that is not their

bodies innate reaction to stress. (Bailey). However, there has been a study on dissociation by

Sally E. McCollum, a clinical psychological specialist, suggesting that dissociation can occur

generationally (McCollum), and it is theorized, though unproven that, “dissociation may

accompany almost every psychiatric disorder and may influence their phenomenology as well as

response to treatment.” (Sar) While dissociation itself is untreatable, there are ways in which a

person dissociating can bring themselves back, this is known as grounding. Grounding

techniques are extremely useful ways in which a person can pull themselves back from
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flashbacks, distressing feelings, or harmful memories into the present moment. Grounding

techniques can include holding a piece of ice or touching something cold, focusing on the scent

of a candle or another object, and even as simple as touching things around you and trying to

focus on what those objects are such as the weight, color, or size of them. It should also be

brought to one’s attention that dissociative disorders are no longer considered personality

disorders and are now their own entity.

Discovery of Dissociation as a Psychological Phenomenon

Dissociation is still a relatively new topic in the psychology field. The disorder first

gained relevance at the end of the 19th century due to Pierre Janet, “who systematically

elaborated on the concept of dissociation, which he viewed as a discontinuous phenomenon that

is only seen in individuals with mental disorders, particularly hysteria, and is absent in healthy

people.” (Spitzer) Though it is still considered to be a relatively young idea, much has been

discovered about the psychology behind all of its accompanied disorders and causes. While the

research for this topic did go cold towards the beginning and middle of the 20th century, it

regained popularity in the 1970’s and has continued to be periodically researched since. While

there is still much to be discovered, terminology and understanding is being changed frequently,

enabling better care and understanding for those who have these disorders.

Studies Regarding Dissociative Identity Disorder (DID)

Dissociative identity disorder (DID), formerly known as multiple personality disorder

(MPD) until 1994, is a very well-known dissociative disorder, likely one the reader may have

heard of before as, “between 1 and 3 percent of people in the world have DID.” (Fischer)

However, information about this disorder is often misconstrued due to heavy controversy

surrounding it and many individuals misunderstanding the disorder. A through explanation of

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DID Is that it is, “a complex, chronic, posttraumatic dissociative psychopathology characterized

by disturbances of memory and identity. It is distinguished from other mental disorders by the

ongoing coexistence of relatively consistent but alternating subjectively separate identities and

either recurrent episodes of memory disruption, frank amnesia, or both, and/or amnesia for a

period of noncontemporary autobiographic memory. It almost invariably emerges as the sequela

of overwhelming childhood experiences.” (Michelson) In short, between the ages of seven to

nine a child’s personality will integrate, but if there is emotional, sexual, or any form of repeated

abuse the personality will not integrate, and instead create alters (sometimes described as

different egos) with amnesic walls in between them that hold separate memories from each other

in order to protect the body. DID diagnosis frequently come later in life and symptoms may not

emerge for a period of time even if the disorder has developed. Individuals with DID typically

have multiple alters, and while there is not an average amount recorded, it tends to vary greatly

from case to case. These alters commonly have different ages, names, sense of identities, and

different jobs to perform within the system. Some examples of the jobs these alters perform are

usually mnemonic, such as trauma holders, who hold trauma memories from other alters and

primarily the host so that the host is unaware of what happened. Other alters may hold memories

for things the host has a particularly hard time with such as sexual encounters. This allows the

system to perform normal things, but mnemonically categorize situations so that they do not

reach the host. This tends to greatly influence the alters personalities, and the appropriate alter

will front for a given situation. For example, a protector may front when the system is feeling

threatened or stressed.
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Fig. 2. A colorful graphic simplifying the complex fundamentals of Dissociative Identity

Disorder. (Clark)

DID is the only dissociative disorder than can only develop in childhood, but symptoms and

diagnosis can be delayed into adolescence and adulthood in some cases. While life for these

individuals is usually very taxing, people with DID can go on to live very successful independent

lives. DID is also a treatable disorder. While some individuals do live their entire lifetimes with

this disorder, they oftentimes work with psychotherapists who attempt to integrate their alters

(alternate states of consciousness) into one personality. While DID is most effective when the

system (the system, or body, that houses multiple consciousnesses) is unaware of their disorder,

communication throughout the system is pertinent for when the alters switch, so the system can

live fluently, and all parts of consciousness can be aware of what is going on in any given

situation.

Amnesia Accompanying Dissociation

Dissociative amnesia, though a symptom of other disorders, can also be a disorder in and

of itself. Dissociative amnesia occurs when a person’s mind blocks out information and certain
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events that are typically associated with traumatic events or memories. The consequences of this

disorder are the inability for an individual to recall important or personal information that

became associated with those events or memories, though these memories can resurface when

triggered. There is a difference between forgetfulness and dissociative amnesia due to the fact

that, “In all cases of dissociative amnesia, the person has a much greater memory loss than would

be expected in the course of normal forgetting.” (Cleveland Clinic) The main difference between

normal forgetting and dissociative amnesia is how memories are recalled. When a person forgets

something, typically this memory can be recalled by an object, or a sentence. With dissociative

amnesia, the brain tries to bury or erase the traumatic or stressful memory to the point of

extinction. In some rare cases, these memories can be triggered and cause flashbacks, but the

purpose of the amnesia is to erase this memory so it will no longer harm the individual and be a

stressor. There are some rare cases, however, in which an individual will lose all memory. This is

known as, “dissociative fugue, [when] person may forget most of all of his personal information

(name, personal history, friends).” (Cleveland Clinic) This is also a trauma response, but a very

extreme one.

Depersonalization and Derealization

Depersonalization and derealization are DD’s that involve a psychological state in which

an individual’s thoughts and feelings seemingly do not belong to them, sometimes accompanied

by a complete loss of identity. Oftentimes individuals experiencing depersonalization or

derealization report viewing themselves from outside of their bodies and have a difficulty

discerning whether their surroundings are real. These disorders are unfortunately unable to be

treated using medication, and while the recommended treatment is behavioral therapy with

grounding exercises as intervention, there has been recent experimental testing regarding
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treatment using small electric shocks to the brain called, “Ventrolateral prefrontal cortex

repetitive transcranial magnetic stimulation.” (Jay) The results from the experiment proved

promising as the magnetic stimulation, “may be a potential treatment option for DPD, which has

previously proved difficult to treat with pharmacotherapy. Six out of seven participants showed

over 25% improvement in symptoms, two over 50%. One participant did not respond to

treatment.” (Jay) There was more research desired to prove that this is a viable option to treat

depersonalization. However, depersonalization and derealization do have the ability to go away

with other treatment. While some individuals may not be responsive to therapy and may have

these disorders over the course of their lifetime, some individuals have shown total extinction of

symptoms and are no longer affected.

Social Stigma Surrounding Dissociative Disorders and how its’ Harmful

While there is much scientific information that verifies the validity of these various DD’s,

there is also a lot of misinformation and social stigma surrounding these disorders, and much of

this stigma is spread by the media. One of the most popular assumptions is that individuals with

DID are dangerous, and this is due to the popular media portrayal of violent or murderous alters.

A popular movie released in 2016 titled Split is an example of how negative media portrayals of

mental illness can have a negative effect on that community. Split follows Kevin Wendell Crumb

(James McAvoy), a man with 24 alters including a violent one which is repeatedly referred to as

The Beast.
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Fig. 3. James Mcavoy’s portrayal of Kevin Wendell Crumb in Split, and his murderous alter The

beast spread harmful stigma suggesting individuals with DID were dangerous. (Split)

The beast plans to eradicate the world of all that is impure, beginning with the kidnapping of

three teenagers from a car after chloroforming their father. (Split) There are several examples

throughout the movie of “switching”, or when alters come forward, and examples of how alters

have their own personalities, memories, and motives as well as visual examples of how alters

view themselves differently from the host, or the person who fronts most frequently. One can

oftentimes find individuals praising the movie for its accurate portrayal of how alters work and

how drastically different they can be from one another, however, mental health professionals

have heavily criticized this movie for its poor, and dangerous portrayal of individuals struggling

with mental health, specifically DID due to the addition of the dangerous, violent alter. Elizabeth

Howell, a psychotherapist from New York, said “the film raises the potential for dangerous

attitudes to emerge and for people with the illness to be damaged.” (Fischer) Psychologists also

stated, “the film stigmatizes the disorder and may have a negative impact on people who have the

condition.” (Fischer) The reason these poor portrayals can be so damaging Is because it ignites a

societal fear of individuals affected by mental health disorders. This costs these individuals the

right to a safe life, as they could be denied basic things due to the fear of their disorder. It has not

been discussed whether this negative portrayal was purposeful or if the film makers considered

the negative impact it could have. Large media corporations and outlets have a duty to be more

mindful when producing content depicting anybody struggling with mental health. When media

outlets reach millions worldwide, depicting a person suffering from a disorder as dangerous

contributes to harmful social stigma and creates an untrustworthy atmosphere around someone

who is seeking treatment or is open about their mental health struggles.

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Academic Controversy and Confusion

Aside from social stigma, there is also academic controversy surrounding the subject of

dissociation, especially regarding how it manifests and how it affects the body. Clinical

psychologists have been recently discussing this, and, “despite the recognized clinical

significance of dissociation, there is an ongoing controversy about its conceptualization. The

notion that it "lacks a single, coherent referent ... that all investigators in the field embrace"

(Spitzer) insists that researchers cannot agree on a single criteria for most of these disorders,

leading to the inability to properly diagnose certain individuals. The article goes on to explain

what this controversy is and how it arose. Essentially, the ICD-10, the 10th revision of the

International Statistical Classification of Diseases and Related Health Problems, a medical

classification list by the World Health Organization, and the DSM-IV, a publication for the

classification of mental disorders using a common language and standard criteria, contradict each

other on what dissociative disorders are, their symptoms, and what causes them. (Spitzer) The

reason this disagreement is troubling Is because it has the potential to disable individual’s ability

to receive correct care based on their symptoms. Depending on how their disorders are

categorized could mean different medications used to treat different groups of disorders or

inappropriate psychotherapy methods used in an attempt to eliminate the disorders, such as the

suggestion that individuals with DID are very susceptible to hypnosis and are very credulous. As

a result, these classifications previously mentioned have come under heavy questioning and there

is a call for additional diagnostic categories for psychiatric patients with assumed DD’s because,

“these inconsistencies between ICD-10, DSM-IV and clinical reality not only illustrate the

confusion surrounding the complex issue of dissociation, [and] may also serve to perpetuate it.”

(Spitzer) Because of this, “[a] particular challenge for clinicians and researchers is
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the fragmentary nature of dissociation and dissociative disorders. This interferes with proper

diagnosis and assessment of them in general psychiatry.” (Sar) If the categorizations of disorders

were agreed upon, this could enable clinicians to better assess and diagnose their patients

appropriately.

Conclusion

Dissociative disorders are natural complex psychological phenomena that are developed

due to trauma and stress. These disorders are developed in a valiant attempt to calm and protect

the body, though can sometimes be startling. When looking at much of the research compiled

about these disorders, it is evident that there are subsets within the dissociative diagnosis that are

less researched than others, and there is still much to be learned about these disorders as they are

still considered relatively new in the world of mental health and psychology. Poor mental health

and mental health disorders are much more common than some may think, but with the

popularity of speaking about ones mental health struggles and a bigger acceptance that it is just

as important as physical health, these topics are being spoken about more and are becoming a

prevalent talking point, as well as a point of concern, in our lifetime. In order to assist those who

struggle with these disorders and to create a society with better understandings of them, as

mental health is on a global decline, it is pertinent that individuals who are both affected and

unaffected by other disorders should approach all mental health topics with a facet of

understanding, as well as a willingness to learn as to not be biased or misinformed. Helping to

destigmatize DD’s has the potential to positively affect nearly three percent of the worlds’

population. Going forward, research needs to focus on therapeutic remedies as well as better

diagnostic criteria so individuals can receive the appropriate help they need and increase the

importance of dissociation within psychology and psychotherapy. Have you ever experienced
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dissociation? If you have, or if you have struggled with a specific dissociative disorder, take

comfort in knowing that there is nearly two and a half centuries of research accompanying these

disorders, and with new information consistently being discovered, better treatment is always on

the horizons. If you have not been personally affected by dissociation, or if you know somebody

who has and would like to seek further information, the International Society for the Study of

Trauma and Dissociation has thorough, professional resources available for professionals or

those seeking general knowledge.

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Works Cited

Bailey, Tyson D., and Bethany L. Brand. “Traumatic Dissociation: Theory, Research, and

Treatment.” Clinical Psychology: Science & Practice, vol. 24, no. 2, June 2017, pp.

170–185. EBSCOhost, doi:10.1111/cpsp.12195.

Clark, Jeff. “Dissociative Identity Disorder (DID).” YouWillBearWitness,

https://youwillbearwitness.com/2019/06/17/dissociative-identity-disorder-timeline-and-

history/. Accessed 12 April 2020.

Cleveland Clinic. "Dissociative Amnesia; Symptoms, Causes, Management &

Treatment." Cleveland Clinic, my.clevelandclinic.org/health/diseases/9789-dissociative-

amnesia. Accessed 26 Mar. 2020.

Fischer, Kristen. "Split: Why Mental Health Experts Are Critical of the Movie." Healthline,

www.healthline.com/health-news/movie-split-harms-people-with-dissociative-identity-

disorder#1. Accessed 27 Mar. 2020.

Higgins, Edmund S. “Is Mental Health Declining in the U.S.?” Scientific American, Scientific

American, 1 Jan. 2017, www.scientificamerican.com/article/is-mental-health-

declining-in-the-u-s/.

Jay, Emma-Louise et al. “Ventrolateral prefrontal cortex repetitive transcranial magnetic

stimulation in the treatment of depersonalization disorder: A consecutive case

series.” Psychiatry research vol. 240 (2016): 118-122.

doi:10.1016/j.psychres.2016.04.027 Accessed 8 April 2020

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McCollum, Sally E. “Multigenerational Dissociation: A Framework for Building Narrative.”

Journal of Trauma & Dissociation, vol. 16, no. 5, Oct. 2015, pp. 563–576. EBSCOhost,

doi:10.1080/15299732.2015.1030717.

Michelson, Larry K., and William J. Ray. Handbook of Dissociation: Theoretical, Empirical,

and Clinical Perspectives. PDF, Springer Science & Business Media, 2013.

Mind. "About Dissociation." Mind, the Mental Health Charity - Help for Mental Health

Problems, www.mind.org.uk/information-support/types-of-mental-health-

problems/dissociation-and-dissociative-disorders/about-dissociation/. Accessed

27 Mar. 2020.

Şar, Vedat. “The many faces of dissociation: opportunities for innovative research in

psychiatry.” Clinical psychopharmacology and neuroscience: the official scientific

journal of the Korean College of Neuropsychopharmacology vol. 12,3 (2014): 171-9.

doi:10.9758/cpn.2014.12.3.171

Spitzer, Carsten et al. “Recent developments in the theory of dissociation.” World psychiatry :

official journal of the World Psychiatric Association (WPA) vol. 5,2 (2006): 82-6.

Accessed 27 Mar. 2020.

Split. Directed by M. Night Shyamalan, Perf. James McAvoy, Betty Buckley, Anya Taylor-Joy.

Universal Pictures, 2016.