Twenty-eight-year-old Marshay refers to herself as “the Little
One” and says she feels as if she was born six years ago. Her mother knows
something really bad must have happened to her when she was very young,
although she doesn’t know what happened. When she asks her daughter why she
thinks she’s still a small child, Marshay answers, “I don’t remember anything.
I don’t want to grow up. I want to stay little.”
اضافة اعلان
Marshay’s brain periodically seeks a safe haven, a persona where
she feels immune to some horrific abuse she apparently suffered early in life.
She has other identities as well who “come out” when provoked by certain
triggering events and she needs these alternate identities to feel safe.
Marshay is one of several people with dissociative identity
disorder who are featured in a new documentary called “Busy Inside,” available
on public television’s World Channel: America ReFramed. It can be watched free
online through April 15. She is among a surprising one percent of the population with
this psychiatric condition, formerly called multiple personality disorder,
which was famously portrayed decades ago in films like “The Three Faces of Eve”
and “Sybil.” It mostly affects women.
The new film shows the challenges involved in learning to live
with the disorder. Still, most of those affected never seek professional help
until and unless their lives become unmanageable.
Karen Marshall, Marshay’s therapist, a licensed social worker,
also has the disorder, and told me that 17 different personalities inhabit her
psyche and can emerge from time to time. She suffered severe sexual and
physical abuse as a young child at the hands of her mother, and said she
experienced tremendous relief when she died “and couldn’t hurt me anymore.” She
says her own trauma, and the ways she learned to manage it, has helped her be
an effective therapist.
Dr. David Spiegel, a Stanford University psychiatrist who gave
the disorder its modern name, explained, “We develop our identity in childhood,
and if you’re abused by someone who is supposed to love and protect you, you
try to detach yourself from” that abusive situation. “In extreme forms, you
assume other identities. It becomes a disorder.” The hippocampus, a part of the
brain that deals with stress, may shrink and cause an extreme sensitivity to
stress hormones, he said.
Early in life when the brain can’t handle something, “it puts it
in a little box in the brain,” Marshall said. Then something else it can’t
handle goes into another compartment in the brain, and so forth, resulting in
some people developing different personalities, any of which can take over for
a time.
A woman in the film named Sarah who has seven or eight
identities describes her childhood trauma as being in a freezing cold basement
with few clothes on and two men grabbing at her while others stood around
laughing. “I can see this happening but I can’t stop it,” she recalls. “The
monster keeps coming out, obliterating everything.”
In the documentary, Marshall encourages Marshay to accept
herself as an adult woman with many facets, saying reassuringly, “We all have
different roles, and we all wear different masks in a way.”
For those with the disorder, when an alternate identity takes
over, the person may lose track of time and have no memory of what the other
personality did while it was “out.” Marshall said one woman she treated had an
alternate personality who was a shoplifter and when she reverted to her main
identity, had no idea how she had acquired all the things in her apartment.
Dissociative identity disorder is both underdiagnosed and often
misdiagnosed as depression or anxiety disorder and consequently mistreated, Spiegel
said. Once affected individuals acknowledge that they have a problem, it takes
an average of six years for them to learn what is causing their symptoms if
they should seek help, Spiegel said.
Some people with the disorder never do, and somehow manage to
live normal lives until and unless something very stressful causes their
alternate identities to take over and disrupt their ability to function. For
example, Marshall told me, one person in the film performed well as a company
executive for many years until a family trauma so unnerved her that her
identities split, very hostile and disabling personalities emerged, and she
could no longer do her job.
Spiegel said some people with the disorder “are afraid of
treatment or ambivalent about it; they don’t believe I’m here to help them
because, based on their history, they see helpers as potentially harming them.”
Alternate identities can also emerge at the same time, as if the
person is two people who oppose one another. The identities develop specialized
roles, coming out under certain circumstances, Spiegel said. For example, one
identity may “protect” against another that might be aggressive or harmful. The
protective identity may think, “I’m going to stay out while so-and-so is
around,” he said. As Marshall explained, people can have one or two identities
that act as gatekeepers, keeping the others inside.
In treatment, by identifying and emphasizing the person’s core
values and beliefs, the person’s adult identity that enables them to function
normally can learn to take over for identities that are distressing or
troublemakers, Marshall said.
Her approach to treatment does not necessarily try to rid people
of their alternate identities unless, of course, that’s what they want to
accomplish. Rather, she said, they may learn to use their alternates
constructively so they can live a normal life as an adult in society.
Also helpful is learning to recognize circumstances that can
prompt a distressing identity to emerge and temporarily replace the adult
persona. Marshall said she has learned, “If I’m tired or sick or stressed, I
can end up splitting,” and a childlike personality emerges.
As in post-traumatic stress disorder, people with multiple
identities can have flashbacks and experience their abuse all over again.
Marshall said, “I don’t watch shows about child abuse.” In treating
dissociative identity disorder, she said, “I try to get the ‘Little Ones,’ who
were traumatized, to know they’re safe, that they’re not going to be hurt
again.”
Dr. Richard P. Kluft, a psychiatrist in Bala Cynwyd,
Pennsylvania, focuses therapy for the disorder on providing “good, caring,
nurturing, comforting support” that helps patients feel safe. “The mind starts
to heal in the face of loving care,” he said. Both he and Spiegel often use
hypnosis to facilitate therapy and teach patients how to calm themselves down
with self-hypnosis between sessions.
For patients reluctant to leave behind their “rich inner world,”
Kluft says he welcomes all parts of their personality, helping their various
identities learn to empathize with and respect one another.
Marshall said that as people with multiple identities start to
get healthier, “they can look at what they’re feeling and experiencing and then
make a different choice. They can learn to use their alternates constructively
so they can function in society as an adult person,” which Marshay is gradually
learning to do.
