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Dissociative Identity Disorder (DID) has a long history, it was first discovered in 1791 when a woman was found to have both a French and a German personality. Many studies were completed between 1880 and 1920 and by 1944 it was reported that 67% of DID patients had been discovered. Dissociative identity disorder then fell off the radar as schizophrenia became increasingly diagnosed. There was a lack of focus on DID until the 1970’s when the book Sybil was released. The publication of this book led to an increased diagnosis of dissociative identity disorder and it is reported that in the 1970’s alone, more cases of DID were reported then all the cases documented since 1816. Furthermore, as more cases of DID came to light, more alternate personalities were also reported. The majority of DID cases in 1944 contained the manifestation of only 2 personalities, whereas in 1997 there was an average of 15.7 alters noted in the cases that were reported. It is now common for a patient to have between 8 and 13 alters, but there have been cases documented with more than 100 alters within one individual .

There are many famous cases of dissociative identity disorder, however, one of the most famous cases where the subject is still alive today is Karen Overhill. Her psychiatrist, Richard Baer’s account of treating Karen can be found in the novel Switching Time. Karen Overhill first discovered something was wrong when she woke up after the birth of her child unaware of who she was and her pregnancy. This led to her developing depression, which was the original reason for her seeing her psychiatrist. Throughout the novel we discover that Karen has suffered horrific abuse from multiple people in her life, both in her childhood and her adult life. She was abused physically by her husband and her father, who would often also leave her to die when she needed urgent medical care. She was also abused sexually by her father, grandfather, Grandma’s friend and by the cult her father took her too. These instances of abuse, specifically some of the sexual abuse she endured, was horrific and played a big part in the formation of her alters. An example is her alter Julie, who experienced intense pain in her legs to the point where she was unable to walk. It is later discovered that Julie was the dominant alter when Karen’s father lent her out to his friends for sex . Julie suffers from the intense pain and lack of ability to walk due to the weight of all the men on top of her. This depicts how an alter is affected by the environment of the person. The personalities helped Karen escape all forms of pain, while it was mostly the different forms of abuse, Karen was protected even from the simple things such as a headache. When forming a headache, she would often dissociate before becoming the dominant personality again once she no longer had a headache. While this did often help protect her, it was also dangerous. For example, she once stayed at her work for an entire day due to not feeling any pain, when in reality she needed an appendectomy. This portrays why it was so important for the alters to be in tune with each other.

Within Karen, as with most cases of DID, most alters had a specific role. Some examples are Holdon, a 34-year-old male, who was the protector that helped make decisions about which alter was allowed to be dominant; Katherine an older lady who helped organised Karen’s daily life and looked after the younger alters within Karen ; Julie who suffered the sexual abuse from her father’s friends; Miles who would become dominant when Karen was present at the cult and would help her keep the cult side of her life separate from her daily life; Jensen who was one of Karen’s earliest personalities and fought back against the abuse. He would often try to bind down Karen’s breasts to make her seem less feminine in an attempt to protect her from the sexual abuse . This illustrates how many of Karen’s alters had a role in attempting to protect her from all forms of abuse and from any events in her daily life that could be upsetting. Furthermore, each personality had distinct characteristics, ages, races and gaits, even the hand they wrote with altered with each personality. For example, 2-year-old Karen Boo was Hungarian, 5-year-old Sydney pathologically stole and 13-year-old Julie had Asthma.

Karen would sometimes get hint of the other personalities within her but wouldn’t be able to understand what she saw. The most common form of this was occasionally hearing voices in her head. Furthermore, she once had a dream were lots of people came to her and spoke before disappearing. Dr. Baer believed this to be her alters that she envisioned in a dream. Through time and patience Dr. Baer met all 17 personalities, even personalities such as Ann who had previously not been allowed to become dominant for over 19 years. Karen was treated as most people with dissociative identity disorder are. Each alter was made aware of each other in an attempt to ensure that she was not “losing time”. This allowed for Karen to live in harmony with her other alters and therefore she almost became a complete personality. As of April 1998, Karen Overhill has reportedly integrated all 17 of her personalities. Dr. Richard Baer stated that although her personalities have been integrated, she still has to continue her therapy and healthy lifestyle changers, which factor into the success of her treatments. She has not had a dissociative episode since April 1998.

When looking at Karen’s story we can determine that abuse has had a large part in in her DID. This conclusion can be made as many of her personalities have a role and become present during certain points of her abuse. Furthermore, some of her personalities have been affected permanently by the abuse, such as Jensen and Julie. This is because young children’s brains are less mature than adults and therefore, they are more susceptible to developing the disorder as their sense of self and personality are not yet cohesive . Furthermore, they are less able then adults to cope with and integrate traumatic experiences which can lead them to dissociate. This is especially relevant to children who live in a neglectful home as their parents will often not help them cope with difficult feelings and situations. This inability to discuss their trauma will lead to them dissociating to ensure that the child does not have to cope with the trauma. Therefore, a reasonable conclusion is that both the physical and the sexual abuse where the traumatic events that contributed to Karen’s DID.

It is important to note when referring to the book Switching Time, that the book was written by Karen’s psychiatrist and not Karen herself. This can influence the reliability with which you perceive the book. Some people may state that it is not completely reliable as Dr. Baer did not experience the dissociating and therefore, he may not accurately present it. Furthermore, he was unable to confirm whether the abuse was always accurate or whether it may have been exaggerated due to the young age (2 years) that Karen claimed she was when the abuse started. This is especially important when taking note that Karen was neglected by her mother and therefore, may have embellished some of the accounts as a form of attention. However, it is then also crucial to look at the counter part which states that her father was eventually jailed in 1993 on 19 accounts of sexual abuse. This ensure that there is more reliability that Karen truly was abused as her father had done it on many accounts. Furthermore, it is vital to note that at the young age Karen was it would have been incredibly hard for to imagine the trauma that occurred to her. A lot of the abuse described in the book was incredibly gruesome and specific. It would be hard for an adult to fabricate let alone for a young child. When looking at the data it is also imperative to understand that the book can also be viewed as more reliable coming from Dr. Baer. Baer was able to talk to Karen throughout her treatment. Even though if the book had been written by Karen it would have been written by the source, she would have not been in the right state of mind to fully understand what was occurring and to later write a book on the topic. This may have led to an unreliable account of Karen’s journey.

Another famous of case of dissociative identity disorder is Billy Milligan. Billy Milligan has become famous after being the first ever court case to plead insanity and win. Milligan was initially arrested on 3 accounts of mugging and rape. It would later be discovered that two different personalities had been in charge of this crime; Ragen Vadascovinich a Yugoslavian, and Adalana a lesbian who is lonely. It was Ragen, the protector and keeper of hate, who would initially attack the women. However, Adalana would then take over without Ragen’s permission and rape the women so that she was able to feel a sense of comfort and belonging. The sudden take over from Adalana led to her becoming an undesirable. Billy’s plea in court led to him seeing a psychiatrist who was able to interact with 10 of Billy’s personalities, the desirables. These interactions allowed him to win his case and from there he was taken to the Athens Mental Health Centre where he met Dr. David Caul. Dr. Caul was the first to see that Billy had more than 10 personalities. Billy ended up having 24 personalities; 10 desirable, 13 undesirables and the teacher. The teacher was the sum of all 23 personalities fused together. The teacher had almost a perfect recall of every event and allowed Billy to start recovery.

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The next question is whether abuse was a contributing factor in Billy’s development of DID. David, who was eight and the keeper of pain, stated that Billy was sexually abused by his stepfather at the age of eight which led to the first ‘split’ in Billy’s personality and to the formation of David. However, this claim of abuse has been heavily scrutinized by many people and to this day we are unable to conclusively say that sexual abuse had occurred. Billy has been in and out of mental treatment throughout his life , whether this was due to the abuse or something else has never been stated.

It is important to look at the differences between Karen and Billy in the disorder. For example, the term undesirables was never mentioned in Karen’s accounts. In Karen’s case each personality was controlled by Holdon to ensure that they were as cohesive as possible. However, with Billy, Arthur was in charge and he had created the undesirables. The undesirables were 13 alters who Arthur stated would never become dominant again as they had undesirable traits. Furthermore, Karen accessed her personalities through a small cupboard which she viewed in her mind. Billy however, viewed it as having a spotlight in his head which all the personalities sat around, and the dominant alter at that time would be standing in the spotlight. This shows that dissociative identity disorder, like any mental illness, has different ways of displaying itself.

When analyzing Billy’s case, it is important to take into consideration that the book was written by an outside source who was not related to the case until they started writing the book. Therefore, some of the information inside the book may not be completely factual or reliable. Daniel Keyes, the author, does however explain in the preface how he has tried to maintain integrity within his work. Keyes ensured that when he spoke to Billy to understand his story, he spoke to the teacher who had a more collated memory. Keyes also accepted that there were people who believed that Billy truly did have dissociative identity disorder, and there were people who believed that Billy was an incredible con man who was willing to fake this disorder to escape prison. Therefore, Keyes tried to ensure that he spoke to as many people from both groups so that he would be able to form a well-rounded view of the situation. Additionally, Keyes approached Billy with an attitude of scepticism to ensure that he did not favour a certain side when writing his book.

Another famous case of dissociative identity disorder is the case of Chris Costner Sizemore. Chris Costner Sizemore remembers her first personality split at the age of two when she witnessed a man being pulled out of a ditch and thought he was dead . After witnessing that event and later witnessing a gory factory accident, Sizemore started acting strangely and would often be blamed for things that she had no memory of. The main difference between Sizemore and the other two cases of dissociative identity disorder, is that Sizemore never suffered any abuse and came from a loving family. Sizemore first sought help after the birth of her child when one of her personalities Eve Black tried to strangle the baby. It was only due to the alter Eve White stepping in that the baby was saved. She saw 8 different psychiatrists in a span of 25 years, during which time she developed a total of 22 alters. It was only in July 1974 that Sizemore was able to integrate all of her personalities to leave her with just one personality.

The book The Three Faces of Eve, which was later adapted into a movie, was written by Sizemore’s first doctor Thigpen and another doctor named Hervey M. Cleckley. The book states that Sizemore only had three personalities; Black Eve, White Eve and Jane, however we know this to be untrue. Therefore, we must question whether the rest of the account can be regarded as reliable. On the other hand, Sizemore herself stated that the movie adaption of the book was accurate in many ways. Sizemore praised the movie for its accuracy in 1977 and stated that the abrupt changes in personality were accurately presented even though it was an area of the movie that was often criticised by the media. Therefore, we can assume that there is an element of truth in the accounts.

Throughout all three cases, and most cases of dissociative identity disorder around the world, not all alters are aware of each other and the suffering they have experienced. Therefore, an important part of treatment is helping the patients find a way to merge all their personalities into one personality. This can be incredibly difficult and time-consuming as seen in Sizemore’s case where it took 8 years of therapy. A part of the therapy would be in ensuring that the alters felt safe. This is because many of the alters will have only truly suffered abuse and may not have been conscious when the patient escaped from the abuser, whether it was by running away, the abuser dying, or the abuser being locked up. This can be a massively influential part in them being able to relinquish control. For many of the alters, protecting the patient is their only goal. For example, in Karen Overhill some of the younger alters were still in fear of Karen’s father who had been locked up and this led to huge amounts of emotional distress. Therefore, helping each alter understand that they are safe is hugely important. It is also important, considering some alters can be harmful to themselves or others, that they are spoken to so that they are able to understand their reasoning for hurting themselves or others. The alters will be able to interact with one another through gradual assistance. This allows them to work cohesively and can be less frightening for those who are ‘losing time’ and don’t understand why.

Psychiatrists need to be considerate and understanding when treating a patient. Abuse is so often a factor in the development of dissociative identity disorder. It can often be incredibly gruesome accounts of this trauma during their childhood. Therefore, they must be treated gently so that personalities feel comfortable showing themselves and re-accounting these moments.

While abuse may not be influential factor throughout these three cases, childhood trauma is. It is believed that dissociative identity disorder is a form of PTSD, also known as post-traumatic stress disorder. Dissociative identity disorder is form of coping that usually occurs when the trauma transpires during their childhood, and they are not given the right tools by parents to cope with that trauma. The prevalence of a DID diagnosis increases among clients of counsellors who offer trauma-focused counselling which suggest that dissociation is often linked to traumatic experiences . It has been documented that the main form of trauma is abuse. A study showed that among those reported to have DID in the US, Canada and Europe, approximately 90% report a history of abuse during their childhood . From these reports of abuse in America, 71% of clients with DID have experienced childhood physical abuse and 74% have experienced sexual abuse. However, while it does seem to be a contributing factor, researchers have never investigated whether abuse was also a factor that contributed to other mental illnesses such as anxiety, eating disorders and other personality disorders . Therefore, while abuse may be a factor for dissociative identity disorder, we are still unable to conclude whether abuse is a factor that is truly linked to only dissociative identity disorder or whether it is generally detrimental to someone’s mental health. Furthermore, we cannot always be certain that the abuse that is stated in cases truly occurred, or even that the disorder is truly present in certain patients. For example, a famous case of DID that turned out to be a lie was Sybil. Sybil, who is really called Shirley Mason, initially sought psychiatric help as she was emotionally unstable . However, she then became attached to her psychiatrist Dr Connie Wilbur who had an interest in dissociative identity disorder. Due to this attachment Shirley started faking having multiple personalities by changing voices and posture. After that Dr. Wilbur had started spending more time with Shirley whether in therapy or having dinner with her. Shirley eventually tried to set the record straight and sent out an email saying that she had lied about the personalities. This case has become famous due to the extent of the lie that occurred, and it has caused many people to question whether dissociative identity disorder is real or whether it is just a “fad” that allows people to get away with crime, or helps them become famous.

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