What Is Split Personality? Early Research on Dissociative Identity Disorder (DID)
Introduction. Split personality
The phenomenon of an alternate personality was first observed by Puységur during his therapy of Victor Race. The insight he gained was the existence of two largely separated psychic layers of the mind which later became the foundation of Freud’s psychoanalysis and Jung’s psychoanalytical psychology. The topic of split personality, also called dual personality, has captured the attention of the scientific community and in today’s mental health nomenclature is called Dissociative Identity Disorder (DID).
The state of alienation in people with split or dual personality (alternated personality) is due to a memory barrier and the fact that a distinct sense of identity is often present in the “second layer” of the psyche. Freud called this psychic layer of the mind the “unconscious”. The unconscious contains thoughts and emotions different, or sometimes even opposed, to those experienced in our ordinary conscious state. When there is a high polarity between the conscious mind and the unconscious, mental health symptoms and disorders manifest.
The cathartic method, the beginning of psychotherapy
Josef Breuer
Josef Breuer (1842-1925), was general practitioner in Vienna. He began using hypnosis to treat patients suffering of psychological symptoms called in this era “hysteria”. He developed his own “cathartic method” for the treatment of hysteria. In the years 1880-82, Breuer treated a patient known as Anna O. (Bertha Pappenheim). He introduced Freud to the case of Anna O. in November 1883. The case fascinated Sigmund Freud to such extent that he gave up neurology and shifted his attention to psychology. Thus, it was the story of this young Viennese girl and the elaborate and sensitive research of Breuer that gave Freud the impulse to start to use hypnosis and set the stage for the development of psychoanalysis.
Case Anna O.
Anna O. (Berta Pappenheim)
In December 1880, Anna O. (Bertha Pappenheim), became Breuer’s patient. She was 21 years old. Breuer used the pseudonym, Anna O., to protect Bertha’s privacy. The most astonishing discovery he made in Anna, was that she presented with two personalities. One personality was in her conscious state where Anna was a fairly normal young woman. The other personality showed in her confused state when she behaved like a naughty and troublesome child. While in her “naughty troublesome child” personality, she showed several abilities she wasn’t able to express in her normal state. Breuer concluded that her illness, her split or dual personality, was linked to her “strong intellect” that she was not using to its full capacity. In his case notes he wrote that Anna was
“physically healthy… intelligence considerable, excellent memory, astonishingly acute gift for combinations and keen intuition”
Tiggering event
Breuer noticed that after Anna’s father dead in 1881, the girl became absent-minded and didn’t eat for days. Breuer observed that in her confused state Anna’s personality changed (split). In such state Anna spoke mostly in English, which she had learned in her early childhood from her governess. Breuer diagnosed Anna with hysteria describing her symptoms as follows:
“severe cough, paralysis of the extremities on the right side of her body, and disturbances of vision, hearing, and speech, as well as hallucination and loss of consciousness.”
He described Anna’s split personality in following words:
“She had two completely separate states of consciousness which alternated quite often and suddenly, and in the course of her illness became more and more distinct. In the one state she was sad and apprehensive, but relatively normal. In the other state she had hallucinations and “misbehaved”, that is, she swore, threw pillows at people.”
Anna was not able to remember in one condition what happened in her other state of mind. Breuer concluded that:
“It is difficult to avoid saying that she dissolved into two personalities, one of which was psychically normal and the other mentally ill.”
Case of transference
Breuer treated Anna for two years spending several hundred hours with her. After her father’s death he had become particularly emotionally important to her.
In modern psychoanalytic language therapists call such emotional connection “transference”. Psychologists and psychiatrist speak of transference when a patient “transfers” his or her feelings that they had for their important childhood “objects” onto the psychotherapist. Transference is natural and, as Freud admitted, the emotions are the same that come into play in a romantic involvement. Today an important cornerstone for psychologists in the psychoanalytic training is to recognize the phenomenon of transference. In the early days of the practice of psychotherapy this psychological mechanism had not been identified yet.
After having recognized his emotional importance for Anna, Breuer decided to terminate the treatment. He referred her to the private Bellevue Clinic in Kreuzlingen.
Breuer’s contribution to psychotherapy
In 1895 Breuer and Freud jointly published the book titled, “Studies on Hysteria”. This text became the foundation of psychoanalysis. Today, the mental health community only recognizes Breuer as a collaborator of Sigmund Freud and the co-author of this book. However, Breuer was the more experienced physician and served as Sigmund Feud’s mentor.
During his work with Anna, Breuer observed that her symptoms were triggered by the illness of her father and worsened massively after his death. He also identified the other core issue, which was Anna’s intellectual stagnation due to the restrictive rules imposed on her by the family. Breuer was aware of the importance of sexuality, but he saw it as one of many factors causing hysteria. In opposition to Freud’s sexual theory, Breuer emphasized the role of psychic trauma as the origin of neurosis. Reporting Anna’s case he wrote: “the element of sexuality was astonishingly undeveloped in her”.
After the departure from Freud, he wrote to the Swiss psychiatrist Auguste Forel:
“Freud is a man given to absolute and exclusive formulations: this is a psychical need, which in my opinion, leads to excessive generalization.”
The psychiatric community largely underestimated Breuer. His name fell into oblivion and Sigmund Freud overshadowed him. But it was Breuer who developed the treatment method remarkably similar to the modern psychotherapy. The later life achievements of Berta Pappenheim (Anna O.) proved Breuer’s treatment had been successful.
Puysegur’s concept of “alternate personality” and the Jungian “Self”
Two decades after Freud’s studies about the case of Anna O., C.G.Jung investigated the mediumistic medium, his cousin Ellen Preisberg. While being in trance, Ellen displayed a different personality that had a far brighter mind than the one in her conscious state. She was able to speak High German whilst in her conscious state she spoke only the local Swiss dialect. Jung described the results of his research in his doctoral dissertation “On the Psychology and Pathology of So-Called Occult Phenomena”.
These cases and later observations led Jung to the conclusion, that underneath the threshold of consciousness a deeper layer of personality was hidden, which he called the “Self”. He observed that the individual develops mental health symptoms when the two layers of the psyche drift apart. He called the conscious part – following Freud – the “Ego-consciousness” and the unconscious part, similar to Puységur’s alternate personality (divided personality) possessing a bigger insight, the “Self”.
Dissociative Identity Disorder (DID)
Breuer, Freud, and Jung created the foundation for psychoanalysis and psychoanalytic psychotherapy including the discovery of the “split personality”. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-II, named split personality or dual personality “dissociative disorder”. In the latest edition (DSM V) the term has been changed into Dissociate Identity Disorder (DID). DID can trigger a sudden shift from one personality to another personality which functions in a helping capacity. The other personality is more suitable to cope with difficult life circumstances. Dissociative Identity Disorder is exceedingly rare psychiatric condition.
DSM-5 diagnostic criteria for Dissociative Identity Disorder are:
– Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
– Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
– The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
– The disturbance is not part of normal cultural or religious practices.
– The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition
