Reconciling multiple personalities

I watched a Tamil film today, Romba Nallavan Da Nee (You’re a Very Good Man; 2015). The story’s antagonist appears to have dissociative identity disorder. This disorder used to be called ‘multiple personality’ disorder (MPD). However, in the film all the “doctors” keep calling it “disolative” identity disorder, and constantly refer to it as a disease and treat the antagonist as a source of harm for others. This is very typical of Tamil cinema, where professional standards are often so low and its bigshots so small-minded that the social values depicted on screen often belong to the 1980s.

But that’s not the point of this post. The actors’ repeated reference to the disorder as “disolative” is what prompted me to Google it, and that’s how I found out the affliction used to be called MPD. Why was the name changed? I found the answer in a WHO document from 1993, which spelled out a new four-part definition of MPD (reproduced below) and classified it under a wider umbrella of dissociative identity disorders:

A. The existence of two or more distinct personalities within the the individual, only one being evident at a time.
B. Each personality has its own memories, preferences and behaviour patterns, and at some time (and recurrently) takes full control of the individuals behaviour.
C. Inability to recall important personal information, too extensive to be explained by ordinary forgetfulness.
D. Not due to organic mental disorders (e.g. in epileptic disorders) or psychoactive substance-related disorders (e.g. intoxication or withdrawal).

According to Psychology Today, the reason for this move was “to reflect a better understanding of the condition – namely, that it is characterised by a fragmentation … of identity rather than by a proliferation … of separate identities.” This is interesting because, as I was watching Romba Nallavan Da Nee, all I was thinking was that its central conflict was very similar to that in Anniyan (The Outsider), a 2005 Tamil film whose protagonist has three identities: a pedantic lawyer, a swaggering model and a lawless vigilante.

However, while the antagonist’s behaviour in Romba Nallavan Da Nee fit the description of a dissociative identity disorder, the protagonist of Anniyan could only be described as having MPD – and that too in its pre-1993 form: possessing three separate identities, not one identity fragmented three ways. I wonder if the film’s production team had thought these labels through or if they just got lucky. (I wouldn’t be surprised if it was the former; its director, S. Shankar, and the male lead, Vikram, are both known for their meticulous preparations.)

The WHO definition had been carried over into the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. In the controversial fifth edition of this manual, published in May 2013, the list of symptoms of dissociative identity disorder was expanded to include “possession-form phenomena and functional neurological symptoms”. Moreover, according to the DSM 5 website, MPD was removed as a dissociative disorder. Now, dissociative disorders are of the following types:

• Dissociative identity disorder
• Dissociative amnesia
• Depersonalisation disorder

What happened to MPD? It’s as if psychiatrists have decided that it’s impossible for personalities to proliferate later in life such that the same body becomes host to more than one of them. Instead, they’ve agreed what’s likelier to happen is that one personality becomes fragmented into multiple parts.

There’s an obviously interesting consideration here – the one of reconciliation. The post-MPD label of ‘dissociative identity disorder’ implies a person with the identities A, B and C has the overall identity signified as A+B+C. On the other hand, the label of MPD implies a person with the identities A, B and C may not be understood as having an overall identity A+B+C. In this framework, the label of ‘dissociative identity disorder’ does seem more realistic – whereas MPD seems more able to accommodate fantastical narratives (also see the syndrome of approximate answers).

If you thought this discussion was interesting, you might like to read this story of how a young woman with multiple personalities worked to develop a sense of self.