While many cases of DID present with perhaps ten to fifteen alters and total/near total amnestic barriers between them, there are many variations and deviations from this usual presentation. I have seen well defined cases of DID with a large number of alters, up to hundreds. I don’t think the number is critical, whether it is a few or several hundred because I did not intend to make every alter my patient. I only spoke to those who wished to speak to me, or those I might help to address their specific issues. At the same time, it is important to be aware that they are always there, that whenever you are talking to one alter, the others are there – behind the curtain, so to speak. In DID therapy, the therapist never really speaks to one alter alone.
Oxnam brings out a point that may be helpful for therapists to get a better sense of the phenomenon of multiplicity. In considering a house, one can look at the number of rooms as the key quality, or the way the house is internally partitioned by walls. He suggests that it is useful to think of the walls, rather than the number of rooms. So, instead of considering the number of alters, let us think of the walls between them. It is the amnestic barriers that are blocking the communication and creating the internal experience that each alter needs to be fighting for its individual right to exist.
This fight is what renders the DID person partially or totally dysfunctional. There may be frequent clashes over time use. For example, one alter may insist on her right to go out partying at night when the host, another alter, may feel strongly that sleep is needed because she has to work the next day. In that same way, there may be intense emotional clashes, such as when one alter wants to start, continue or return to a retraumatizing relationship that another alter is terrified about and yet another alter may be enraged about. I have also had patients with alter(s) who kept on sabotaging the therapy. What can you do with a patient who is motivated to come for treatment but keeps missing appointments?
There are exceptions I have come across. These exceptions are when someone has DID but whose alters are all there in the open, with minimal amnestic barriers or partitions. However, they still have a will of their own sense of individuality. They fail to see the need to compromise, communicate and coordinate. They do not see such conduct, to do what is good for the common good of the one individual whose body they all share, as beneficial for them. When they each insist on individual rights because of a sense of separateness, the system will run into trouble.
The most common DID complaint is the symptom of “time loss.” In time loss, the patient cannot account for periods of time when he/she is not sleeping. But, there is no memory of what happened during those periods. For people without dissociative pathologies, it is hard to imagine having zero recollection of what had transpired while awake and conscious.
This might seem incomprehensible. After all, when we forget what we did yesterday, once we get a few cues for our memory – the new shoes that were purchased, or the wine stained shirt – we usually remember. So, the first reaction of ordinary individuals is that perhaps this person is faking it. This degree of dissociation is hard to grasp, until someone you trust tells you, “yes, that indeed happened.”
Dissociative symptoms are much more frequently encountered than people are willing to acknowledge. Therapists should change their index of suspicion to overcome that general lack of awareness of this DID.
