Chapter 6

The Multiple Identity Response (MIR)

The DCS responds to and is shaped by its environment. Under certain conditions, it produces the multiple identity response (MIR), which specifically refers to the adaptive response of the DCS that produces the embodiment of alternate identities. As an adaptive response, the MIR blends resistance and submission to the environmental stressors.

Before the MIR is activated, the abused child undergoes a number of other stress responses to the abuse. These responses are often present at the beginning of the MIR. The MIR takes its place in a spectrum of general responses to pain and shock.

The stress response to abuse

The responses to abuse follow the stages of the stress response - alarm, resistance and exhaustion. However, the cycles are layered. There are responses to individual acts of abuse, generalized stress as a result from ongoing oppression and adaptive responses to the social environment. There are also simultaneous levels of the GAS taking place. For example, physiological processes may reach exhaustion quite early on, and damage is done to the body that is irreparable, while other responses are only beginning.

The strategy to survive severe stress is to avoid using up adaptation energy before one escapes the stressor (Selye, 1978). Therefore we can predict that:

Survivors of abuse report a wide variety of responses to their trauma as well as effects from the abuse. They include minimizing the effects of abuse, leaving the body during the abuse, repressing all memories of abuse or denying some aspects of abuse, forgetting the abuse even as it happens, feeling depressed, spacing out, keeping oneself busy, drinking or abusing drugs, escaping through fantasy or television, self-mutilation, attempting suicide, lying, stealing, gambling, workaholism and developing low self-esteem, compulsive behaviours and eating difficulties (Bass & Davis, 1988). Sometimes conditioning effects are evident, such as in the well-developed startle reflex exhibited by many survivors of abuse, and the critical inner self.

The model predicts that it would be rare that a survivor of abuse would have only one response to abuse. Each coping strategy has only a limited effectiveness. The DCS will naturally use responses that take the least effort, and vary the responses, seeking a homeostasis that accommodates the level of abuse and requires no further adaptation.

Unfortunately, there seems to be little systematic research into examining what types of responses emerge first, how rapidly sequential responses are employed and how these responses change over time. There is considerable evidence that individuals with Dissociative Identity Disorder also have a plethora of other difficulties, possible testimony to the variety of responses that have all been employed in surviving ongoing abuse. Some studies have indicated that 60% (Ross et al., 1990) to 70% (Horevitz & Braun, 1984) of Dissociative Identity Disorder patients also met the criteria for borderline personality disorder. Others suggest that 80% of Dissociative Identity Disorder patients have a co-morbidity for Post Traumatic Stress Disorder, and that the remainder are likely have some symptoms of Post Traumatic Stress Disorder (Armstrong & Loewenstein, 1990; Dell & Eisenhower, 1990; Kluft, 1988a).

The GAS model predicts that responses will generalize and become systemic as they accumulate over time. For example, the difficulties in staying in one's body during sexual abuse may lead to broader disruptions in embodiment, such as eating disorders (Young, 1992).

Mechanisms of dissociation

Autohypnosis

High hypnotizability is consistently mentioned as a factor in Dissociative Identity Disorder (Marmer, 1991; Watkins, 1993; Hilgard, 1977; Bliss, 1986). However, because of the dearth of longitudinal studies, it can be difficult to tell whether the high abilities of autohypnosis and capacity for dissociation are inherent and somehow genetically predetermined, or if long practice has developed this skill.

We do know that only individuals who are highly hypnotizable are more effective in reducing the sensation of pain (Bowers, 1991). In the DCS, autohypnosis is a preferred method of pain reduction because it requires little effort to maintain once it has been established (Bowers, 1991). While cognitive strategies can reduce pain, they impair cognitive function and are effortful to maintain (Miller, 1986). Conserving adaptive energy is essential in surviving ongoing abuse.

State dependent learning

Once dissociation of any type has begun, the phenomenon of state dependent learning must be taken into account. As the identities diverge, their learning curves also differentiate. The changing states of inhibition and disinhibition provide divergent chemical and electrical sensitivities between identities. For example, in treating Dissociative Identity Disorder, frequent state-dependent medication effects have been reported (Loewenstein, 1991). This effect is not limited to Dissociative Identity Disorder patients. Individuals in extreme states of mania and with delirium tremens have also demonstrated high medication tolerances that are state dependent (Loewenstein, 1991). The state dependent effects could be the result of "altered peripheral metabolism or clearance alone, or the varying activation or deactivation of neuroendocrine aggregates in different behavioral states; variation in the neuroendocrine environment of the drug receptors in the central nervous system (CNS); state-dependent changes in drug receptor number, receptor conformation or binding ability; alterations in second messenger function; or more than one of these processes (Loewenstein, 1991, p. 724)." These physiological markers for state-dependent effects are the same as the responses of the GAS to a stressor.

Body memories of pain

There is some debate about how dissociation exactly manages to inhibit the sensation of pain. Some theorists have suggested that the pain is displaced into underlying ego states or the hidden observer, but it does not just "go away" (Watkins & Watkins, 1990). In a neurological model, pain is an internally produced experience, a response to stimuli. Dissociating from pain is the process of selectively inhibiting pain receptors below the conscious levels of the central nervous system, so the chemical and electrical responses to pain is localized in the part of the body where the direct pain is occurring. This model predicts that only "memory" or chemical and electrical responsiveness to similar stimuli, would occur directly in this region. Selye (1978) frequently reported such conditioned responses to stressors occurring on a cellular level. This may account for the high rates of somatization disorders in Dissociative Identity Disorder patients (Coons, 1988).

The body literally holds the memories of the painful experience at the cellular level (Selye, 1978). A specific area might be sensitized to certain stimuli, for example the arthritic swelling of ankles and wrists that have been chained during abuse (Frank, 1990) or unexplained pelvic pain (Coons, 1988).

In the MIR, the sensitization process can be limited to a specific identity. In this sense, it appears that Watkins & Watkins are correct that the pain does not simply disappear. The MIR encapsulates the pain response. Anecdotal evidence indicates that physical stigmata can be associated with the emergence of alternate identities, such as welts and marks emerging upon transition to a child identity (Miller & Triggiano, 1992). Asthma, a stress related illness, is found in some alternate identities (American Psychiatric Association, 1994). Abreacting the memories can relieve the somatic diseases of adaptation (Coons, 1988). Abreaction is the process of reliving the experience, often under hypnosis, where the patient is encouraged to break the amnesiac barrier and allows the DCS to re-establish integrative functions (Fike, 1990b). The fact that emotional catharsis can relieve physical illnesses is yet another indication of the importance of bridging the gap of the mind/body split when examining the MIR.

The stages of the MIR

The stages of the MIR follow the three stages of the GAS - alarm, adaptation and exhaustion. Within each of these stages, are the two interconnected aspects of submission and resistance. Resistance is lowered during the initial alarm stage and the stage of exhaustion.

Resistance is at its height during the adaptation stage. This cycle is ongoing throughout the life history of the MIR, with different levels and cycles building cumulative responses. The developmental aspects of this cumulative response will be discussed in the next chapter, here the mechanisms of adaptation in childhood and adulthood are outlined.

Stage 1 Alarm

The first stage takes place during each incident of trauma. At this point, the identities that characterize the MIR are not entirely formed. The gradual sensitization effects of different modules will create dissociative relationships in the DCS. The alarm stage involves a lowered level of resistance, a state of shock that largely accommodates the trauma. Although there are elements of resistance, they are mostly passive and focus on making the shock bearable.

Submission

The child must present a submissive response to the abuse - compliance to the stressor in order to survive. Sensitization and conditioning effects are likely to have already developed in some modules in the DCS. For example, if the abuser demands the child act as if the abuse is enjoyable, carrying out this behaviour involves inhibiting emotions and thoughts that contradict this behaviour. This results in a shifting relationship between modules.

With the continuing presence of certain stimuli (such as the demands of the abuser), some modules become more developed and capable of inhibiting other modules. As time progresses, these modules must begin to function more independently and on a wider range of behaviour. During the abuse, the child must still respond to demands for sleep, food and other behaviours that may be elicited during the abuse. The module becomes more complex over time until is has its own integrated and coherent structure.

Identities created at this time are the nearly ubiquitous child identities, found in 86% (Ross, Norton & Wozney, 1989) of all cases of multiple personality. They are frequently without awareness of feeling and unable to experience pleasure (Fike, 1990b). Clinical observations of child identities characterize them as "shy and withdrawn and have difficulty coming out except when the patient is alone or in psychotherapy" (Fike, 1990b, p. 1003).

Resistance

Even such apparently submissive behaviour has elements of resistance. The creation of identities is a form of diversion, like the opposum that plays dead when attacked, presenting this compliant appearance confuses the abuser into thinking their control is complete and their assault has worked. This may prevent the abuser from attempting further and more damaging techniques to dominate the child.

The child also resists the conditioning effects of abuse, by inhibiting the re-entrant signals between parallel modules that allow information to be integrated throughout the DCS. This isolates the conditioning effect to only one module. The process is gradual and incomplete, survivors of shock frequently report feeling distanced from their memories, forgetting them at times or finding them easy to "put out of mind" (Bass & Davis, 1988). This inhibitory process strengthens with repetition and gradually forms the MIR. Initial identities are likely to be limited and fragmentary in nature. Children have fewer identities, and the identities are less defined than adolescents or adults (Baldwin, 1990).

By the time the MIR is fully developed, the inhibition of re-entrant signals is virtually complete. Even when amnesia was not a criteria for Dissociative Identity Disorder, amnesia between personalities occurred in 94.9% (Ross, Norton & Wozney, 1989) to 98% (Putnam, 1986) of cases reported. The amnesia is similar to the inflammation that occurs during a physiological GAS, its purpose is to localize the stressor by putting a barrier around it (such as that of inflamed tissue). This amnesiac barrier prevents the spread of the irritant into the system. It represents fight, not flight, and is an attempt to inactivate the aggressor and protect the surrounding dynamic consciousness system. The MIR is an attempt to adapt to the trauma by isolating parts of the modular system and at the same time providing appropriate responses to ensure survival. The sensitizing effects of the trauma on one module is deepened, but isolated from the rest of the DCS.

The capacities of the DCS are expanded by the MIR. The MIR multiplies the number of times some basic responses can be used before exhaustion sets in, because the effects of such trauma are limited from doing systemic damage. Putnam et al. (1984) observed that several disorders could be sequestered in specific identities, but not across the dynamic consciousness system. The DCS survives by avoiding the cumulative effects of the trauma.

Stage 2 Adaptation

In this stage, most of adaptive energy still goes to creating new identities. However, the focus is now on resisting the influence of the stressor. The role of amnesia is also changed.

Submission

As the abuse continues, the stages of the GAS repeat themselves over time. However, the DCS is now affected by the ongoing development of alternate identities. The function of the identities created directly in response to the abuser's demands are frequently compliant or passive. The stability of the DCS is affected by increasingly conditioned identities. Once the alarm stage has passed, increased resistance resumes in the DCS in an attempt to resume a heterostasis.

Resistance

The next step of the DCS is to form counter identities to stabilize the adaptations. For example, where the abusive experiences are stored in a passive, child identity (the submission), the DCS creates a protector identity (resistance) to balance the system. Where one identity is conditioned to present sexual submissiveness, another identity will express the suppressed rage. This stage is cumulative to the initial changes that took place during the alarm stage. The basic structures created during the alarm stage cannot be disturbed, but new developments can take place. For example, creating a protective identity involves resisting abuse, yet this resistance is encapsulated. In the abusive situation, resistance is not tolerated, and the child must control the resistance and anger as long as the abuser is present.Consequently, the resistance is contained as much as the submission is contained, but the system is now balanced. This represents the cumulative processes involved in the GAS. For example, the four most common identities are the child (or victim) personalities and protector (or rescuer) identities, persecuting identities and inner healers (Price, 1988; Ross, Norton & Wozney, 1989). They often are found in exact balance to each other. For example, persecuting and healing identities are both found in 84% of patients (Ross, Norton & Wozney, 1989).

The amnesia at this stage also functions to reduce conflict between identities, as well as isolate the specific effects of the abuse (Berman, 1981). Kluft (1984) reports that as the amnesiac barriers begin to fall during therapy, the MIR loses some of its functioning effectiveness. Social skills, self-care skills, the ability to keep a job, maintain relationships and care for their children diminish, especially during difficult stages of therapy.

Stage 3 Exhaustion

In the exhaustion stage, adaptive responses, of either submission or resistance, no longer take place. It is the end of the GAS. The stressor is no longer contained, and its effects become systemic. In most cases, exhaustion does not occur. Preventing exhaustion is that main function of the MIR. Although individual strategies may be exhausted and no longer able to maintain the adaptive resistance, systemic exhaustion occurs when the individual has no more strategies. Hopefully, systemic exhaustion is never reached while the individual is still in the control of the perpetrator. Once the adaptive energy is consumed, the child would have no defenses against the trauma. The fact that 72% of patients with Dissociative Identity Disorder attempted suicide at some point in their life (Ross & Norton, 1989) indicates how ongoing abuse truly taxes the limited resources of the child. The rapid deterioration in physical health that can occur in older patients also indicates the rapid progression of stress related diseases that can occur during decompensation (Kluft, 1988c).

Stages of exhaustion are seen in clinical studies with adult clients. The early stages of exhaustion are similar to the initial alarm stages, with a lowering of resistance, as the adaptive functions lose their ability to respond. Decompensation is sometimes seen in patients during therapy where new identities emerge as the layers of defense are peeled away (Kluft, 1986). It could be that individuals who seek therapy are aware that their responses are nearing exhaustion and/or that the re-traumatizing process of therapy leads to decompensation. Often, Post Traumatic Stress Disorder emerges in 80% or more of the patients in intense therapy (Loewenstein, 1991). Horevitz & Braun (1984) also reported that the co-occurrence of other indices of discomfort and pathology is correlated with overall difficulties in functioning. This may indicate that individuals who have survived extreme abuse, and used many different strategies to survive over time, have reached the limit of their adaptive energy and now have difficulty simply adapting to more common stressors in life.

Awareness of the developmental nature of the MIR should alert therapists to this type of client. In such cases, the therapy should proceed with caution. In the case of older clients, whose adaptive energy is limited, therapists recognize that treatment needs to proceed more slowly than usual, avoiding dramatic changes that might initiate decompensation (Kluft, 1988c).

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