Tuesday, 27 February 2018
Dissociative Identity Disorder, Ambivalence and Responsibility
Today's post is by Michelle Maiese, Associate Professor of Philosophy at Emmanuel College in Boston, Massachusetts. Her research focuses on topics in philosophy of mind, philosophy of psychiatry, and moral psychology.
There has been debate among philosophers about how to address issues of responsibility in cases where subjects suffer from dissociative identity disorder (DID). If one personality commits a wrongful act of which another was unaware, should we regard this individual as responsible for her actions? If we regard DID as a case in which multiple persons inhabit a single body, it may seem natural to conclude that each alter is a separate agent and that one alter is not responsible for the actions of another. However, in “Dissociative Identity Disorder, Ambivalence, and Responsibility", I argue that even once we acknowledge that a subject with DID is a single person, there are still serious reasons to question the extent to which she is responsible for her actions.
This is because a subject suffering from DID often will find it difficult to exercise autonomous agency. This individual cannot control the slide into one or another alter-state, and once she is in that state, she will lack awareness of many considerations favoring a particular course of action. In addition, due to disturbances in memory and self-awareness, the subject with DID is either incapable of remembering prior decisions, or incapable of being properly motivated by them. Even if a subject decides on a course of action, other desires and priorities may ‘take over’ once she switches to a different alter-personality. Also, there may be so much psychological fragmentation and memory loss that it becomes difficult for her to foresee what she will do or assess the long-term consequences of her actions.
I argue that these impairments in agency are the direct result of extreme ambivalence: young children who develop DID experience extreme inner conflict regarding emotional needs to which they feel deeply attached. Suppose that Sue hates her mother and wants her to die, but also loves her mother and wants to have a close relationship with her. Rationality demands that Sue alter her desires appropriately. However, suppose that Sue feels so strongly attached to both of these conflicting desires that there is no way to achieve a well-integrated, unified perspective. What allows her to avoid crumbling under the pressure of inner contradictions is the belief that her conflicting mental states belong to separate selves. That is, she both accepts certain desires and tries to rid herself of them, and those desires that seem like ‘unacceptable intruders’ are handed off to an alter-personality. This ‘handing-off’ of desires and actions thus can be understood as Sue’s attempt to mask contradictions and manage inner conflict. Although extreme dissociation may intensify emotional disturbance over the long-term, it may be in Sue’s short-term interests in the sense that it allows her to compartmentalize painful feelings and memories.
Such compartmentalization can be paralyzing or lead to other disruptions of agency. It is notable that “competing” alter-personalities often vie for control of the body. For example, alters sometimes intervene in the lives of other alters by destroying their school work, spending their money, or hiding their things. This lack of a coherent will also is evidenced via the phenomenon of waverings, when one alter attempts to do something that is directly at odds with the goals and intentions of another. Such struggles for control should be understood as the outward signs of inner conflict. Because the subject with DID suffers from persistent and pervasive ambivalence, she does not form an integrated will and is largely incapable of restructuring it. Since her concerns and attitudes are not integrated, she is unable to arrive at an ‘all-things-considered’ judgment about what it would be best to do
If it is true that subjects with DID suffer from extreme ambivalence of the sort I describe, then it would be a mistake to regard them as responsible for their wrongful actions in the same way that we regard ordinary adults as responsible. However, although autonomy and responsibility are eroded in such cases, they do not disappear altogether. If such a subject behaves wrongfully, there certainly is ‘part’ of her that wanted to do so, and thus, the action is attributable to her. Furthermore, even if she cannot exercise self-determination, it is important to acknowledge that her overall capacity for autonomous agency remains intact. This means there may be steps she can and should take to attempt to restore her autonomy or prevent any immoral actions from occurring.