How does DID disrupt lives? The chronicity of a DID diagnosis, would normally determine the gravity of its interference in the normal lifestyle of the patient. The level of DID severity is measured by several psychiatric and psychological instruments in an initial diagnostic intake interview, that would also assess the client’s Global Assessment of Functioning. Hence, the treatment regime would invariably focus on alleviating the disruptive nature of the disorder, inclusive of the threat of a suicide attempt, if present. Here are a few stories of patients’ experiences of their disorder.

Catherine is a food technologist and a team leader in her department in a multinational corporation. The high stress level in her division meant that from time-to-time she would dissociate at work. There would be periods at her workplace she has no memory recall. This is an additional level of stress for her as teamwork is essential. When she gets home, she is mentally exhausted, and further dissociates herself by fugue trips during the early hours of the morning without her husband’s knowledge. (Fugues are periods when a person wanders away from home with no memory of who she is, and do not remember how they got there). On one occasion, one of her dissociated parts was planning a fugue suicide trip: by bringing an overdose of her medicine with her in the car. Thankfully, she woke-up from her fugue in time, after driving to her destination, in a remote part of Singapore.

Any disagreements between husband and wife or any major unforeseen family news would trigger Jane’s dissociative state. At times she would faint while she was shopping or marketing and would remain unconscious for 15 minutes or so. At times longer. She would also suddenly sit-up in bed at around midnight and berate her husband for his past indiscretions and mistakes. Occasionally, she would physically attack him. All her dissociative incidents remain outside of her conscious memory system.

Jonathan, in his 20s, would be watching television and when a violent scene was screened, he would dissociate. One of his alters would take over and be watching the rest of the TV programme. None of his family members were aware of these changeovers, but when they questioned him after the show on different incidents in the movie, he cannot recall viewing them. Similarly, this would recur when he was reading a story with brutal episodes or a description of savagery in the newspapers. To discuss any event with violent scenarios with Jonathan would become a frustrating affair for anyone.

Amanda would be discussing a class topic with friends at her college when a loud noise nearby or someone quarrelling in the distance would suddenly cause her to dissociate. When her friends call out to her as she walks away from her group, she does not hear them. It’s as though the part that surfaces do not recognize her friends. These episodes happen so regularly that Amanda’s friends had taken for granted that she was habitually in a rush to get somewhere rather than be talking with them.

Janet would be sitting quietly, with her husband next to her, in church, during a Sunday service. While preaching, the pastor raised his voice excitedly to make a point in his sermon over the microphone, Janet immediately dissociated. She screamed at the top of her voice followed by uncontrollable weeping, disrupting the service. This happened numerous times, and on each occasion, she would be led away from the service by a staff. After she had time to regain her composure and back to her normal self, she couldn’t recall her screams and tears nor what triggered her dissociation. But after each occasion, her reactions to her pastor’s occasional loud pronouncements deeply embarrassed her and her husband.

​The occurrence of individual triggers affect DID patients in numerous ways, and their regularity and severity in disabling normal thinking and memory processes would depend on whether the person is co-conscious or not with their respective alters or dissociative parts. When co-consciousness exists, a level of control can be learnt. Inversely, without co-consciousness with surfacing parts can be frustrating, and certainly disorientating and demeaning to one’s self-confidence and self-efficacy.  

These are a few patients’ stories in my previous caseload who suffered from schizophrenia. Their names have been changed.

Thomas was my very first case in counselling. A staff had found him wandering outside a church’s compound. I happened to be visiting their office to finalize my attachment as a trainee psychologist to the church’s counselling centre. Thomas’ case was immediately assigned to me. 

The next two hours were spent in an initial intake interview. Thomas was incoherent and his thoughts seemed disorganized. He had spent the morning walking the streets aimlessly after parking his taxi nearby. All he could recall was that some years back, he had attended a service at this church. In between his answers to my questions, his mind would wander. From time-to-time he would be in a catatonic state. Suspecting schizophrenia as a possible diagnosis, I began probing him on his background leading to his psychiatric condition. 

Thomas was fifty years of age, married, with a teenage daughter, but living alone. He had been driving a taxi for a living for about three months. Prior to that, he was the CEO of his deceased father’s business. Soon after, his mother and younger brother voted him out of the Board and took over the business. When his wife discovered that he had lost his company, she moved out of their home and proceeded to divorce him. He began to go downhill mentally. He had not seen a doctor.

That afternoon, I took him to a psychiatrist for a proper medical evaluation, and also made an appointment with a lawyer who was into pro bono cases. The next three months were focused on ensuring that Thomas was medication compliant, as we met twice a week. Four months into our sessions, when his mental condition stabilized, a divorce mediation with his wife was held before a judge. Property discussions and support level for his daughter were agreed, and he was happy with the outcome. I was thankful to be able to sit in on the mediation process.

I was concerned all this time about his driving, with schizophrenia as a diagnosis. He told me that at times he heard his customers talking to him, but when he replied, they gave him a queer look! Relapses are a regular recurrence with this category of patients, and driving can be stressful and hazardous at times, especially encountering difficult clients or being caught in heavy traffic. I continued to meet with Thomas once a week for two years, to ensure that his mental condition was not compromised; his medication level was adequate, and adjusted when necessary, and he knew his mental limits while on the road, sufficiently to take a break from driving when he was mentally exhausted. 
 
*****                  
Jeremy was in his late twenties and was a steward with a prestigious airline. This fulfilled his life-long dream. He had a couple of run-ins with the chief steward on some trips, but they were resolved. One morning, when he reported for duty, he left his name tag at home. He was grounded. This happened again a few months later. His service was terminated. It caused a mental breakdown in Jeremy. Twelve years later, he came for counselling. He was non-compliant on his prescribed medication, and he has had several relapses in the past; some relapses were violent in nature. When they occurred, Jeremy would physically assault his wife and family members. The police were called to his home several times previously following altercations. Relapses in schizophrenia may have future deleterious effects towards the brain, and therefore, further damaging mental health. 

In my treatment regime for clients who are on medication but are non-compliant, an agreement is reached with the client for an initial three counselling sessions. As we met, we attempt to work through their non-compliant attitude. Thereafter, if they still renege on their medication, I would terminate their counselling. In Jeremy’s case, the threat to report him to the police when he becomes abusive, and subsequently being incarcerated in a mental institution, was sufficient to elicit some co-operation in the ensuing months. 
 
*****
Cynthia, 18 years old, had just passed her Junior College National Examination with distinction. She was offered a place in medicine at the local university on a government scholarship. Six months before commencing her first semester, Cynthia suffered a mental breakdown. Probably the cumulative effects of exam stress compounded by several scholarship interviews for her medical course took their toll on her. Her scholarship was cancelled, and whether she was mentally able to tolerate the stress required in higher education, further complicated her recovery. She withdrew into her shell, becoming a recluse, and became non-adherence towards her medication. 
 
*****
John was 16 years old. He was sent to me by his parents after he came under psychiatric care for schizophrenia, just before the National Examination for high school. As he sat across from me, I noticed he had his right hand in his canvas knapsack, which he held close to his body. His cautious behaviour aroused my curiosity. After a few minutes of conversation on his background, I casually enquired what he had in his hand in the knapsack. He slowly brought out a nine-inch kitchen knife and pointed it at me. Keeping my cool, I asked him why he felt he needed to protect himself from me. He said that he was coming to see Dr. Hannibal Lecter. (Dr. Lecter is a character created by the American novelist, Thomas Harris, who was a serial killer who eats his victims). He recently watched the movie.

“Do I look like Dr. Hannibal Lecter?” I enquired in a low , non-threatening tone.

“No.” John replied.

“Then you can put your knife away safely in your bag.” 

John slowly wrapped the knife with a piece of paper and returned it to his knapsack.

Later, I spoke privately with his parents to have John’s psychiatrist increase his medication dosage, as I continued to monitor him in our succeeding sessions.
 
*****
Several schizophrenia cases I saw involved teenagers and young adults. These were invariably to do with examination stress and relational difficulties, especially going through a boy-girl break-up. The developmental stages in malleable brain functions are still evolving at this stage of their young lives, and for some, a sustained, elevated level of stressful stimuli would tip them over into a psychotic break. Similarly, a few cases of military recruits were referred to me, as these were boys in their late teen years. Some were suicidal, due largely to the intense regimental training at the recruit stage of conscripted military service. 

These seemingly non-descript circumstances were triggers for an onset of psychosis. Stressful events are not uncommon but at an uninterrupted level with multiple layers of stress piled on simultaneously, a sensitive mind may reach a critical juncture where it implodes into a breakdown.