My wife has epilepsy and has auras or deja vu or other spacey feelings before a seizure. After having seizures, she doesn't really know where she is or what's going on and isn't able to talk at all for at least an hour. I wouldn't be surprised of DID had many similarities to epilepsy, so I would guess this guy's girlfriend gets the same auras, deja vu, or spaciness too.
Same with my ex girlfriend, though her disorientation doesn't last as long. It was scary the first time when she asked me "who are you?" but eventually I got used to and it even had funny aspects. Such as the time when she collapsed on the bedroom floor, me making sure she doesn't hurt herself and when she comes out of it, asks me "What happened?". I tell her "you had a seizure" to which she replies, quite resolutely, "No, I didn't!"
Because there is a self-aware, behavioral component to not just dissociative events, but to most maladaptive psychiatric disorders. This component may be small or large - the fact that we've medicalized the disorder simply says that the overall pattern of behavior is causing severe problems, nothing about cause or self-awareness. The people afflicted with them are not simply normal people who are possessed by a random event, like a lightning strike; Their expectations, moods, and desires play a role in the onset of crises. The temptation is to split their agency, their consciousness and their participation into a boolean and say they either have it or they don't have it, that psychiatric disorders must be entirely out of someone's control before we give them a pass on "But it's their fault" and "Just snap out of it!". But allocating problems this severe to the realm of personal responsibility and purely voluntary deviancy is not very helpful to anyone.
The most infuriating thing about having a family member with a personality disorder, my own dive into ab-psych, is that they can turn it on and off in certain contexts, they can be triggered and they can avoid being triggered, but not in a context where you need them to, where you beg them to. It is a way in which they are acting, an unhealthy coping mechanism and pattern of thinking that colors all their thoughts - but it is not something that they can't control or observe at all, only something that they don't usually control or observe well enough to avoid causing problems. There is no clear line between their disorder and their voluntary behavior and their personality, it is one unified whole.
Do we hate them for that? What's the use? Who does that help?
Before we started medicalizing these things, we relied on public shaming and ostracism to control them until the person's behavior got so out of control they became a danger. While it's a cruel way of doing things that we have wholeheartedly rejected, it was surely at least somewhat effective, because of this voluntary component, because telling yourself "Keep it together" is not a 0% effective treatment technique. The country did not suffer from a 26% mental illness rate in times past, and I think it's foolish to assume this represents pure underreporting. Mental illness at least partially conforms to the outlines of the society which defines it - immigrants to the US find themselves substantially healthier than the US on arrival, but develop statistically average rates of US mental illness over time; Symptoms shift from whatever is recognized in their home country to symptoms more in line with US-recognized disorders.
We have decided, rightly or wrongly, that classifying these things according to an insurance-industry handbook, and doling out pills like candy, and pretending these people have no control whatsoever over their disorder in order to relieve them of social responsibility for it, is the correct approach. While the truth is more complex, I tend to find this more humane than some other national attitudes towards the topic, and I have no better approach to offer.
Edit: The problem is, when you acknowledge that these things are maladaptive and problematic behaviors that someone presently does not control well, rather than some kind of seizure that completely robs one of consciousness... you get people popping up who want to go back to the boolean definition again and deny there's any problem whatsoever, claim that they're doing this for attention and faking it and horrible hoaxers who are sucking the precious fluids from our society... There may be too many douchebags out there for a nuanced view to prevail. I see this post already has one, https://news.ycombinator.com/item?id=9147386 . The problem is the boolean: A 100% controlled premeditated affectation must represent a malicious manipulator, the theory goes, while a 0% controlled mental illness strikes a victim, all victims, like a bus hitting an innocent pedestrian. But the mind isn't so simple, and the onus of personal responsibility is not a cure-all.
"The most infuriating thing about having a family member with a personality disorder, my own dive into ab-psych, is that they can turn it on and off in certain contexts, they can be triggered and they can avoid being triggered, but not in a context where you need them to, where you beg them to. It is a way in which they are acting, an unhealthy coping mechanism and pattern of thinking that colors all their thoughts - but it is not something that they can't control or observe at all, only something that they don't usually control or observe well enough to avoid causing problems. There is no clear line between their disorder and their voluntary behavior and their personality, it is one unified whole."
This is so very true. The member of my family with a clear personality disorder would likely be a criminal if she wasn't able to turn it off or otherwise limit it in various public contexts.
Take an upvote for explaining what I have suspected from observations of myself, friends and family for a few decades. I do not have the ability/skills/education to iterate my suspicions quite so succinctly but I do recognize my weaknesses and know if I consciously mitigate the triggers I can prevail over certain impulses and self-destructive behaviors...which is a far cry from what the author wrote about, but still a correlate, IMO.
> it was surely at least somewhat effective, because of this voluntary component
No, it was a cruel and inhumane way to treat people. Personality Disorder used to be a diagnosis of exclusion in England - people with PD would be turned away by mental health services because they were seen as untreatable. That left them at the mercy of criminal justice systems.
We don't think Mental Health hospitals are the place for people with PDs. It's clear that prisons are even worse.
Here's just one example, but there are hundreds, thousands, of others. And this is England where we have free mental health care.
For anyone interested in the treatment of personality disorder: The current NICE guidelines are a bit old and are currently being re-worked. "Meeting the Challenge, Making a Difference" is an excellent short document detailing what PD is, how it affects people, what best current practice for treatment should be, and a list of recommended psychological therapies.
Such rose-colored glasses of the past you have. The handling of the mentally ill in the past was atrocious. Hiding mental illness away is very convenient for society, but it doesn't fix the actual problem.
People who suffer brain trauma often end up with it affecting their personality. It is quite possible that many personality disorders have a physiological basis, one that is not as simple as someone "just stopping their behavior".
Yes, we hid them away, we ostracized them, we caged them, we lobotomized them, we murdered them. I'm not downplaying that by any means.
The physiological and the psychological and the sociological interact to produce psychiatric problems in the forms and rates we see. The fact that we've diagnosed a person with a disorder means that the person is failing to control their condition as well as we desire; It's wishful just-world thinking to believe they have no control whatsoever on the one hand, but on the other hand condemning them for failing to control their condition is needlessly cruel. Some of it is in our head, because the place we exist is in our head. There is still a person living in that head, and they deserve our empathy regardless of why they're behaving the way they're behaving... no matter how much our normal interpersonal script demands culpability of them at times.
We suspend culpability not because "It's the disease doing it, not the person" - the two are not easily separable - but only because culpability has proven not to be effective at enhancing control in the past with this person.
The harsher treatment isn't really what I was talking about. People were often said to be "off" or "crazy", but no one talk about it much. Likely mental disorders were underreported because there was less interest in understanding them and more ostracization of those who were open about it. Classifying mental disorders does not mean we're letting people off the hook.
Like I posted previously, physiological factors with the brain can cause poor emotion and impulse control. Abuse during the developmental stages of the brain could also wire the brain in strange ways that, again, someone may not be able to actually control.
Saying society is "soft" and these people are "weak" doesn't solve anyone's problems.
On the other hand, up until fairly recently in the usa[0], some mentally ill people were held in great regard as faith healers, witches/witchfinders, preachers, etc.
> The country did not suffer from a 26% mental illness rate in times past, and I think it's foolish to assume this represents pure underreporting.
I think it's foolish for you to assume you know this. As our understanding of the brain and human behavior grows it's obvious that we'll detect and diagnose previously unknown and underreported illnesses and disorders, especially with spectrum disorders like Autism and ADHD.
Your argument reminds me a bit of Thomas Szasz's book, The Myth of Mental Illness, which you might be interested in (if you haven't already read it). I don't 100% agree with his overall thesis, and I think your stance may actually be a bit more nuanced than his, but it's an interesting read.
Because she's experienced it before and it doesn't happen instantaneously?
Even some of the most fast-acting drugs still have a ramp-up. I'm thinking, IV propofol, if you've experienced it before (and even if it's your first time), you can tell that something is happening.
