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Multiple Personality Disorder, (MPD), a dissociative disorder resulting from severe, ongoing childhood abuse may provide a new perspective on the development of the self in healthy individuals. Structural Interactionism describes the development of the integrated self in relation to the external world. As infants, humans experience emotions as separate states of being. As children develop, the environment provides the opportunity to integrate these separate emotional states into an integrated self. However, for children who have been severly abused, this integration process may not occur, reulting in the un-integrated selves or personalities seen in multiple personality disorder. MPD therefore, may be the result of a developmental failure. In recent years, awareness has grown around the phenomenon of Multiple Personality Disorder (MPD). Clinicians working with adult survivors of severe childhood abuse now realize the extent to which severe trauma affects young children and the various coping mechanisms the children must develop to survive both physically and mentally. Some recent reseachers estimate that as much as one percent of the population may suffer from the most serious of dissociative disorders, MPD (Ross, 1991). As a result of the increasing number of people diagnosed with MPD, there has been a need to develop theoretical perspectives to understand the link between childhood trauma and the development of MPD. As researchers attempt to understand the phenomonon of MPD, new insights are being made into understanding the human mind and how people develop a healthy sense of self. In the person with MPD, not only is there an impaired sense of self, but there are several differing "selves", each claiming an existence, sometimes separate from the others. To understand how these different "selves" develop in the mind of a person with MPD, an awareness of the definition and etiology of MPD is helpful as well as a definition of the self. According to the DSM-III-R, MPD is: A. The existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).The development of these distinct personalities or personality/ego states has been strongly linked to severe childhood trauma, most often physical and or sexual abuse in early childhood (Bloch, 1991; Braun and Sachs, 1985; Kluft, R.P. 1986; Putnam, 1989; Ross, 1989). It is believed that as young children are confronted with traumatic experiences which are beyond their limited abilities to cognitively process, they often resort to primitive defense mechanisms such as dissociative phenomena (i.e. playing dead, putting themselves into trances etc.). These dissociative experiences protect young children phychically from the trauma and later play a key role in the development of the alter personalities. Reber (1985) defines the self as "an organized personalized whole...concentrating on the integrated aspect. [People] often present it as a logical construct which is inferred indirectly by an individual's experience of personal continuity despite changes over time". Reber defines identity as, "a person's essential, continuous self, the internal, subjective concept of oneself as an individual". Studies show that infants are born with discrete emotional states (Prechtl et al, 1973; Prechtl & O'Brien, 1982; Putnam, 1988; Wolff, 1987). It is not until later that children learn how to integrate the various emotional states and experience more than one feeling at a time (Emde et al, 1976). Putnam (1989) states: One can postulate that among the many developmental tasks that we face in the course of growing up are consolidating self and identity across behavioral states and learning to modulate transitions among behavioral states. We see evidence of progress in these developmental tasks as children manifest increasing attention spans (i.e. the ability to sustain a given state longer) and a more unified sense of self across contextual changes... (p.51).As the child develops their ability to recognize when they have moved from one emotional state to another increases. They begin to understand that they can have a range of feelings and all their feelings are a part of who they are and how they react to the world around them. Children develop an initial sense of self by listening to how other people identify or label the different emotional states that the child experiences and integrating those various aspects of the other person's perception of who the child is. According to Structural Interactionism children go through various stages in the development of the self. Children first learn that they are an object in relation to other things or people around. Hewitt states: The child is, after all, an object to other people. He or she has in their eyes, certain characteristics, abilities, limitations, and natural tendencies. The child is something towards which they act--by providing care, teaching, disciplining, loving, or even wishing the child would grow up and go away. The child thus has a meaning to parents and to other adults. This meaning consists of a set of beliefs and attitudes they hold towards the child, and their readiness to act toward the child in certain ways. Thus, whether a child is felt to be strong or weak, intelligent or stupid, or wanted or unwanted, will influence how parents act towards it. Such beliefs will shape what they demand of the child, the pattern of rewards and punishments they administer, and what they permit (or require) the child to do.Children therfore, learn who they are by initially understanding who others think they are. When parents provide a healthy sense of how they see the child, the child will in return begin to develop the same healthy sense of self. For example, if a parent encourages a child to do the best he or she can and expresses the belief that the child can achieve the desired goal, the child will trust that he or she is a capable person, able to meet the desired goals. If, however, the parents discourage the child with remarks to the effect that the child is stupid or lazy, then the child will believe that most goals are impossible to achieve and therefore limit his or her efforts to reach the goal. The resulting sense of self becomes one where the child feels inadequate. Mead discusses a two stage developmental model of how children develop a sense of who they are. In his model Mead (1934) refers to a play stage and game stage. In the play stage the child "plays at various roles made evident by others, their activities and their use of language (p.151). Playing at various roles or play acting is a process that helps the child begin to realize who he or she is. Hewitt states that "in the play stage, the child is always responding to and imagining himself or herself to be a particular other..."(p.117). This is a part of normal development and many children develop imaginary companions to help them play out the various roles. The second stage Mead refers to is the "game stage" (Hewitt, 1991). It is in the game stage that the child learns to see the broader picture (i.e. his or her relation to a larger system rather than one person). The child learns that they are someone in relation to the situation they are in and who is around them at the time. Hewitt discusses how the situation determines the role the person will play. Hewitt (1991) states "whenever a situation is defined so that participants know who the are and what they are to do , each has a situated self that is linked to the persons role in the situation (p. 122). He continues by saying that "the role one is called upon to play emphasizes or brings out certain skills or characteristics or subdues others (p.122). Hewitt (1991) also discusses "multiple realities of the self". In any given situation people have an awareness that they are indivduals in relation not only to the immediate situation but also in relation to future and past situations. He cites the example of a professor who is writing a book but also knows that he is expected to go home to spend time with the family, he is a parent and also a child of elderly parents. He has an awareness that he is all of those people wnd takes on various roles depending upon whom he is with. He will act differently towards his children than he does towards his wife, parents or boss. Individuals with MPD do not seem to be able to view themselves as one individual who takes on a variety of roles in relation to the environment or situation/context. Rather than developing an integrated sense of self, the various alters/personalities express themselves individually depending on the situation and context. Putnam (1989) believes that "we are all born with the potential for multiple personalitites and over the course of normal development we more or less succeed in consolidating an integrated sense of self." Since personality is acquired and developed over time we are not born with multiple personalities. At birth, our behavior is organized into a series of discrete states which later become integrated into a singular personality capable of experiencing a range of emotions. As the child grows, additional behavioral states are added and the transitions between states are smoothed out, so that it becomes increasingly difficult to identify discrete behavioral states in children older than a year (Emde et al., 1976). It seems that we all start out in infancy with our behavior organized into a series of discrete states, but we eventually learn to change behavior states and expand our sense of self across different contexts to develop what we experience as a unified personality. Victims of childhood trauma, however, experience difficulties during these developmental periods. Rather than integrating a self across a series of behavioral states, they create multiple "selves" by elaborating a series of dissociative states into alter personalities. Putnam (1989) believes that these dissociative experiences during trauma to the young child contributes to the development of MPD. He cites Ludwig, 1983; & Nemiah, 1981 as saying "Dissociative states are characterized by significant alterations in the integrative functions of memory for thoughts, feelings, or actions, and significant alterations in sense of self". Instead of the child learning to integrate the various aspects of the personality, the dissociative experience used to guard against the trauma inhibits this normal developmental process. Another developmental factor that may play a role in MPD is the ability of children to fantasize in general. "Imaginary companionship is a personification of this ability...among the suggested functions [of imaginary companions] are dealing with fears (Baum,1978), serving as a scapegoat or as an auxiliary superego (Nagera, 1969), and acting as a form of transitional object (Benson & Pryor, 1973). If the child can fantasize that the abuse/trauma is happening to another (the imaginary companion) then the child can displace the memory of the abuse. Putnam (1989) states that alter personalities sometimes claim that they first existed as imaginary compaions but later took on a life of their own when the child was unable to cope with abuse or some other trauma. Lovinger (1983) believes that imaginary companions "become alter personalities when the child is not able to complete specific developmental tasks because of a traumatic environment." These dissociated states, or alter personalities, each with a specific sense of self, is elaborated over time as the child repeatedly re-enters a given emotional state to escape from trauma or to perform demanded behaviors. The severe, sustained, and repetitive trauma that occurs during the early to middle childhood of most victims may be the trigger that promotes the development of MPD. Putnam states, "Each time the child re-enters a specific dissociative state, additional memories, affects, and behaviors become state-dependently bound to that state, building up a `life history' for the alter personality." Each time that a specific type of abuse occurs or emotion is expressed a different alter will present itself to deal with the experience. For example, if the child is not able to cognitively process incidents of sexual abuse, an imaginary companion may be called on to deal with the abuse. As the sexual abuse occurs over a period of time, that imaginary companion may be called on ferquently to deal with the overwhelming feelings of the child. Later, whenever incidents involving sexual activity arise, that particular companion emerges to deal with the situation, allowing the child to remain unaware of the sexual activity. Over time, the imaginary companion acquires its own experiences and develops its own life history. In people with MPD there is no integration of the various aspects of the personality. As children experience traumatic situations they must dissociate themselves from those experiences. The more frequently these traumas occur, the more frequently disociation must be relied upon to survive. As the abuse escalates the children are not afforded the opportunity to integrate the various ego states that eventually represent an identity of self. For the individual who has not been able to successfully integrate the various emotional/behavioral states the situated self become the various selves or personalitites, each operating independently of the othere. For example, an abusive parent may have one set of rules and expectations for the child at one time and a totally different set at an other. In one case the abuser may expect the child to participate in sexual acts and at another time expect the child to deny all knowledge of those same sexual acts. For the child to maintain his or her positive belief in the parent he or she must disown knowledge that may impede the parent/child relationship (i.e. that the parent sometimes hurts the child). Abusive parents frequently place children in double-bind situations. When children are encouraged or forced to participate in a required sexual activity they later are labelled as dirty or called derogatory names for having participated. Young children do not have the cognitive ability to assimilate the two opposing images of the self presented to them by the parent (as obedient for obeying and bad for obeying). As a result, the normal integration of the emotional/behavioral states does not occur. In view of the above, it may be that rather than trauma causing the dissociated states, traumatic experiences simply do not permit individuals to integrate the various emotional and behavioral states into a singular identity. In this light, multiple personality disorder may be a devlopmental failure rather than a development in itself. Given the opportuntity, some traumatized children are able to integrate some aspects of the personality into an identity. Others, as in the case of children who later present with multiple personalities, may be traumatized on such a consistent basis that there is no opportunity to integrate any of these personality aspects. According to Structural Interactionism, people begin to develop a sense of self from the experience of learning how other people see them. In infants, emotional states are separate and as the child develops, an integration of these emotional states occurs. However, it seems that for individuals who were severly abused as children and later develop MPD, this integration of the various emotional states does not occur, resulting in each emotional state developing separate senses of self.
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