Chapter 11. Basic Attitude for the Treatment of Dissociative Disorder (6)

However, when I say that two identities of an individual with DID are different, I might be challenged as follows. “It is reported that sometimes two identities can coexist and share the same experiences in DID. Would you still maintain that these are two individuals?” Still my answer is the same. One of my DID patients says that she feels the presence of an observing identity near her shoulder almost constantly. In that case so-called “amnestic barrier” is not clear as the observing identity often feeds key information to relevant identities. However, they are still different identities. They can be compared to Siamese twins: two individuals share one body, and therefore inevitably share the same experiences most of times, but they are different individual nonetheless.
Dissociation is not necessarily a serious problem
Number of clinicians who are skilled enough to treat dissociative disorder in psychotherapy seems to be very limited in Japan. One major reason is that they have never seen (or at least they are not aware that they have seen) a dissociative patient. Dissociative patients tend to avoid, as far as they can afford to, showing their different identities if they have a concern of creating a confusion in clinicians or being misunderstood by them. No wonder majorities of clinicians feel they never contacted dissociative patients in their careers.
However, even if they have quite a lot of chance to treat dissociative patients, they might not feel skilled enough to help them. It is because they try to address dissociative symptoms of their patients directly and get disappointed to see them still exhibiting dissociative symptoms.
I consider that dissociation itself is not quite likely to play an essential role in the patient’s pathology. DID might not be the primary diagnosis in patients with severely impaired functional level, as typically other comorbid conditions, such as depression or PTSD, directly interfere with the patient’s life while worsening dissociative symptoms at the same time. Sometimes I even ask myself whether DID or DDNOS are really a mental illnesses in some cases. In DID, if several identities help each other to co-exist peacefully, it cannot qualify the definition of mental illnesses.