Dissociative identity disorder: the multiple voices of Psychology Connie Batt

This article was published in the ATP Today magazine

Connie Batt Lower Sixth

Dissociative identity disorder (DID), previously known as multiple personality disorder, is characterised by a fragmentation of identity. The personality of the one person is comprised of many ‘parts’ or ‘alters’ that are not functioning together in a smooth, coordinated and flexible way; the single person does not have a unitary single sense of self, put perceives themselves to be multiple. DID reflects a failure to integrate various aspects of identity, memory and consciousness into a single multidimensional self.

People diagnosed with DID may experience feeling like a stranger to themselves or feeling as if there are different people within their mind. This can cause them to feel uncertain about their identity. This disruption in identity involves a change in sense of self which causes a shift in behaviour, consciousness, memory, perception, cognition and motor function. Some people experience amnesia, so they do not remember what has happened when another alter has been in control. This can cause frequent gaps in memories of personal history, for example people, locations and events. Individuals may report hearing voices and trains of thought over which they have no control. Others experience a sense of physical change; their bodies suddenly feel different, such as the body of a small child or someone big and muscular.

Alters each have their own names, ages, genders, voices, histories and mannerisms. Each alter perceives the environment and self differently. Some people feel that they have one ‘main’ part of their identity that feels most like ‘you’; this is referred to as the host identity and may be the alter that presents to others most frequently. Some people with DID prefer to refer to themselves as “we” as it better represents their identity. Particular identities may emerge in specific circumstances and become the driver of the mind; they gain control of the mind and body, however the individual experiencing this may not have control as to when different alters decide to take over.

Dissociation is a defence mechanism that helps people cope during trauma. This can become a dissociative disorder if the environment is no longer traumatic but the individual acts as if it still is; the dissociation needed to protect themselves suggests that the individual has not been able to process past traumatic events. People who develop DID frequently report having experienced physical, sexual or emotional abuse and/or severe neglect during childhood. Brand, Classen, Lanius et al found that amongst their patients with dissociative disorders, 86% reported a history of sexual abuse and 79% a history of physical abuse. Taking into account the amnesia between different alters, these percentages could be even higher if they had been able to recall the trauma. In childhood, the brain and personality are still developing which means any trauma experienced can have a long-term effect. DID is intimately associated with attachment, and attachment patterns are formed from a young age, providing a template for the rest of life. If children do not feel supported to cope with difficult emotions and situations, they are more likely to use dissociation as a way of dealing with trauma. It is less

likely that they will be able to integrate it into their autobiographical narrative if they do not have the words to describe it or anyone willing to listen and care for them. Therefore, traumatic events become dissociated. The psychodynamic approach would suggest that DID could be caused by childhood experiences. This implies that trauma at a young age will significantly influence an individual’s adult life. The ego protects itself using defence mechanisms. In the case of trauma, such as physical abuse, the trauma would be repressed into the unconscious, and effectively forgotten. However, the thoughts of our unconscious can be expressed in dreams. People with DID may have post-traumatic symptoms such as nightmares, flashbacks or startle responses. Freud would suggest that dream analysis therapy could be used to decode the manifest content of the nightmare into the latent meaning, the therapist would have to reverse the dream work processes. The cognitive approach would highlight the internal mental processes of the different alters. Each alter perceives the world differently which would lead cognitive psychologists to research perception, memory, language and attention of the different alters. However, Dissociation is a defence it is very difficult to investigate internal mental processes. Wundt, mechanism a pioneer experimental that helps people cope psychologist, advocated an adapted form of ‘scientific’ introspection during trauma. to isolate and identify the constituent parts of consciousness to try and infer what is occurring inside an individual’s head. The biological approach may suggest that people are more likely to develop DID if the individual has close biological relatives who also have the disorder. They would argue that genetics may play a role in inheriting the disorder. They may suggest that the disorder could be caused by neurotransmitters and prescribe antidepressants or anti-anxiety drugs to help control the psychological symptoms.

Given the concentration of high-value economic sectors in big cities, is a promise to reduce significantly regional inequalities by ‘levelling up’ possible to fulfil?

This essay was submitted to the Young Economist of the Year competition

Jack Ramseyer Lower Sixth

Levelling up is a phrase introduced by Boris Johnson during the 2019 election campaign, in which he used to try to convince less prosperous towns and constituencies to join the Conservative boat. He was promising to ‘level up’ their towns, to upgrade their opportunity in life and reduce regional inequality across the UK. For this question to be answered effectively, four questions must be answered. What are the problems with regional inequality across the UK? Why have these occurred? How are we able to ‘level up’? And is this promise truly feasible?

In the UK, we are seeing London strive further ahead of all other regions, notably Wales, the North East and Northern Ireland, based on GDP per head. This is not just a recent problem, however. During the 1900s, London’s GDP per worker was 30% higher than the national average. We did see this gap close during the 1950s due to tough economic times, but since the 1980s, this gap has widened again and most likely will not close anytime soon in our capitalist society. This is indicated by the way in which just over 50% of the UK’s financial services and 45% of our knowledge intensive business services are found in the centre of cities. This signposts that we are not seeing huge numbers of these high-value economic sectors in depressed towns for many reasons which I will come on to. Furthermore, the UK’s regional coal or from the fishing industries, are productivity gap is the widest it has been now losing their fundamental reason for for a century, we saw the gap widen when existing, their identity. Businesses were rapid deindustrialisation massacred North more attracted to bigger cities as people England in the 1980s and 1990s leaving moved from left-behind rural areas, such regional inequality of productivity as high as coastal towns including Blackpool, to now as at the start of the 20th century. To work in the cities such as London and exacerbate this problem, what followed Manchester. We are also witnessing how was lower spending cities are becoming younger on transport infrastructure in North England’s Towns and cities which thrived with innovation from the agglomeration of highly educated and talented people, regions than in London. So therefore, the from the mining of coal or from whereas, coastal towns are growing older and outdated. This very high proportion of cities in which this the fishing old people hurts the dynamism infrastructure was installed became more successful industries, are now losing their of these areas and our ageing population is worsening this problem that is increasingly from the attraction of transnational companies (TNCs) fundamental reason for difficult to fix. Not only are these areas suffering from ageing populations, but which increased existing, their they suffer from the loss the value of the economic sectors identity. of prosperous people who move to London where there in the cities as they are plentiful opportunities attracted investment. Therefore, for this compared to their old, impoverished town. promise to be achieved, we must reverse The issue is that this is aggravating the this trend that has been a problem for regional disparity problem rather than almost a century now. helping our economy grow from what this This problem of regional inequality has worker can add to the agglomeration within developed ever since the UK started to the cities such as London and Manchester industrialise in the late 1800s. Towns and This illustrates to us the clear scale of cities which thrived from the mining of the challenge that Boris Johnson has set

himself and how there are copious factors he must consider.

So, what can we do to try and ‘level up’ these deprived areas in the UK to the level of our prosperous cities today? The obvious answer would be to look towards education, the most important tool for promoting equal opportunities. If everyone in society is entitled to go to school and university, we can ensure a certain degree of equal opportunities. Therefore, in the recent 2020 Budget, the government announced it was committed to giving everyone the opportunity to fulfil their potential, regardless of where they are from. They allocated an extra £7.1 billion for schools in England by 2022-2023, compared to 2019-20 budgets. We also saw an allocation of £1.5 billion over 5 years to bring the facilities of colleges everywhere in England up to a good level, and to support improvements to colleges to raise the quality and efficiency of vocational education of provision. Most impressively, the government focussed on regional disparities and provided £7 million to support a total of 11 maths schools in England, covering every region. But we must take into account that money cannot fix everything. Throughout the UK, money could be invested into improved facilities for education, however, this may not have the full effect expected as students may not use them to full efficiency due to their attitude towards education and training.

As well as looking towards education to develop the rural parts of the UK, the government could also look towards using infrastructure to help us climb out of this hole. Infrastructure would not only provide surplus numbers of jobs in areas where structural unemployment has occurred, such as Sheffield, but would also have a positive feedback impact where investment would only lead to more investment. The government have definitely glanced, if not stared, towards the use of infrastructure as it would allow high-value economic sectors to move into new regions and would trigger new agglomeration in these areas. HS2 is a perfect example of this, it provides numerous jobs for the unemployed between London, Birmingham and Manchester. It provides access to London from Manchester in just over an hour, potentially allowing these huge companies to move out to areas along the HS2 route as they now have greater access to these areas. But is this going to be easy to fulfil? If we recall the French experience regarding the construction of the early Paris to Lyon branch of the TGV then HS2 may just be a repeat. The TGV operated in the opposite way to what was expected; businesses in Lyon moved their high-tech services to Paris, in some cases their headquarters. Businesses were meant to move out to Lyon and smaller towns along the route. Instead they saw movement from these smaller towns to larger towns along the route. The overall impact of this project was that geographical inequalities increased and no ‘levelling up’ effects were felt until 30 years later. Even then they were still very small.

Developing rural parts of the UK will also require an improvement in mobile coverage because as of October 2019, 23 million consumers struggle to connect to 4G. This is a huge problem that requires addressing to ‘level up’ because without good mobile coverage in deprived areas how can we invest there? With an improvement in mobile coverage across the UK we would see a huge boost to consumers as the speed and efficiency of services increase, potentially causing quality of life to increase in these areas. Not only will it boost spending, it will allow homes and businesses to become better connected, so businesses in these areas can start ‘levelling up’ these towns prior to investment. The government undeniably detected this, so it allocated a £5 billion investment in gigabit broadband rollout in the hardest-to-reach areas of the UK, hoping to boost regional economic growth to close the digital divide. Boris Johnson even keenly boasted how 4G coverage will reach 95% of the UK by 2025. But will it? This operation would require a huge number of workers to build these networks in such a short space of time and so does seem slightly ambiguous and optimistic.

Lastly, we could look towards an increase in the national minimum wage, desirably increasing the income of the low paid

Rishi Sunak and reducing wage inequality. This has worked recently with the number of UK workers benefiting from minimum wage rising from 830,000 in 1999 to 2 million in 2018. The effects this could have would allow productivity to increase, potentially destroying our regional inequalities. Productivity would increase as it makes firms look towards cheaper alternatives like investment into automation, so they can reduce costs and employ more workers. This was discussed in the recent Budget and the national living wage was increased to reach £10.50 an hour by 2024 as the government set a target for the wage to reach two-thirds of median earnings. However, sadly it is not that easy as it risks unemployment; firms cannot afford the workers and so it would worsen inequality as poverty would rise in the UK. These rising costs of production may just be passed onto the consumers via higher prices, so in effect we would see inflationary pressures from the rising prices within the economy.

The idea of moving high-value economic sectors to deprived regions in the UK may never be seen. We will always see regional disparities in the UK because, as the old-aged towns become more prosperous, our big cities will continue to blossom. However, along with the government, I also believe education, infrastructure and improved mobile coverage will have a colossal positive impact on our regional disparities.