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mental health mondays :: "psycho" therapy

is this your idea of "crazy"?
i originally had a different and equally valid idea for this week's mental health monday and i'll undoubtedly get to that some time in the not too distant future, but dom and i were watching psycho yesterday, in honour of mothers' day, of course, and i couldn't fail to note just how much that film is responsible for in terms of the popular understanding of what it means to but insane. everyone knew that deranged people could be dangerous [although, if you'll hearken back to last week's mhm, that is only rarely the case], but psycho was the first time when you had the confluence of an immensely successful film, modern pop psychology and a depiction of a central character able to interact to a limited extent with the outside world while still suffering from a severe mental illness.

to call attention to the clinical details of norman bates' shattered psyche, director alfred hitchcock chose to have a psychiatrist [or at least an actor playing one] give an explanation of what had happened- how trauma and guilt had caused part of bates' mind to divide from another, leaving him in a state where his body was alternately occupied by mild-mannered, socially awkward norman and his tyrannical, overbearing mother. the last shot we see of norman in the film, is of his expressionless face, with the voice of his mother having completely taken over, working to come up with a course of action for escape.



the film psycho was based on a book of the same name by former lovecraft-disciple robert bloch, who came up with the idea after the arrest of ed gein, who lived not far from bloch in wisconsin. psycho is hardly the only work to try to examine the case of gein, but it is one of the few examples where there is some attempt to look at the nature of the psychosis at work, the mysterious and controversial dissociative identity disorder.

there are many symptoms of this disorder, but the best-known, of course is the division of the psyche into multiple identities, most often in response to trauma. there is evidence to suggest that d.i.d. is linked through genetics and that the brains of d.i.d. patients share certain physical characteristics, which would indicate that there are people who are physically and genetically predisposed to the disorder. of course, not all people who are predisposed end up developing d.i.d. because, thankfully, very few of them are submitted to the sort of extreme stress that can act as a trigger. even under stress, it is still comparatively rare that d.i.d. develops.

in those extremely rare cases, the brain basically takes normal behaviour and carries it to a frightening extreme. say you've just had a nasty break-up with someone, or a fight with a family member, or are annoyed by someone putting demands on your time, there are a number of steps you might take to limit your exposure to them- blocking them or hiding their activities on facebook, screening or blocking  phone calls, deleting prior phone or email messages, avoiding locations where contact would be likely and so on. all of those activities help block the irritant, yes, but they also help keep the source of your stress and annoyance out of your mind by directing and keeping it out of your face. you are limiting your stress by clearing it from your field of vision, because the old adage is true: out of sight is out of mind.

the extremely rare "giger personality"
dissociative identity disorder functions much the same way, but on an exaggerated scale. in this case, the stress is so great that the mind won't even risk you accidentally thinking about it and effectively puts certain memories, thoughts and experiences in an area of your brain and doesn't allow the rest of you to look at it. unfortunately, the brain can't completely close the barrier, so it attempts to set up a system whereby you are either in the space with the traumatic memories or you are outside it and don't know about its existence. i'm grossly oversimplifying the process, but in the interests of keeping this on a basic level, i'll leave it at that. there are hundreds of people who know more about this than i do who have written scholarly papers and i highly encourage you to shake off intimidation at their dense language and have a look through a few of them.

i understand why this particular disorder has such romantic appeal. what's more intriguing than the idea that we could all have some dark twin inside them, acting through our body without our knowledge? it's a great twist for hack writers to pull out in mysteries. it's like the lamborghini of mental disorders- flashy, exotic and incredibly rare. people who actually have the disorder will tell you it isn't a damn thing like that. it really isn't. but, when compared with mental disorders that make you want to stay in bed and do nothing all day, or that compel you to turn the key in the lock 16 times before opening the door, you can see how it captures the public imagination.

the first and most important thing about dissociative identity disorder is that it is incredibly, incredibly rare. winning the lottery jackpot rare. getting struck by lightning rare. so rare that chances are even those working in the psychiatric field will go their whole lives without coming into contact with a single case. it's so rare that some medical professionals debate whether it exists at all [link goes to direct pdf download]. so the odds against you or someone you know developing it are astronomical. so the fact that you've seen four movies and read three books about people with the d.i.d. means nothing except, as i mentioned, it makes a more compelling story than most other disorders.

the second thing to know, and this seems to be the best-kept secret about d.i.d., is that it is not schizophrenia. it is astonishing how completely these two diseases have become conflated. as we were watching "psycho" yesterday, dom- who knows they are different because he lives with me and i talk about this stuff a lot when i'm not writing about it- referred to norman bates as "schizophrenic" or "schizo" three or four times. like i said, this is someone who knows the difference, but the mistake is so ingrained in the public mind that the confusion comes out unbidden. perhaps it's because the term "schizo" has become slang for someone who behaves erratically or contradictorily, leading people to conflate bipolar disorder, schizophrenia and dissociative identity disorder. perhaps it's because a lot of people like to think of their fellow citizens as being either crazy or not crazy and don't want to think too much about the shades of grey. it doesn't matter. as with many things, if we want to legitimately help people who have mental disorders we need to realise that what needs to be done varies greatly depending on what exactly their particular problem is. you wouldn't want to seek help from someone who wasn't sure if you had cancer of the brain, colon or lungs now would you?

i have no doubt that people will still continue to watch "psycho" [as well they should -ed.] and continue to see the mentally disordered person as knife-wielding norman bates dressed in his mother's clothing [ahem, spoiler alert -ed.]. and i have no doubt that "united states of tara" will continue to be a successful vehicle for the underrated toni colette, while my 300-page screenplay about a woman who stays in bed staring at precisely the same paint crack in her wall for three weeks will gather dust. but i hope that there are a few of you who now know just a wee bit more about dissociative identity disorder [including the fact that it's no longer called "multiple personality disorder", at least not in north america] and might be more curious to learn what it's really about.

oh and by the way, ed gein, the prototype for not only norman bates, but also leatherface and buffalo bill, was never diagnosed with dissociative identity disorder. in fact, there is no evidence to suggest that he exhibited signs of "alters" or alternate personalities. that's how rare the condition is. even the people infamous for having it didn't have it.

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