Ohh, I'm so excited to share this. The other day I was looking through Clinical Perspectives on Multiple Personality Disorder (1993). It was mildly interesting but mostly uncomfortable to read (I have a deep dislike for the way Kluft talks about his patients). Then I found the chapter on ego-state theory, by Watkins and Watkins. I'm going to share an excerpt from that chapter here along with my thoughts. If you're interested in reading it in the book for yourself, without all my interruptions, you can borrow it for free from the Open Library. The pages are 277 - 280!

As a disclaimer, what is referred to as "MPD" (multiple personality disorder) was changed to "DID" (dissociative identity disorder) a year after this book was published.

"Ego-state theory holds that humans develop their personalities through the process of integration, a putting together, and differentiation, a taking apart. Integration consists of a regrouping of experiential elements to allow us to develop generalizations and evolve higher-level concepts. Thus, a child learns that horses, dogs, and cats all belong to the category animals. Differentiation helps the child distinguish between those animals that are dangerous and those that are not, or between those individuals who care for the child and those who may be hostile. Both processes are originally adaptive. They increase the likelihood of survival and facilitate coping with an increasingly complex world (Watkins and Watkins 1991).

Most psychological processes lie on a continuum. Over certain portions of this continuum they are adaptive and facilitate life and growth; at others, usually when excessive, they become maladaptive and may impair the individual's adjustment. . . . At one portion of the continuum, differentiation helps us make finer discriminations and can be quite adaptive. However, an excess of differentiation is less adaptive, and as it intensifies, it becomes increasingly maladaptive. In its extreme form, it is so different from its more moderate forms that we no longer call it differentiation. It is now better understood as dissociation and may involve the segmentation of the mind into ego states, extreme forms of which may lead to the development of multiple personality disorder (MPD). . . .

The initial part of the excerpt introduces us to how ego-state theory conceptualizes integration and differentiation. In the theory, these are processes that everyone goes through. They are inherently natural and useful. Like with many things, problems can arise if these happen too much or too little. To much differentiation becomes dissociation, which can sometimes lead to DID.

"In our theory and therapy (Watkins 1984), we define an ego state as an organized system of behavior and experience whose elements are bound together by some common principle but that is separated from other such states by boundaries that are more or less permeable. Such a definition includes both true cases of multiple personalities and those less rigidly separated personality segments that lie in the middle of the differentiation-dissociation continuum and that may be more 'integrated' and hence more adaptive.

In working with research subjects under hypnosis, we have found that individuals who show no sign of mental illness may nonetheless manifest segmented divisions in their personalities that may act like 'covert' multiple personalities. However, the boundaries that separate them from other such states are more permeable and are not necessarily maladaptive. These parts often have awareness for one another but retain their individual senses of identity. They are 'integrated' in the same sense that Montana and Idaho are 'integrated' within a larger 'federal' jurisdiction. . . ."

Here's where things start to get more interesting! The authors acknowledge that having separate ego states isn't restricted to DID or even mental illness in general. Some people experience a more functional blend of ego states that aren't as dissociated as the ones in DID, but can still experience themselves as their own individuals. The more hidden ego states become apparent through purposeful and non-harmful dissociation (through hypnosis, in this case).

That sounds a lot like non-disordered plurality to me!

"In MPD, on the other hand, the dissociated parts exist near the extreme end of the differentiation-dissociation continuum. There are often rigid, impermeable boundaries between the ego states, which permit little communication between them; they often posess no awareness of one another. Sometimes it seems as if these ego states live behind locked doors, oblivious to the needs or feelings of other aspects of the mind. The first personalities to be formed are the result of an extreme and excessive use of the separating function, mobilized in the face of tremendous childhood stress. Thereafter, the mind may make further such divisions under various circumstances."

Their differentiation between the ego states in DID versus ego states outside of it resonates with me as someone who has lived with DID. The other day, my husband brought up times from before my final fusion where I switched to headmates who knew nothing about the rest of the system. At that time, we had been in recovery for years and worked hard to gain reliable communication between most of the system. Yet, we still had parts that were completely cut off. The dissociation in DID is no joke!

Now, onto the section about ego-state therapy.

"Ego-state therapy uses group and family therapy techniques to resolve conflicts between the various ego states, which in this model are understood to constitute a 'family of self' within a single individual. . . . In treating patients with classic MPD, we help them progress down the continuum toward increasing integration and lesser dissociation — hence, toward levels where the remaining degree of differentiation among the personality segments cease to be maladaptive. The personalities of some of our increasingly integrated MPD patients express their situation in this manner: 'We are still here, but we are no longer separate persons. We are now parts of her, and we work together.'"

I find this extremely relatable as someone who has achieved a final fusion that didn't erase my plurality. All the parts that previously made up my system are still here. We don't view ourselves as being a part of another part, though. I am all of my parts. I am both a complete person who is made up of parts, and all the parts that make up a complete person.

If I were to erase the parts, I wouldn't be whole anymore. If any of us got erased, we'd feel closer to what it was like to have DID instead of final fusion...

"Because we find ego states in control subjects, from the perspective of ego-state therapy it seems both unnecessary (and perhaps not even adaptive) to attempt the elimination of these states through 'fusion.' Personalities in control subjects are integrated but not fused. Efforts to totally eliminate all boundaries between personality segments increase resistance."

So, what they're essentially saying here is that fusion isn't possible. Is it strange that I agree? Hah!

It's a matter of semantics. In the eyes of the authors, 'fusion' is the erasure of ego states. I don't use the term in the same way.

The authors believe that all people naturally have ego states of varying degrees. The idea of the self being inherently singular is a very Western-centric one that many don't agree with it (including myself). If nobody has a truly singular self but the goal of fusion is to achieve that, then that sort of 'fusion' just isn't possible. To attempt it would be extremely harmful and unnecessary.

I don't believe that treatment which aims to 'get rid' of plurality is healthy or even possible. It's based on outdated and restrictive understandings of integration, plurality, and the self. Final fusion cannot erase parts, not a single one...but we can still suppress them and eject their individuality out of our awareness. Since the beginning, people have questioned if doing that is really as integrative as it claims to be.

"Ego states (or part-persons) may at times join other parts or even voluntarily leave (such as a fragment may in a true MPD patient). However, to enforce the need for the fusion of all parts may be viewed by the patient as the therapist's attempt to push the personalities toward nonexistence or death. . . .

Our clinical work with both neurotic patients and patients with true MPD, plus our research studies with non-mentally ill volunteer subjects, indicate that non-mentally ill individuals are not 'fused' into single entities, but frequently manifest covert segmentation under hypnosis. Successfully treated MPD patients, who show all overt evidence of 'integration,' may under hypnosis reveal their former alters as continuing covert existence, but now adaptive and with flexible boundaries — such as those we find in college students who are research volunteers."

ISN'T THIS SO COOL, THOUGH?!

I was beaming when I first read this. Even though the authors and I see the term 'fusion' differently, this is incredibly validating to my existence and recovery. Not only do they affirm that plurality still exists after full integration, but they also affirm the existence of plurality outside of dissociative disorders!

I'm so glad I found this!