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Interviewer: Hollywood has been banking on fascinating taboos in their shows and movies and this is why psychiatric illness have been such a major theme. But what do you really know about them? That's next on The Scope.

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Interviewer: We're talking today with Dr. Jason Hunziker, psychiatrist at the University of Utah about Hollywood and psychiatric illnesses, in movies and TV shows. One that pops into my head is the film Sybil, which was actually a real case taken from a book that was actually based on a real life patient.

Dr. Hunziker: Yes, dissociative identity disorder or at that time known as multiple personality disorder.

Interviewer: Like Sybil had.

Dr. Hunziker: Exactly. It is one of the more common psychiatric illnesses used in movies because so much is not known about that illness. But it also plays on all of our kind of fantasies and fascinations, and our interest about what the brain can do and how fragile it really can be.

Interviewer: So what exactly is Hollywood's definition of dissociative identity disorder?

Dr. Hunziker: The way films look at it is a way that I think it was described early on, which is somebody who has suffered from a very bad trauma, usually some type of sexual trauma, when they were young, that may or may not have been repeated over and over again, that somehow fractures their brain.

Interviewer: What does fracture your brain mean?

Dr. Hunziker: What that means is that the brain is so powerful that it does what it can to protect the human body against some outside source that's so overwhelming that it feels like you might die literally from that exposure. So the brain then separates itself and allows you to protect it by sending your consciousness level off somewhere else while your body just kind of remains there in person dealing with that trauma.

Interviewer: So it's kind of like you have multiple views.

Dr. Hunziker: Exactly, and that's where this came from. While you're gone somebody else is interacting with the people around, and so the thought was that people would form these different personalities to deal with different stressors in their life. And so Hollywood, of course, jumped all over that. What a great story, you have all these different people living inside you and when you go to the grocery store you can be Jill, and when you go to the carwash you're Bobbie, and when you're at home with your Mom you're a three-year-old girl who's scared. So Hollywood loves that stuff. But that's not the reality of what this illness really is.

Interviewer: Reality then; what have you seen in your studies and patients' cases?

Dr. Hunziker: There is so much controversy, even in the mental health industry about dissociative identity disorder. There are those that swear by almost the Hollywood version of what this looks like. And then there are others who say people clearly use dissociation to help protect themselves, and that's kind of where I fall in line. I think that people use that mechanism to get out of a stressful situation, and they then have a different personality style that interacts with you during those moments that they are real self is not present.
So when patients that I've seen, and that's generally what I've seen, is that when they get under stress they fall back onto disassociation to protect themselves, and they literally are not the same person. I talk to them, and they don't respond as quickly. They respond differently. But they are not Bobbie or Johnny, or Cindy; they don't have a name to it. It's just a part of their personality that remains to get the job done while the other part is protected and away from the stress.

Interviewer: This sounds to me, and correct me if I'm wrong, but kind of like a PTSD.

Dr. Hunziker: Exactly like PTSD. I think we see that a lot more now and I think dissociation is becoming more prominent because of our soldiers who are coming home and they struggle with flashbacks and paranoia, and depression and anger. All of these things, and when they get into a experience that's similar to what they experienced in the Middle East, they shut down and disappear, and they try to alleviate the stress by letting their brain wander somewhere else.

Interviewer: But it's not exactly like having multiple personalities, and that's what the illness was called back then.

Dr. Hunziker: That's correct. And again, it's hard, because there are two different camps on this, and there will be arguments that there are distinct personalities, and those distinct personalities need to all be reintegrated into one person, so the person can be whole again. But that's just not been my experience clinically when I have somebody who has that diagnosis or come to me with that diagnosis. That's not what I have seen.

Interviewer: When someone comes to you and they tell you, I have multiple personalities, as you mentioned before that some of your patients come and they tell you that they have multiple personalities, are they aware then that they have multiple personalities?

Dr. Hunziker: Again, that's where the controversy is, too. If they really are not present with the other personalities, it's hard to know why they know that they have multiple people and who they are and what their names are and what they are doing.

Interviewer: Right.

Dr. Hunziker: But they will, and I do have patients who tell me they have multiple personalities, and they'll have four or five or ten, and they have names for all of them. And some patients have been through the reintegration process and so they feel like it's mainly under control and all their personalities are meshed together. Others say they're still struggling with that. But the importance is when they tell me that, what I understand is they are extremely distressed, and whatever that stress is is causing their brain to not function in a way that's healthy for them. And so we focus more on that, and not so much on each individual personality.

Interviewer: Because you really don't know how many personalities they might have.

Dr. Hunziker: That's correct, and it's easier to say, we want to keep you, the real you, here with us dealing with everyday life, and we don't want you to keep using that crutch or that defense mechanism of dissociation to leave and then not deal with the issue that we really need to deal with.

Interviewer: How do you develop something like this? It's so fascinating, and like you said, controversial in so many areas of film and life?

Dr. Hunziker: It's hard to know how this really develops and we do see patterns in people who have dissociation as a major feature of their illness. And that pattern generally is the trauma. Some type of extreme trauma where you think your life is being threatened will then promote this type of defense.

Interviewer: It's almost like you're protecting yourself.

Dr. Hunziker: Yes, from experiencing what's going on, because it's too overwhelming. Because when you're young, we use these types of defense mechanisms all the time. I mean, we all use dissociation...

Interviewer: We play house or doctor.

Dr. Hunziker: Exactly, and we disappear into, and you'll hear your mom say, well you used to disappear into this different world. Well you did, and that works for us when we're kids. But when we're adults disappearing doesn't work as well. But when you get a trauma, particularly at that age, you get stuck and then that defense mechanism can become the prominent defense mechanism that you use later in life when it doesn't work anymore to disappear and go to your...

Interviewer: Happy place.

Dr. Hunziker: Your happy place, exactly. And instead you are not present with the people around you and then when you interact with them it's different, it's odd.

Interviewer: Any final thoughts on this?

Dr. Hunziker: Again, I'm glad that Hollywood brings awareness to mental illness, but I think we have to remember that Hollywood tends to over generalize and/or overly extreme put mental illness in the forefront that some of the symptoms that they describe are not accurate. But if you do have family members that struggle from zoning out or not being present all the time, or forgetful and don't remember doing certain things, that's probably time to get them into the doctor and be evaluated to make sure that dissociation is not something that they are experiencing.

Dr. Miller: We're your daily dose of science, conversation, medicine. This is The Scope; University of Utah Health Sciences Radio.