A woman diagnosed with dissociative personality disorder presented with 10 separate personalities, some of whom exhibited psychogenic blindness.
Key Information
- Dissociative identity disorder is a controversial disorder, thought by some to originate from severe childhood trauma.
- Psychogenic blindness is a psychological condition which can occur when the visual system is functioning normally.
- The woman’s psychogenic blindness was limited to specific personality states, and ‘healed’ with therapy in most cases.
Dissociative identity disorder is a controversial condition1, with some psychiatrists questioning its validity and suggesting that it is in fact driven by therapist suggestion. However, its link with psychogenic blindness is compelling.
It’s worth noting here that dissociation is a mental illness which may or may not include dissociation identity disorder. Many people experience dissociation at stressful times of their lives or following traumatic events, without having a disorder. Dissociative disorders are often a result of child abuse.
This article examines the case of a woman with more than 10 separate personalities, differing by gender, name, reported age, spoken language – in fact, the full spectrum of traits associated with an individual’s personality.
And, remarkably, her ability to see.
How the Visual System Works – and Why it Can Fail
Healthy vision relies on a complex system comprised of multiple processes, some being physiological, and others neurological. If any part of the system fails, vision can become impaired.
Perhaps most interestingly, even when the system is working properly, blindness can still be experienced. This is known as psychogenic blindness, meaning physical abnormalities or trauma are absent, with the cause instead being psychological. There are a couple of theories about what may cause the condition.
The visual system processes information hierarchically, and it has been proposed that psychogenic blindness occurs at the specific processing level of the lateral geniculate nucleus (LGN). The LGN is a visual relay center located in the thalamus, which some researchers believe may act as an early gatekeeper of visual awareness2.
Intriguingly, the LGN is also thought to play a role in another phenomenon related to vision, known as blindsight. Those affected are physically blind due to damage to their primary visual processing areas in the brain. However they remain able to see unconsciously and continue to be aware of objects presented to them and may even successfully navigate their surroundings.
Another suggestion for the mechanism of psychogenic blindness is that selective attention modulates incoming visual information, effectively disregarding the sensory input and interrupting the process, before it reaches the brain for processing. This has been previously linked to both cortical areas and the LGN.
The Woman With 10 Personalities – Some of Whom Were Blind
An interesting case demonstrates the phenomena of psychogenic blindness in a woman, known as B.T., with dissociative identity disorder (DID), previously referred to as multiple personality disorder. The change of name reflects an improved understanding of the condition, in that it does not involve different personalities, but distinct identities splintered off from your core self.
According to Cleveland Clinic, DID is thought to be caused by extreme childhood trauma, such as physical abuse, emotional abuse, or sexual abuse at a young age, and is characterised by disturbances of memory and coexistence of at least two distinct personalities. However, as mentioned earlier, sceptics of the diagnosis exist.
In the case of B.T., the then 33 year old woman visited Dr. Bruno Waldvogel to receive psychotherapy for her DID diagnosis at his practice in Germany. She reported having become severely visually impaired, and then completely lost her sight 13 years earlier following an accident. Waldvogel noted that her medical records showed a diagnosis of cortical blindness from trauma to the skull and brain.
B.T. had spent some of her formative years in an English-speaking country, and her later life in Germany. During the course of her therapy sessions, B.T.’s disorder presented as more than 10 different personalities, some of which states she could communicate only in English, others only in German, and some in which she was able to use both languages.
Her sight was fully restored – but this remained limited to only one personality state.
Dr. Hans Strasburger of Ludwig Maximilian University in Munich, who saw the patient once for an fMRI, and coauthored a report describing the case, published in PsyCh Journal, reported that four years into her sessions with Waldvogel, and immediately following a therapy session in which a major traumatic event was worked on, B.T. was suddenly able to recognise words on a magazine cover. By this time, it would have been 17 years since her blindness first occurred.
During subsequent sessions, the woman was able to recognise more and more until her sight was fully restored to everything normally visible to others – but this remained limited to only one personality state.
As B.T.’s psychotherapy continued, more of her personality states regained their sight, though two remained blind and, in fact, “sighted and blind states could alternate within seconds,” according to her doctors.
An Unconscious Desire to Retreat?
The doctors carried out an electrophysiological measurement used to detect vision impairment, and their observations were confirmed: electrical activity evoked in the brain in response to visual stimuli were absent in the blind states, yet normal and stable in seeing personality states.
Physiological visual systems can remain in tact and functioning normally, yet sometimes be overridden psychologically.
Whilst blindness following a brain trauma is entirely feasible, researchers have suggested this is “highly unlikely” to be the case for B.T. given the rapid switching observed between blind and sighted states.
The more plausible scenario is that the prior injury caused temporary impairment to B.T.’s vision, acting as a primer for subsequent psychogenic blindness. In other words, the physiological visual system was in tact and functioning normally, however it could sometimes be overridden psychologically, causing loss of vision as a coping mechanism.
Strasburger explains B.T.’s persisting blindness in two personality states to “presumably serve as a possibility for retreat. In situations that are particularly emotionally intense, the patient occasionally feels the wish to become blind, and thus not ‘need to see’”.
Can Brains Function on Multiple Programmes?
While unusual, B.T.’s disorder is not an isolated case.
A young Ethiopian woman was documented as having suddenly lost her sight following stressful life events, but with treatment went on to regain her vision3. And in another case an entire family temporarily lost their vision, with no signs of physiological abnormality4.
Psychobiological evidence from patients with DID has shown that distinct personality states are associated with differing cortical activation patterns.
While psychogenic blindness remains somewhat unexplained, B.T.’s case does bring some important insights to the conversation surrounding the controversy of dissociative identity disorder.
Researchers have stated that psychobiological evidence from patients with DID has shown that distinct personality states are associated with differing cortical activation patterns5. They said B.T.’s case shows:
“Differences between personality states are not limited to higher-level processing but can differ with respect to the fundamental processing of early sensory information and corresponding perceptual change. It therefore provides compelling evidence for the existence of the dissociated identities in a more biological sense.”
According to Dr. Richard P. Kluft, a clinical professor of psychiatry at Temple University School of Medicine, who disagrees with the notion of the condition as a cultural and therapeutic artefact, the findings presented in the report by Strasburger and Waldvogel add to the research demonstrating that dissociative identity disorder “is a legitimate psychophysiologically based syndrome of psychological distress”.
Though it would be remiss not to acknowledge that culture may influence the way it is expressed, Kluft said the syndrome “represents the mind’s attempt to compartmentalise its pain”, suggesting the condition is essentially the same worldwide.
If you suspect you or someone you care about may be experiencing dissociation or a dissociative disorder, seek help from mental health professionals.
Sources
- Piper A, Merskey H. The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Can J Psychiatry. 2004 Sep;49(9):592-600. doi: 10.1177/070674370404900904. PMID: 15503730.
- Wunderlich K, Schneider KA, Kastner S. Neural correlates of binocular rivalry in the human lateral geniculate nucleus. Nat Neurosci. 2005 Nov;8(11):1595-602. doi: 10.1038/nn1554. Epub 2005 Oct 23. PMID: 16234812; PMCID: PMC1470662.
- Mulugeta S, Tesfay K, Frank R, Gruber-Frank C. Acute loss of vision in a young woman: a case report on psychogenic blindness. Ethiop J Health Sci. 2015 Jan;25(1):99-104. doi: 10.4314/ejhs.v25i1.13. PMID: 25733790; PMCID: PMC4337078. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337078/
- Ziegler DK, Schlemmer RB. Familial psychogenic blindness and headache: a case study. J Clin Psychiatry. 1994 Mar;55(3):114-7. PMID: 8071248.
- Reinders AA, Nijenhuis ER, Quak J, Korf J, Haaksma J, Paans AM, Willemsen AT, den Boer JA. Psychobiological characteristics of dissociative identity disorder: a symptom provocation study. Biol Psychiatry. 2006 Oct 1;60(7):730-40. doi: 10.1016/j.biopsych.2005.12.019. PMID: 17008145.