Hello Again, Western Psychiatry

It's perhaps not surprising that the beliefs of a community that tends to focus on pathologized experiences (often at the expense of those outside of the medical paradigm) tends to lean aggressively into the beliefs of Western psychiatry. Those beliefs are very relevant when we talk about whether or not system members can die.

I'm going to go a bit deeper into this. Western psychiatric writing can be frustratingly insistent on dismissing the lived realities of those who experience themselves outside of the norm, and we're going to quote some of the treatment guidelines used for DID to make it very clear where this belief came from. If medical invalidation is a problem for you, then please skip to the bolded phrase: Discussion of Western psychiatry ends here.

Under Western psychiatry, system members are never truly separate people; they will only ever be the same person appearing differently as their access to memories, emotions, and other traits change. The "real person" is often defined as the sum total of all of their alters. From the International Society for the Study of Trauma and Dissociation's adult treatment guidelines for Dissociative Identity Disorder:

"The DID patient is a single person who experiences himself or herself as having separate alternate identities that have relative psychological autonomy from one another. At various times, these subjective identities may take executive control of the person’s body and behavior and/or influence his or her experience and behavior from “within.” Taken together, all of the alternate identities make up the identity or personality of the human being with DID." (Page number 120, which is the 7th page of the actual document when taken on its own- feel free to take a look for yourself.)

From the next page of the same document:

"It can be helpful to use the terms that patients use to refer to their identities unless the use of these terms is not in line with therapeutic recommendations and/or, in the clinician’s judgment, certain terms would reinforce a belief that the alternate identities are separate people or persons rather than a single human being with subjectively divided self-aspects."

This is even applied to spiritual experiences that are diagnosed as DID despite the cultural acceptance criterion (often because the experience is involuntary or upsetting). Again, from the ISSTD DID Adult Treatment Guidelines:

"However, they also note that pathological alterations of identity and/or consciousness may present in other cultures as spirit possession and other culture-bound syndromes (Cardeña, Van Duijl, Weiner, & Terhune, 2009)."

From another source (Merck Manual's page on DID, Professional Version):

"In the possession form, the multiple identities are readily apparent to family members and associates. Patients speak and act in an obviously different manner, as though another person or being has taken over. The new identity may be that of another person (often someone who has died, perhaps in a dramatic fashion) or that of a supernatural spirit (often a demon or god), who may demand punishment for past actions."

Regardless of whether the system experiences their members as isolated self-states, independent people, spiritual possession, or something else, the same basic model is applied within Western psychiatry: these states are not people, these states always come from inside the same mind, and all of these states belong to one dissociative person.

This is the formal clinical view of DID and OSDD: that alters are not truly separate people, and that the entire system is a single person with dissociated states of self.

Discussion of Western psychiatry ends here.

More than One Model

Western psychiatry's model of systemhood does work well for some systems. It can normalize their experiences or make it easier to move towards the life they want to live. Some find that seeing themselves this way reduces dissociation that interferes with their daily lives.

If this model is taken as absolute truth, then it makes sense to say that system members cannot die or be born- if the person's brain is still alive, then all of its contents must be there regardless of whether alters are present or not. If an alter "dies," then the person is still there, just with a slightly different pattern of dissociation than before.

The trouble is that this model does not work as absolute truth for all systems.

Some systems find this model of plurality to be dismissive of their lived experiences or outright harmful to them. This is often particularly the case for systems whose definition of "person" is not equivalent to their entire brain or body, as well as for those who prefer to understand their experiences outside of mainstream Western concepts of mental pathologies. Insisting that their system members are all dissociative states of the same person can be deeply dismissive of their lived realities and chosen frameworks, and this can do concrete harm to their ability to work with their experiences or live with each other.

Western psychiatry is not the only institution with the ability to define one's self-experience, and there are many other ways to understand plural experiences outside of that paradigm. Some of them are cultural or spiritual. Some of them are personal. It is entirely possible that some of these models do allow for the possibility of birth or death within a system, and that is what we see anecdotally from some systems.

Some systems contain ghosts or the undead. Some experience headmates truly dying. Sometimes the dead come back to life; other times, they are simply gone. We have seen this interpreted as symbolic representations of trauma or life changes just as often as we have seen it interpreted as a literal reality.