IMAGES IN PSYCHIATRY

Trauma, Creativity, and Trance: Special Ability in a Case

of Dissociative Identity Disorder
Vedat Şar, M.D., Tuba Mutluer, M.D., Işıl Necef, M.A., Parmis Fatih

This report describes a 19-year-

old male patient with disso-
ciative identity disorder who
has an extraordinary skill in
drawing. After carefully ob-
serving people, objects, or their
photograph, he later creates
hyperrealistic charcoal draw-
ings of them entirely from
memory. Remaining partly
amnestic, he produces these
pictures during a trance, that
is, in control of an alternate
personality state. He day-
dreams about unrelated themes
while “his hand” keeps draw-
ing. Such episodes follow an
“appetite-like” urge to draw.
Withdrawing to his studio,
he suspends daily activities
(e.g., skipping meals), enters
an apparent stupor, and the
“child inside” takes control.
He does not experience these
drawings as produced by him-
self. As an artist “still in de- A portrait, drawn by the patient, of “Grandma Rosie” (epithetic pseudonym), who lives in the same town as
velopment,” he does not sign the patient. (Original size: 150 cm 3 175 cm. Drawing provided with permission, from both the patient and the
subject.)
them yet by name; he uses a
cipher instead.
According to DSM-5, dissociation is characterized by a dis- (3), as it is a mechanism also involved with automatic pro-
ruption in usually integrated psychological capacities such cessing (4).
as perception, consciousness, attention, memory, and sen- The patient reported amnestic gaps in daily life, such as
sorimotor functions. While it serves to cope with unbearable finding himself in a new place without having any idea how he
developmental stress, genetic predisposition for a special arrived there. Others have observed him talking to himself
skill may “benefit” from such dissociation by finding a niche occasionally. He also reported childhood-onset visual hallu-
of “freedom” in which to flourish. Dissociated action ten- cinations and illusions, such as seeing the image of a skeleton
dencies (including sensorimotor phenomena) can be adopted or of an unfamiliar person. He used to laugh inappropriately
and gradually dominated by discrete behavioral states (1) or or behave in a childish-playful manner. He frequently failed
parallel-distinct mental structures (2) in dissociative identity to keep up with personal responsibilities. He lacked close
disorder to obtain a sense of self and agency, and even a friends among peers. He was previously diagnosed as having
narrative. Greater suppression of the default mode net- atypical pervasive developmental disorder, Asperger’s syn-
work during a state of mind-wandering trance (absorbed in drome, or attention deficit hyperactivity disorder.
vivid imaginations and memories) may be associated with He started to perceive another child “inside” when he
better performance on an otherwise attention-demanding task was 9 or 10 years old. Because he was frightened by strange

506 ajp.psychiatryonline.org Am J Psychiatry 175:6, June 2018


internal voices, his mother let him wear an amulet as pro-
tection against supernatural jinnies. Having the same voice as
his, this “inner” child made very persuasive demands that he
felt obliged to carry out (e.g., “screaming when bored” re-
gardless of the social situation). The “child inside” refused
the existence of time (detemporalization). Both he and the
child perceived themselves as 6–8 years old. His childish
manners manifested in particular when he experienced in-
terpersonal conflict. Nevertheless, he enjoyed conversations
with adult acquaintances who were like-minded.
He was the oldest of three siblings, and he was exposed
to physical and emotional maltreatment and witnessed do-
mestic violence from early childhood. He was separated from
his parents for 4 months when he was 4 years old and ex-
perienced a physical assault by older children when he
was 6. He had oppositional behavior in primary school (e.g.,
violating classroom rules, leaving the school building with-
out permission) because he did not like the “meaninglessly
monotonous order.” Labeled as a “nut,” he became an out-
sider in school and was bullied by his peers. His artistic talent
drew attention during painting lectures when he was 12.
Despite his rebellious attitude against the “system” (5), he
succeeded in graduating from an art secondary school. Be-
cause he believed that school killed creativity, he declined to
attend a college. His mother’s uncle and a cousin were also
talented in painting. His paternal grandmother wrote epics
and poems before she became chronically psychotic. His
parents divorced when he was 16.
He was talkative during interviews, and he responded to
jokes with a childish joy. He had no affective blunting, formal
Am J Psychiatry 175:6, June 2018
IMAGES IN PSYCHIATRY
thought disorder, disorganized behavior, or delusions. His IQ
was in the normal range. He had an elevated score (6.3/10)
on the Adolescent Dissociative Experiences Scale, and the
Structured Clinical Interview for DSM-IV Dissociative Dis-
orders confirmed the diagnosis of dissociative identity disor-
der. He declined proposed psychiatric treatment, as he and his
internal doppelgänger enjoyed their productive comradeship,
which made social isolation and loneliness rather negligible.
Moreover, both considered the drawing sessions relieving.
Nevertheless, he was eager to share his experiences “to serve
the science.”
AUTHOR AND ARTICLE INFORMATION
From the Department of Psychiatry, Koç University School of Medicine,
Istanbul, Turkey.
Address correspondence to Prof. Şar (vsar@ku.edu.tr).
Am J Psychiatry 2018; 175:506–507; doi: 10.1176/appi.ajp.2018.17121347
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2014
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