In movie "Shattered" (1991), Dan Merrick survives an accident and develops total amnesia regarding his past. His battered face is reconstructed by plastic surgeons and, with help of his loving wife, he gradually recovers his will to live. But he never develops a proper sense of identity. It is as though he is constantly ill at ease in his own body. As plot unravels, Dan is led to believe that he may have murdered his wife's lover, Jack. This thriller offers additional twists and turns but, throughout it all, we face this question:

Dan has no recollection of being Dan. Dan does not remember murdering Jack. It seems as though Dan's very identity has been erased. Yet, Dan is in sound mind and can tell right from wrong. Should Dan be held (morally and, as a result, perhaps legally as well) accountable for Jack's murder?

Would answer to this question still be same had Dan erased from his memory ONLY crime -but recalled everything else (in an act of selective dissociation)? Do our moral and legal accountability and responsibility spring from integrity of our memories? If Dan were to be punished for a crime he doesn't have faintest recollection of committing - wouldn't he feel horribly wronged? Wouldn't he be justified in feeling so?

There are many states of consciousness that involve dissociation and selective amnesia: hypnosis, trance and possession, hallucination, illusion, memory disorders (like organic, or functional amnesia), depersonalization disorder, dissociative fugue, dreaming, psychosis, post traumatic stress disorder, and drug-induced psychotomimetic states.

Consider this, for instance:

What if Dan were victim of a Multiple Personality Disorder (now known as "Dissociative Identity Disorder")? What if one of his "alters" (i.e., one of multitude of "identities" sharing Dan's mind and body) committed crime? Should Dan still be held responsible? What if alter "John" committed crime and then "vanished", leaving behind another alter (let us say, "Joseph") in control? Should "Joseph" be held responsible for crime "John" committed? What if "John" were to reappear 10 years after he "vanished"? What if he were to reappear 50 years after he "vanished"? What if he were to reappear for a period of 90 days - only to "vanish" again? And what is Dan's role in all this? Who, exactly, then, is Dan?

II. Who is Dan?

Buddhism compares Man to a river. Both retain their identity despite fact that their individual composition is different at different moments. The possession of a body as foundation of a self-identity is a dubious proposition. Bodies change drastically in time (consider a baby compared to an adult). Almost all cells in a human body are replaced every few years. Changing one's brain (by transplantation) - also changes one's identity, even if rest of body remains same.

Do narcissists also suffer from eating disorders such as bulimia nervosa or anorexia nervosa?

Answer:

Patients suffering from eating disorders either binge on food or refrain from eating and sometimes are both anorectic and bulimic. This is an impulsive behaviour as defined by DSM and is sometimes comorbid with Cluster B personality disorder, particularly with Borderline Personality Disorder.

Some patients develop eating disorders as convergence and confluence of two pathological behaviours: self-mutilation and an impulsive (rather, obsessive-compulsive or ritualistic) behaviour.

The key to improving mental state of patients who have been diagnosed with both a personality disorder and an eating disorder lies in focusing at first upon their eating and sleeping disorders.

By controlling his eating disorder, patient reasserts control over his life. This newfound power is bound to reduce depression, or even eliminate it altogether as a constant feature of his mental life. It is also likely to ameliorate other facets of his personality disorder.

It is a chain reaction: controlling one's eating disorders leads to a better regulation of one's sense of self-worth, self-confidence, and self-esteem. Successfully coping with one challenge - eating disorder - generates a feeling of inner strength and results in better social functioning and an enhanced sense of well-being.

When a patient has a personality disorder and an eating disorder, therapist would do well to first tackle eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like obsessive-compulsive behaviours, or depression can be ameliorated with medication or modified). The treatment of personality disorders requires enormous, persistent and continuous investment of resources of every kind by everyone involved.

From patient's point of view, treatment of her personality disorder is not an efficient allocation of scarce mental resources. Neither are personality disorders real threat. If one's personality disorder is cured but one's eating disorders are left untouched, one might die (though mentally healthy)…

An eating disorder is both a signal of distress ("I wish to die, I feel so bad, somebody help me") and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and discharge. This way I can control at least ONE aspect of my life."

This is where we can and should begin to help patient - by letting her regain control of her life. The family or other supporting figures must think what they can do to make patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences, and choices matter.