Marcella: the real-life disorder behind the detective’s black-outs

Remy Aquarone, Director of the Pottergate Centre for Dissociation & Trauma, has given us his diagnosis: Marcella has dissociative identity disorder (DID).

Between 0.5 and three per cent of the British population will suffer from a form of dissociation at some point in their life, meaning it could affect almost two million people in the UK. Despite this, dissociative disorders are not a big part of public discourse and we don’t know much about them.

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In a recent interview with RadioTimes.com, Marcella actress Anna Friel emphasised that the series is very much a drama, not a documentary, and therefore isn't supposed to be a spot-on depiction of the disorder. Yet it's clear it's what inspired the show's creator Hans Rosenfeldt in his depiction of Marcella.

To try to understand it a little more, we spoke to Aquarone about the condition.

What causes dissociative identity disorder?

Aquarone explains that DID is nearly always rooted in childhood trauma. The disorder begins on the basis of a “difficulty of attachment” which is essentially when a very young child’s connection to their parent is disrupted.

This disruption is usually a result of physical, sexual or emotional abuse, but it can also be caused by suddenly losing a parent in, for example, a car accident. If a child loses their “primary connection” at a very young age, they can develop the condition.

Aquarone gives a “typical” example of the kind of trauma that would lead to DID.

“Let’s say there’s a young girl, maybe four years old, who's being brought up by her dad, the single parent. During the week, he does everything you'd expect a good parent to do both in terms of physical and emotional needs.

“But then on Fridays he goes home via the pub, gets paralytically drunk, comes back and beats his daughter up.

“What you've got there is a child with a brain state that can't deal with two very different presentations. She has to keep connected to the parent that is looking after her, but she can only do that by having no memory of those times when he does the opposite, because the mind can't reconcile the two.”

Is it always caused by a childhood trauma?

Not always. DID can happen in adults for the first time, but usually only in “extreme situations”. Aquarone gives two historic examples of the disorder setting in for adults: people coming out of concentration camps in the Second World War and soldiers returning from fighting in Vietnam.

Of the soldiers, he says: “Coming back, their brain state was still in that hyper arousal mode of shoot first and ask questions afterwards, so you had quite a lot of stories back then of people in the States hearing a car backfire and thinking they were back on the battlefield, so taking their gun out to shoot.”

That sounds a lot like post traumatic stress disorder, and Aquarone confirms that it is “an extension of complex PTSD”.

He does emphasise, however, that more often that not DID is linked to when people are children, because that’s when the brain is forming and the dissociation becomes a defence mechanism.

In Marcella's case, it seems as though the disorder set in after the cot death of her baby daughter, Juliet.

What triggers the black-outs that happen years after the trauma?

Dissociation is often triggered by something that reminds the person of the original event that took place in their childhood.

“For some people,” Aquarone explains, “they are walking down the street perfectly normally and then they see someone coming towards them that looks like their abuser.”

They don't necessarily “consciously” realise that the person they see reminds them of their abuser, but the brain is activated into thinking that they’re back in that traumatic situation. They “switch” in order to deal with the trauma.

Are the black-outs always violent?

Definitely not. Aquarone bemoans the fact that violence is something associated with this disorder in the media, saying it’s “unfortunate because it gives the impression that these people are psychopaths”.

What generally happens, he says, is that people go back to a “childlike state”. Mentally, they revert to the age they were when the trauma happened. “It's like when a computer crashes, it goes back to when you last backed it up,” explains Aquarone.

“In therapy, this happens a lot. You're dealing with someone who’s in an adult body, but is behaving with all the mannerisms, the language and the body movement that you'd expect a four-year-old to have.”

Recent research conducted in Holland shows that there is a biological brain change, where it literally switches to the state of a child’s mind.

Aquarone says that violence may occur if someone was abused as an adolescent, and they reacted violently at the time to try and protect themselves.

Is dissociation treatable?

According to Aquarone, the disorder is “treated very well” – but not on the NHS because “they are finding it very difficult to recognise and they try to treat it with short term therapy”.

He says that because the condition is so deep-rooted, it cannot be treated using cognitive processes.

Instead, it requires a long-term process, at least three years, of working with a therapist.

Aquarone describes the treatment as “a bit like a brain gym” where, with the help of a therapist, the person begins to allow their memories to come back without running away from them.

“It’s not lost memory,” he says, “it's compartmentalised. Nothing is lost, they just don’t have the key to access those memories.”

Therapy can enable people to remember not only their original trauma, but also the events that occurred during subsequent bouts of amnesia.

Hypnosis is a form of treatment that Aquarone says he is “dubious” about. It’s widely used to treat dissociation in America, but he says it is risky because it means the therapist is the one with the power and the patient might be unable to say stop if they need to.

Aquarone says: “They may find themselves going away and acting out on the overwhelming terror of having remembered – and they may even kill themselves.”

He explains that when hypnotism is brought into therapy as part of the process it can be helpful – but he would be against having it as the basis of the treatment.