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Dissociative identity disorder

Dissociative Identity Disorder (DID) is the current name of the psychiatric condition formerly listed as Multiple Personality Disorder (MPD) or Multiple Personality Syndrome. This condition should not be mistaken for schizophrenia.

Overview

In psychiatry, Dissociative Identity Disorder (DID) is the current name of the condition formerly listed in the Diagnostic and Statistical Manual of Mental Disorders as Multiple Personality Disorder (MPD) and Multiple Personality Syndrome. The International Statistical Classification of Diseases and Related Health Problems continues to list it as Multiple Personality Disorder. Multiple Personality Disorder should not be confused with schizophrenia.

This diagnosis is controversial. The main points of disagreement are:

1. Whether MPD/DID is a real disorder, or just a fad.

2. If it is real, is the appearance of multiple personalities real (MPD) or delusional (DID)?

3. Whether it can be cured.

4. Whether it should be cured.

5. Who should primarily define the experience -- therapists, or multiples.

6. Whether it is invariably a disorder or simply a way of being.

In rough terms, believers in DID or MPD argue that children who are stressed or abused (especially sexually abused), split into several independent personalities or ego states as a defense mechanism. How people with DID/MPD perceive their actions varies, but often only one personality (or "alter") can control the body at any given time. Sometimes alters are co-conscious and share all memories. Sometimes each alter remembers only the times when he/she/it controlled the body, and has amnesia for all other periods. People diagnosed with DID may exhibit erratic alterations of personality and may "lose time".

Skeptics claim that people who act as if they have MPD/DID have learned to exhibit the symptoms in return for social reinforcement, either from therapists, from others with DID, from society at large or from any combination thereof.

Believers in DID retort that people with the syndrome really do have multiple selves or experience themselves so, really cannot control their behaviors, and should be treated with the same respect and consideration afforded those with other mental disorders.

In addition, some people would argue that it is normal to experience oneself as multiple and that "multiplicity" is not necessarily a disorder, so that it is possible to be multiple without having MPD or DID.

The debate over DID and MPD has been inextricably mixed with the furor over recovered memories of childhood sexual abuse, the child sex abuse panic of the 1980s, and associated tales of satanic ritual abuse. In the U.S. (and to a much lesser extent in other English-speaking countries, like the U.K. and Australia), it was widely believed that sex and satanic abuse were rampant and that they often caused MPD. More people began to suspect that their psychological problems were caused by childhood abuse and that they had MPD. As the stories told by the clients grew ever more bizarre and unbelievable, as the numbers of people claiming MPD spiked, as public prosecutions of daycare workers began to seem like Salem witch trials, the public at large eventually grew less accepting and more hostile to stories of recovered memories, ritual abuse, and MPD.

However, there are still many mental health workers who would argue that while there was much exaggeration and bad therapy during the 1980s and early 1990s, and a few supposed MPD clients who were merely suggestible, that it is a real disorder, with real victims. This view is common enough that DID still figures in American diagnostic manuals, and MPD in those of England and Europe.

At stake is how we are to treat those claiming multiple selves. If DID is real, then DID clients have suffered some form of childhood trauma which is obviously impacting their present lives sufficiently as to require treatment. If it is factitious, then the supposed victims have something like histrionic personality disorder; the adoption of a less-than-ideal strategy for controlling others.

Given that the stakes are so high and opinions so fundamentally opposed, it is extremely difficult to present information about multiplicity, MPD and DID in a way that all sides will accept. Perhaps the best solution is to give each side a chance to state its case. These sides might be said to be:

* "Believers", who argue that we must trust and believe those who claim to have DID/MPD and to have recovered memories of childhood sexual abuse.

* The debunkers -- mental health professionals, scientists, and others who have challenged the believers. Most would argue that DID is a fad rather than a real disease.

* Mental health professionals, scientists, and others who believe that DID is a valid diagnosis, while distancing themselves from the perceived excesses of the believers.

* People who believe that it is possible to be multiple and psychologically healthy. Arguments that assume all multiplicity is an illness, whether MPD or DID, do an injustice to healthy multiples. Note that the existence of psychologically healthy multiples does not preclude the existence of MPD/DID as a disorder.

"Believers"

The basic premise of the believers is that child abuse or child sexual abuse are trivialized and under-reported. We do not want to believe that real mothers and fathers would abuse their children or allow them to be hurt; we shut our ears to the survivors who dare to speak up. Believers say that we must believe them, even when they say things that we do not want to hear. Otherwise, we are protecting the pedophiles who prey on children, smugly sure that any children who do complain will not be believed.

Not only should we believe the children, we should believe the adult survivors who have struggled to recover repressed memories of childhood abuse. Many believers trust that hypnosis, dream analysis, body memory analysis, and other such techniques are valid ways to uncover the repressed memories.

Believers may differ in how far they will accept all details of children's accounts and recovered memories. When survivors report satanic ritual abuse and alien abduction, some people say that we must still believe the survivors. Others would say that while not all details may be accurate, it is still likely that something untoward occurred.

Believers are particularly incensed by the False Memory Syndrome Foundation, a support and advocacy group for parents accused of child sexual abuse. By encouraging the public not to believe the victims, they say, the FMSF in effect supports pedophiles. (See note at end of article for a pro and con on this accusation.)

Prominent believers:

* Dr. Colin Ross M.D., author of Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment (1989), Satanic Ritual Abuse: Principles of Treatment (1995). Dr. Ross later reversed his position, declaring multiplicity to be "an elaborate form of pretending" and essentially agreeing with the detractors.

* E. Sue Blume, clinical social worker, author of Secret Survivors (1991).

* Laura Davis and Ellen Bass, authors of The Courage to Heal (1988). Quotes from this book:

" ... if you are unable to remember any specific instances like the ones mentioned above but still have a feeling that something abusive happened to you, it probably did" (p. 21).

" ... demands for proof are unreasonable" (p. 137).

Debunkers

Debunkers and skeptics would say that humans often lie, exaggerate, and fantasize, and that it is a mistake to demand uncritical belief in stories of child abuse, recovered memories, and multiple personality. To do so is to invite misuse of the blank check given the story-tellers.

If we are told we must believe the children, what are we to make of the sensational and completely unreal details disclosed in the daycare child abuse trials?

* The McMartin Preschool trial

* The Fell's Acres trial

* The Little Rascals trials

These trials received much publicity and are still controversial. The MacMartin trial ended without a conviction; convictions in the Fell's Acres and Little Rascals cases have been reversed. After the children in these cases were questioned at length, they told stories of underground tunnels, secret rooms, children being thrown to sharks, trips in rocket ships, etc. Believers would say that we must believe "something happened" because children do not lie.

If we are told we must believe recovered memories, what of the people who recover memories of alien abductions and satanic ritual abuse? There is no scientifically acceptable evidence for any such events. What of the people who recover memories and later disavow them? Skeptics point to cases like the following:

* Dr. Bennett Braun was a respected therapist and a founding member of the International Society for the Study of Multiple Personality and Dissociation. In 1993 he was accused of malpractice by one of his patients, Pat Burgus. Under Braun's treatment at a Chicago area hospital, Burgus discovered that she had 300 personalities and recovered memories of a long career as a satanic priestess presiding over cannibal feasts. Eventually she rejected Braun's diagnosis and sued. In 1997, Braun settled for $10.6 million. He was sued by other patients and lost his medical licence for a time.

Other such material has been collected by the False Memory Syndrome Foundation, founded in 1992.

Debunkers state that the child abuse/recovered memories/ritual abuse/MPD panic bears all the signs of a mass mania, like the Salem Witch Trials or the New Delhi monkeyman hysteria. DID cannot be a real disease or it would be much more widespread. But DID is limited to a specific place (the United States and to a much lesser extent, other Western countries exposed to the U.S. media) and time (roughly, the period from 1976 through 1996). As media coverage spiked, cases climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990. Per Joan Acocella, 40,000 cases were diagnosed from 1985 to 1995.

Not only is DID centered in the U.S., it is centered in a few practitioners. Most mental health professionals have never seen a patient with DID; others apparently see nothing but! This does not inspire confidence in the diagnosis.

Debunkers would argue that by lavishing attention and care on persons diagnosed with DID/MPD, we reward them for the supposed disease. For example, multiples often present with child selves. By enacting a childlike role, multiples can demand to be treated with the indulgence we afford to real children. This behavior is especially noticeable on the Internet, where diagnosed MPD/DID multiples who congregate in online forums type in a bizarre jargon which supposedly expresses accurately the speech patterns of their "littles".

There is now a vast psychological literature on memory and recovered memory, as well as arguments pro and con for the usefulness of the DID diagnosis. For readable introductions to the debunking point of view, see:

* Creating Hysteria by Joan Acocella, 1999.

* Multiple Identities and False Memories by Nicholas Spanos, 1996.

Professionals who still find the DID diagnosis useful

Many professionals would admit that uncritical belief and questionable therapeutic practices were rife during the heyday of the recovered memories/ritual abuse/MPD mania. However, they insist that publicity or no publicity, some patients would still have DID and still require treatment.

Mainstream opinion now says:

* A pushy therapist can lead patients to recover false memories. Many supposed memory recovery methods, like hypnosis or dream work, are unreliable. Any therapist working with patients who claim to be abuse survivors (or whom they suspect to be abuse survivors) should be scrupulously neutral, careful to avoid suggestion, and wary of uncorroborated claims.

* A therapist should work with "alters" if they come up spontaneously, but should not reward the patient for displaying them.

Mental health professionals and researchers working with dissociative disorders can join an organization called The International Society for the Study of Dissociation.

Healthy multiplicity

Some professionals and multiples would say that multiplicity is not inherently dysfunctional. So long as there is co-consciousness and no loss of memory, so long as the various "selves" can communicate and negotiate with each other, multiples can lead happy and productive lives. It is mere prejudice and bigotry to insist that everyone be a singleton (have a single "self").

Some contend that the unity of the self is an illusion and that everyone is fundamentally multiple (an opinion similar to the observations of William James). Others take the position that some people are inherently singletons, some inherently multiple, and that people should be allowed to express themselves as they are. Independent or self-recognized multiples are beginning to form groups like those established by autistic people, to speak for themselves and educate the public.

Truddi Chase, author of the widely read When Rabbit Howls, is one believer in healthy multiplicity. Her "selves" rejected integration and live as a cooperative. Another is therapist Dr. David Caul, who treated Billy Milligan. He said of multiplicity therapy "It seems to me that after treatment you want a functional unit, be it a corporation, a partnership, or a one-owner business."

There is a fair bit of cross-cultural evidence to suggest that a small but persistent fraction of humans everywhere experience themselves as multiple. Many religions recognize shamans, people who claim to communicate with and be possessed by gods or spirits. Devotees visit the shaman, who may go into trance and speak with the god's voice, making predictions or giving advice. Some religions may also attribute some illnesses to spirit possession. Those who recover from possession may go on to become shamans. This could be seen as a transition from dysfunctional to functional multiplicity.

In yet other religions, like voodoo and the orisha religions of Africa, all devotees aim to be possessed by the gods. Here, multiplicity is not a dysfunction, but a spiritual goal.

While such evidence suggests a common psychological mechanism for multiplicity, it also highlights the influence of the surrounding culture on the perception and subjective experience of multiplicity. For example, people in other cultures who are multiple do not express their other selves as "parts of themselves", but as independent souls or spirits. There is no evident link between multiplicity, dissociation or recovered memories, and -- surprisingly -- between multiplicity and sexual abuse. Belief that multiplicity is invariably associated with abuse and dissociation may characterize the "late 20th century Western" template for multiplicity, known to some in the psychiatric community as "the post-Wilburian paradigm".

Note on FMSF (False Memory Syndrome Foundation)

Believers say that the FMSF protects pedophiles. The FMSF will admit that it cannot be sure that all of its members are innocent of abuse, as it does not, and cannot, investigate all prospective members.

Indeed, one of the founders of the FMSF, Ralph Underwager, was later found to have argued for better understanding and toleration of pedophilia in a 1993 interview with a Dutch magazine. Underwager resigned from the FMSF that same year, while claiming that his views had been misrepresented.

Believers point to this embarrassment as an example of the true agenda of the FMSF. The FMSF would disagree.


The information above is not intended for and should not be used as a substitute for the diagnosis and/or treatment by a licensed, qualified, health-care professional. This article is licensed under the GNU Free Documentation License. It incorporates material originating from the Wikipedia article "Dissociative identity disorder".

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