Multiple personality controversy

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The existence of multiple personalities within an individual personality is diagnosed as dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Prior to the publication of the DSM-IV, it was termed multiple personality disorder (MPD). Both the International Statistical Classification of Diseases and Related Health Problems (ICD) and Diagnostic and Statistical Manual of Mental Disorders list the condition in their taxonomies of mental disorders, as MPD and DID respectively.

Contents 1 Recent history 2 Contemporary views 2.1 Supporters of the therapy view 2.2 Critics 2.3 Healthy multiplicity 3 Chronology 4 See also 5 References 6 Further reading 7 External links

[edit] Recent history

Some of the criticisms of the diagnosis arose in the wake of the controversy over Satanic ritual abuse (SRA). Allegations of Satanic cults operating secretly kidnapping children and using them in human sacrifices, was advanced in the early 1980s by evangelical Christian writers, among them Hal Lindsey and Johanna Michaelsen.^[1] Bennett Braun and others believed that abuse by such cults was widespread, and that some deliberately used mind control to induce multiple personalities in victims.^[2]

Some therapists formed the view that the allegations derived from a moral panic.^{[citation needed]} Others who did not necessarily agree with either of these views did believe that psychological distress in adulthood was sometimes due to repressed memories of childhood sexual abuse, and/or to other personalities formed by trauma.^{[citation needed]} As the memories described by some patients identifying with MPD/DID in recovered memory therapy were bizarre, and seemed to strain credibility, or described incidents that could not have happened, the debate over MPD and DID became indelibly linked to the debate over repression for skeptics and critics.^[1][3]

People with DID often report that they have experienced severe physical and sexual abuse, especially during their childhood.^[4] Reports by people with DID of their past physical and sexual abuse are often confirmed by objective evidence, though .^[4] People responsible for the acts of sexual and physical abuse might be prone to distort or deny their behavior.^[4]

Self-identified multiples who state they do not experience multiplicity as being connected to repression, abuse, or dissociation appear on the internet websites and discussion groups devoted to this type of multiplicity.

A few accused criminals, especially murderers, have claimed one of their "alters" committed a crime and used the diagnosis as a defense. Jeffrey MacDonald, who was convicted of killing his wife and children, and Hillside Strangler Kenneth Bianchi were among the most notable. The most recent on record was the 1994 trial of a Pennsylvania woman who did not claim she killed because of the disorder, but confessed to a murder as one of her "alters" commanded (The Morning Call, Easton Express 1993-1994, numerous articles). She and other family members related bizarre episodes of memory loss and that she often looked and acted like totally different people at different times. It was theorized that her disorder was brought on by years of sexual, emotional, and physical abuse. Two psychiatrists testified for her defense, one claiming she had the disorder, the other claiming it was not MPD. The defense appeared to work to some extent. She was acquitted in the murder of another woman.

[edit] Contemporary views

DID has consistent diagnostic features^[5] but it is a very controversial diagnosis^{[6][7][8][9][10]} with some researchers considering it a culture bound, iatrogenic condition^[8][11] though this idea is neither confirmed nor universally accepted.^{[12][13][5][14][15]}

The DSM is explicit about the controversy over the condition, identifying both the objective evidence of physical and sexual abuse in the history of individuals diagnosed with DID and that individuals accused of abuse are motivated to deny or distort past actions, but also points out that childhood memories may be distorted, and that individuals with DID are highly hypnotizable and unusually vulnerable to suggestion.^[4] The skepticism of doctors regarding DID can contribute to misdiagnosis.^[16]

Scientific study of DID peaked in the mid 1990s, and since declined sharply, a pattern described by Pope et al. as "a brief period of fashion", and may not have widespread acceptance in the scientific community.^[17]

[edit] Supporters of the therapy view

Those who believe MPD/DID is a fact believe that children who are stressed or abused (especially sexually abused) may split into several independent personalities or ego states as a defense mechanism.^[18] DID is attributed to the interaction of overwhelming stress, insufficient childhood nurturing and an innate ability to dissociate memories or experiences from consciousness.^[16] Prolonged childhood abuse is believed to be a factor in DID,^[16] with a very high percentage of patients reporting documented abuse.^[19] DID has been found to be a severely lasting dissociative response to overwhelming and normally traumatic antecedents and results from childhood trauma.^[20] It has been proposed that "alternate personalities are formed to shield MPD sufferers from pain and memories of abuse."^[21]

There is insufficient understanding of consciousness to be able to explain how a novel split occurs in a previously undivided mind and how it is maintained in the mind. Psychoanalytic theorists believe a schizoid phase of development occurs in childhood, which may have encouraged this view of traumatic splitting. It is not clear what differentiates those children who split from those who do not under comparable types of stress. An alternative view is that a developmentally appropriate multiplicity of selves, became arrested or fixed in place by the repeated shocks of sadistic abuse and established themselves as independent entities rather than grow normally into a cohesive self. According to these views, the primary function of these separate ego states is then to hold traumatic memories in a secure neural network, keeping them out of the consciousness of the original self. This frees the person to continue functioning in daily life as if nothing had happened. Some of the alternate selves, also called "alters," take turns controlling the body. Some take responsibility for learning at school, or for work and career and others for seeing the doctor for mysterious illnesses or injuries, some self-inflicted. Sometimes each alter reports remembering only the times when they were 'out' and in conscious control, and report amnesia for all other periods.

This model holds that since alters represent dissociated fragments of the original self, they have a limited capacity handling only defined emotions or tasks. This gives these 'others' an appearance lacking psychological depth with a limited range of affects and restricted life experience. As a result any one of them is ill prepared for making decisions, which affect the rest whose agendas differ. Realizing this, one or more selves in concert may take the group into therapy. That is a process fraught with the same difficulties of forming consensus as the collective has on its own.

This model is a better fit with the current understanding of Complex post-traumatic stress disorder (C-PTSD), as described by van der Kolk, et. al (2005).^[22] and traumatic grief in childhood.^[23][24] A variety of treatment approaches, such as psychodynamic or cognitive therapy, have been successful.^[25]

A critical psychology view is that therapists only see high functioning multiples (with the wherewithal to pay for therapy) who were sadistically abused as children, whilst there are other types without psychiatric disorder or dysfunction who don't come to their attention. Those supporting that view believe in human neurodiversity or evolutionary variation in brain wiring that gives rise to different sensitivities to the inner workings of consciousness." Dissociative identity disorder is found in 3 to 4% of people in hospitals for other mental health disorders and a large number of patients in treatment facilities for substance abuse.^[19]

[edit] Critics

Some psychologists and psychiatrists regard DID as being iatrogenic or fictitious, or contend that true cases are extremely rare and that the majority of reported cases are iatrogenic. Drs. Paul McHugh and Herbert Spiegel are among the leading critics of the DID paradigm, and have made their views known in articles and television interviews. Brown, Scheflin and Frischholz state that McHugh's publications on DID are "mere speculation" and that McHugh himself has made it clear that he has had very little actual clinical experience with the ongoing treatment of DID patients and is unfamiliar with the clinical features of the disorder and what usually occurs in treatment.^[12]

Skeptics contend that those who exhibit the symptoms of MPD/DID have learned to behave as though they had different selves in return for social reinforcement and reward, either from therapists, from other DID patients, or from society at large. The modern DID model relies on the premises that multiplicity is a disorder of memory and that repression of memories is a common defense against childhood sexual abuse and linked to multiplicity. As such, some critics have focused on studies citing the fallibility and flawed nature of human memory, the weaknesses of hypnosis as a tool for recall, and on disproving claims of the accuracy of recovered memories.^[26] The work of psychologist Elizabeth Loftus, who specializes in human memory, is usually cited to support this conclusion.^[26]Some of Loftus' work, however, has been critiqued in terms of the applicability of its conclusions^[27][6]and for not having been subjected to rigorous scientific scrutiny.^[28][7]A more lengthy review of the normal fallacies of memory is given by Nicholas Spanos in his sociocognitive model.^[29]Gleaves states that the research on DID does not support the ideas that DID is a construct of either psychotherapy or the media (the sociocognitive model), but that there is a connection between DID and childhood trauma.^[13] Gleaves states that treatment recommendations that follow from the sociocognitive model might be harmful due to the fact that they ignore the posttraumatic symptomology of people with DID.^[13]

Critics of the DID model point to the fact that the diagnosis of MPD and DID is a phenomenon largely unique to English-speaking countries.^[29] Prior to the 1950s, cases of dual personality and multiple personality were occasionally reported and treated as curiosities in the Western world.^[30] The 1957 publication of the book The Three Faces of Eve, and the popular movie which followed it, revived the American public's interest in multiple personality. The diagnosis of Multiple Personality Disorder, however, was not included in the DSM until 1980, following the publication in 1974 of the highly influential book Sybil. As media coverage spiked, diagnoses climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990.^[31] According to Joan Acocella, 40,000 cases were diagnosed from 1985 to 1995.^[1] The DID diagnosis is supposedly centered in North America, particularly the United States, and in English-speaking countries more generally.^[29] There is some evidence that the majority of diagnoses are made by only a few practitioners.^[32]

The DSM currently treats dissociative amnesia, dissociative fugue, and DID as mental disorders characterized by dissociation.

Other researchers assert that the present scientific evidence is inadequate to support that “suggestive influences allegedly operative in psychotherapy can create a major psychiatric disorder like MPD per se” and that “there is virtually no scientific support for the unique contribution of hypnosis to the alleged iatrogenic creation of MPD in appropriately controlled research.”^[12] It has been found that specialists in MPD(DID) do not influence their clients to make an increased number of personalities or to develop additional diagnostic criteria.^[5] A patient’s being exposed to hypnosis does not appear to “influence the phenomenology of MPD(DID).”^[5][15]

[edit] Healthy multiplicity

Some people who self-identify as having multiple personalities contend that it is not a disorder, but a natural variation of human consciousness. They believe that so long as communication and (especially) cooperation between selves are present, multiples can lead happy and productive lives, and that it is not necessary for healthy persons to have only a single self. Groups which experience blackouts between personality switches can function by referring to jointly owned calendars, datebooks and lists.^{[citation needed]}

Some people who hold this view believe that the unity of the self is an illusion and that everyone is fundamentally multiple, an opinion some claim is similar to the beliefs of William James^[33] and other modernist writers. Others take the position that multiplicity can arise in a variety of ways, from being born naturally multiple to dissociating due to trauma; but that regardless of origins, a group of selves can cooperate and function well in tasks of daily living.^[34]

Truddi Chase, author of the best-selling book When Rabbit Howls, is one believer in healthy multiplicity. Although she described the multiplicity as originating from abuse, she claims to live as a group of selves who rejected integration and function in mutual cooperation.^[35]

[edit] Chronology

• (1546) Paracelsus reportedly wrote an account of a woman who had amnesia about an alter personality who stole her money^[36]
• (1791) Eberhard Gmelin describes a case of "exchanged personality" in a 21-year-old German woman who manifested a second self, speaking French and claiming to be a French aristocrat. Gmelin believed that cases such as hers could aid in understanding the formation of personality.^[37]
• (1816) Dr. Samuel Latham Mitchel described the case of Mary Reynolds, first published in the 1816 edition of "Medical Repository". Mary experienced a severe convulsion, becoming blind and deaf for five weeks, followed by amnesia and double consciousness.^[38][39]
• (1838) Antoine Despine describes a case of dual personality in "Estelle," an 11-year-old girl.^[40]
• (1887) to (1896) Eugene Azam, a professor of surgery interested in hypnotism, described the case of Felida X who exhibited three different personalities.^[41][36]
• (1906) Morton Prince's book The Dissociation of a Personality describes his work with multiple personality patient Clara Norton Fowler, alias Christine Beauchamp.
• (1943) E Stegnel declared the condition extinct^[42]
• (1954) Morton Prince published the case of Chris Costner-Sizemore in his journal later renamed as 'The Journal of Abnormal Psychology'.^[43]
• (1954) Shirley Jackson's book The Bird's Nest, a fictional story of multiple personality, is published.
• (1954) Thigpen & Cleckley's book The Three Faces of Eve, loosely based on the therapy of Chris Costner-Sizemore, is published, reviving the American public's interest in the subject of multiple personality.
• (1957) A movie version of The Three Faces of Eve, starring Joanne Woodward, is released.
• (1973) Flora R. Schreiber's bestselling book Sybil, a novelized treatment of the life and therapy of Shirley Ardell Mason, alias 'Sybil Dorsett' in the book.
• (1976) A made-for-TV film version of Sybil is produced, starring Sally Field in the title role.
• (1977) Chris Costner-Sizemore publishes an autobiography, I'm Eve, alleging that Thigpen and Cleckley's book was a misrepresentation of her life.
• (1980) Publication of Michelle Remembers.
• (1981) Daniel Keyes' book The Minds of Billy Milligan is published, based on interviews with Billy Milligan, some of his therapists, lawyers and family members.
• (1986) Publication of When Rabbit Howls by autobiographical author Truddi Chase.
• (1989) Frank Putnam's Diagnosis and Treatment of Multiple Personality Disorder, is published.^[36]
• (1995) Astraea's Web, the first Internet website to describe non-disordered and self-recognized multiplicity, goes online in September.
• (1996) Publication of Rewriting the Soul by Ian Hacking.
• (1998) Joan Acocella's New Yorker article detailing the excesses of MPD therapy, Creating Hysteria, is published.
• (1999) Cameron West's book, First Person Plural: My Life as a Multiple is published.
• (2005) Robert Oxnam's autobiography, A Fractured Mind, is published.
• (2007) Richard Baer's Switching Time: A Doctor's Harrowing Story of Treating a Woman with 17 Personalities, is published.^[44][45]

[edit] See also

• DID/MPD in fiction
• Spiritual possession
• Repressed memory

[edit] References

[edit] Further reading

• Goettmann, B. A.; Greaves, B. G., Coons M. P. (1994). Multiple personality and dissociation, 1791-1992: a complete bibliography. Lutherville, MD: The Sidran Press, 85. ISBN 0-9629164-5-5. 

[edit] External links

• Essay from the Skeptic's Dictionary
• What About Recovered Memory?
• Childhood Trauma Remembered: A report on the current scientific knowledge base and its applications Published by International Society for Traumatic Stress Studies
• International Society for the Study of Dissociation