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Dissociative identity disorder (DID) is the current name of a condition formerly listed in the Diagnostic and Statistical Manual of Mental Disorders as multiple personality disorder (MPD). The International Statistical Classification of Diseases and Related Health Problems continues to list it as Multiple Personality Disorder. MPD and DID should not be confused with schizophrenia, even though the media often use the terms interchangeably.

History Edit

File:Vivé.jpg

Before the 19th century, people exhibiting symptoms similar to those were believed to be possessed.[1]

An intense interest in spiritualism, parapsychology, and hypnosis continued throughout the 19th and early 20th centuries,[2] running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings.[3] Hypnosis, which was pioneered in the late 1700s by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puységur, challenged Locke's association of ideas. Hypnotists reported what they thought were second personalities emerging during hypnosis and wondered how two minds could coexist.[2]

The 19th century saw a number of reported cases of multiple personalities which Rieber[3] estimated would be close to 100. Epilepsy was seen as a factor in some cases,[3] and discussion of this connection continues into the present era.[4][5]

By the late 19th century there was a general acceptance that emotionally traumatic experiences could cause long-term disorders which may manifest with a variety of symptoms.[6] These conversion disorders were found to occur in even the most resilient individuals, but with profound effect in someone with emotional instability like Louis Vivé (1863-?)who suffered a traumatic experience as a 13 year-old when he encountered a viper. Vivé was the subject of countless medical papers and became the most studied case of dissociation in the 19th century.

Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation.[7] It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation.[8] One of the first individuals diagnosed with multiple personalities to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp; American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a Personality.[8] Fowler went on to marry one of her analyst's colleagues.[9]

In the early 20th century interest in dissociation and multiple personalities waned for a number of reasons. After Charcot's death in 1893, many of his so-called hysterical patients were exposed as frauds, and Janet's association with Charcot tarnished his theories of dissociation.[2] Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma.[2]

In 1910, Eugen Bleuler introduced the term schizophrenia to replace dementia praecox. A review of the Index medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia became popular, especially in the United States.[10] A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DID was the decline of interest in dissociation as a laboratory and clinical phenomenon.[7]

Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports.[7] Bleuler also included multiple personality in his category of schizophrenia. It was concluded in the 1980s that DID patients are often misdiagnosed as suffering from schizophrenia.[7]

The public, however, was exposed to psychological ideas which took their interest. Mary Shelley's Frankenstein, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde, and many short stories by Edgar Allan Poe had a formidable impact.[3] In 1957, with the publication of the book The Three Faces of Eve and the popular movie which followed it, the American public's interest in multiple personality was revived. During the 1970s an initially small number of clinicians campaigned to have it considered a legitimate diagnosis.[7]

The highly influential book Sybil was published in 1974, which popularized the diagnosis through a detailed discussion of the problems and treatment of the pseudonymous Sybil. Six years later, the diagnosis of multiple personality disorder appeared in the DSM III.[1] Controversy over the iconic case has since arisen, with some calling Sybil's diagnosis the result of iatrogenic therapeutic methods[11] while others have defended the treatment and reputation of Sybil's therapist, Cornelia B. Wilbur.[12] As media coverage spiked, diagnoses climbed. There were 200 reported cases of DID as of 1980, and 20,000 from 1980 to 1990.[13] Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995.[14] The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally[15] with reports recently emerging from other countries.[16][17][18][19][20][21][22]

ControversyEdit

DID is a controversial diagnosis and condition, with much of the literature on DID being generated and published in North America, to the extent that it was regarded as a phenomenon confined to that continent.[2][23] Even within North American psychiatrists there is a lack of consensus regarding the validity of DID.[24][25] Practitioners who do accept DID as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America.[26] Criticism of the diagnosis continues, with Piper and Merskey describing it as a culture-bound and often iatrogenic condition which they believe is in decline.[23][27] There is considerable controversy over the validity of the multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the DID diagnosis. While other disorders require a certain amount of subjective interpretation, those disorders more readily present generally accepted, objective symptoms. The controversial nature of the dissociation hypothesis is shown quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has addressed, and re-addressed, the categorization over the years.

The second edition of the DSM referred to this diagnostic profile as multiple personality disorder. The third edition grouped MPD in with the other four major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as dissociative identity disorder (DID). The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder.

Over-representation in North AmericaEdit

In a review,[28] Joel Paris offered three possible causes for the sudden increase in people diagnosed with DID:

  1. The result of therapist suggestions to suggestible people, much as Charcot's hysterics acted in accordance with his expectations.
  2. Psychiatrists' past failure to recognize dissociation being redressed by new training and knowledge.
  3. Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria".

Paris believes that the first possible cause is the most likely.

The debate over the validity of this condition, whether as a clinical diagnosis, a symptomatic presentation, a subjective misrepresentation on the part of the patient, or a case of unconscious collusion on the part of the patient and the professional is considerable. There are several main points of disagreement over the diagnosis.

Skeptics claim that people who present with the appearance of alleged multiple personality may have learned to exhibit the symptoms in return for social reinforcement. One case cited as an example for this viewpoint is the "Sybil" case, popularized by the news media. Psychiatrist Herbert Spiegel stated that "Sybil" had been provided with the idea of multiple personalities by her treating psychiatrist, Cornelia Wilbur, to describe states of feeling with which she was unfamiliar.

One of the primary reasons for the ongoing recategorization of this condition is that there were once so few documented cases (research in 1944 showed only 76[29]) of what was once referred to as multiple personality. Dissociation is recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and borderline personality disorder[30].


Contemporary views Edit

Supporters of the therapy viewEdit

Those who believe MPD/DID is a real disorder generally contend that children who are stressed or abused (especially sexually abused) may split into several independent personalities or ego states as a defense mechanism. [1] According to this view, the primary function of these separate ego states is to hold traumatic memories and keep them out of the consciousness of the original self or "host," allowing the host to continue functioning in daily life as though nothing had happened. The alternate selves, or "alters," take turns controlling the body. Sometimes each alter reports remembering only the times when they controlled the body, and claims amnesia for all other periods. This model also holds that since alters represent dissociated parts of the original self, they are very limited in role, only capable of handling specific emotions or tasks.

Most doctors who believe in the diagnosis contend that the goal of treatment for a DID patient is to recover all the memories of trauma held by various selves, through hypnosis, guided visualization, dream analysis or other techniques, and then integrate the alters into the host's personality. Some believe that all reported details of recovered memories, even strange or unusual ones, should be taken seriously at least as narrative truth even if they are unlikely or impossible as historical truth.

CriticsEdit

Some psychologists and psychiatrists regard DID as being iatrogenic or factitious, or contend that true cases are extremely rare and that the majority of reported cases are iatrogenic.

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, that repression of memories is a common defense against childhood sexual abuse and linked to multiplicity, and that repressed memories can be accurately recovered through techniques such as hypnosis. As such, most critics' arguments 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.

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. Prior to the 1950s, cases of dual personality and multiple personality were occasionally reported and treated as curiosities in the Western world. [2] 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 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 [3]. According to Joan Acocella, 40,000 cases were diagnosed from 1985 to 1995. The DID diagnosis is largely centered in the United States, and in English-speaking countries more generally. Some critics contend that a majority of diagnoses are made by only a few practitioners.

Some professionals are critical of a majority of DID diagnoses, and believe that many iatrogenic cases were induced during the height of its media popularity, but still argue that true cases of DID exist and must be treated. They contend that dissociative amnesia, dissociative fugue, and DID are all mental disorders characterized by dissociation.

Healthy multiplicityEdit

Main article: Healthy multiplicity

Some self-identified multiples contend that multiple personality is not a disorder, but a natural variation of human consciousness which need have nothing to do with dissociation. They believe that so long as communication and 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.

Some people who hold this view believe that the unity of the self is an illusion and that everyone is fundamentally multiple, an opinion similar to the observations of William James and other modernist writers. Others take the position that multiplicity can arise in a variety of ways, from being born naturally multiple to splitting from abuse, but that regardless of origins, a group of selves can cooperate and function well in tasks of daily living. Some independent or self-recognized multiples have begun to form groups like those established by autistic people, to speak for themselves and educate the public.

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 writes that her group of selves rejected integration and live as a collective.

Cross-cultural viewsEdit

There is some cross-cultural evidence to suggest that the concept of a human body inhabited by more than one soul or consciousness recurs in many cultures. 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.

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

Anthropologists Luh Ketut Suryani and Gordon D. Jensen believe that the phenomenon of trance-possession in Balinese society is the same as multiple personality in the West. [4]

Such traditions and beliefs also suggest the influence of culture on the perception and subjective experience of multiple selves. People in shamanic cultures who experience multiple selves do not express these other selves as parts of themselves, but as independent souls or spirits. There is no evident link in these cultures between this multiplicity, dissociation or recovered memories, and sexual abuse.

Chronology of multiple personality and MPD/DID in the Western world Edit

  • (1646) Paracelsus reports the case of an anonymous woman who claimed that someone was stealing money from her; the thief was revealed to be a second self, whose actions the primary self was amnesiac of.
  • (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.
  • (1816) The case of Mary Reynolds, a "dual personality," is published in the magazine "Medical Repository."
  • (1838) Charles Despine describes a case of dual personality in "Estelle," an 11-year-old girl.
  • (1876) Eugène Azam describes a case of dual personality in a young French woman, whom he calls Felida X.
  • (1899) Théodore Flournoy's book "Des Indes à la Planète Mars: Etude sur un cas de somnambulisme avec glossolalie" ("From India to the Planet Mars: A case of multiple personality with imaginary languages") is published.
  • (1906) Morton Prince's book The Dissociation of a Personality describes his work with multiple personality patient Clara Norton Fowler, alias Christine Beauchamp.
  • (1915) Walter Franklin Prince publishes a lengthy case history of patient Doris Fischer, entitled "The Doris Case of Multiple Personality." This is followed two years later by a long account of psychical experiments performed with Fischer and her other selves.
  • (1943) Stengel declares the condition of multiple personality to be "extinct."
  • (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 extensive interviews with both Billy Milligan and his therapists.
  • (1986) Publication of When Rabbit Howls.
  • (1995) Astraea's Web, the first Internet website to describe non-disordered and self-recognized multiplicity, goes online in September.
  • (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.

See also Edit

References and external links Edit

ReferencesEdit

  1. 1.0 1.1 Sadock 2002, p. 681
  2. 2.0 2.1 2.2 2.3 2.4 Atchison M, McFarlane AC (1994). A review of dissociation and dissociative disorders. The Australian and New Zealand journal of psychiatry 28 (4): 591–9.
  3. 3.0 3.1 3.2 3.3 Rieber RW (2002). The duality of the brain and the multiplicity of minds: can you have it both ways?. History of psychiatry 13 (49 Pt 1): 3–17.
  4. Cite error: Invalid <ref> tag; no text was provided for refs named pmid6427406
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  6. Borch-Jacobsen M, Brick D (2000). How to predict the past: from trauma to repression. History of Psychiatry 11 (41 Pt 1): 15–35.
  7. 7.0 7.1 7.2 7.3 7.4 Putnam, Frank W. (1989). Diagnosis and Treatment of Multiple Personality Disorder, 351, New York: The Guilford Press.
  8. 8.0 8.1 van der Kolk BA, van der Hart O (December 1989). Pierre Janet and the breakdown of adaptation in psychological trauma. Am J Psychiatry 146 (12): 1530–40.
  9. includeonly>Bethune, B. "What drove women mad?", Maclean's, Rogers Communications, 2007-11-26. Retrieved on 2009-02-18.
  10. Rosenbaum M (1980). The role of the term schizophrenia in the decline of diagnoses of multiple personality. Arch. Gen. Psychiatry 37 (12): 1383–5.
  11. Rieber, R (1999). Hypnosis, false memory and multiple personality: a trinity of affinity. History of Psychiatry 10 (37): 3–11.
  12. includeonly>Ritter, M. "Doubt Cast on Story of 'Sybil'", Associated Press, 1998-08-16.
  13. Adams, C (2003). Does multiple personality disorder really exist?. The Straight Dope. URL accessed on 2008-01-22.
  14. Acocella, JR (1999). Creating hysteria: Women and multiple personality disorder, San Francisco: Jossey-Bass Publishers.
  15. Spanos, Nicholas P. (1996). Multiple Identities & False Memories: A Sociocognitive Perspective, American Psychological Association (APA).
  16. Cite error: Invalid <ref> tag; no text was provided for refs named pmid2589555
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  23. 23.0 23.1 Piper A, Merskey H (2004). The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Canadian journal of psychiatry. Revue canadienne de psychiatrie 49 (9): 592–600.
  24. Pope HG, Oliva PS, Hudson JI, Bodkin JA, Gruber AJ (1999). Attitudes toward DSM-IV dissociative disorders diagnoses among board-certified American psychiatrists. The American journal of psychiatry 156 (2): 321–3.
  25. Lalonde JK, Hudson JI, Gigante RA, Pope HG (2001). Canadian and American psychiatrists' attitudes toward dissociative disorders diagnoses. Canadian journal of psychiatry. Revue canadienne de psychiatrie 46 (5): 407–12.
  26. Rhoades, G. F., Sar, V. (editors) (2006) Trauma And Dissociation in a Cross-cultural Perspective: Not Just a North American Phenomenon. Routledge. ISBN 978-0789034076
  27. Piper A, Merskey H (2004). The persistence of folly: critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie 49 (10): 678–83. Full Text
  28. Paris J (1996). Review-Essay : Dissociative Symptoms, Dissociative Disorders, and Cultural Psychiatry. Transcult Psychiatry 33 (1): 55–68.
  29. includeonly>"Creating Hysteria by Joan Acocella", The New York Times.
  30. Marmer S, Fink D (1994). Rethinking the comparison of Borderline Personality Disorder and multiple personality disorder. Psychiatr Clin North Am 17 (4): 743–71.


Clinical viewEdit

Skeptical viewpointsEdit

Repressed/Recovered memoriesEdit

Cross-cultural viewsEdit

  • Trance and Possession in Bali: A Window on Western Multiple Personality, Possession Disorder, and Suicide by Luh K. Suryani and Gordon D. Jensen, 1994, ISBN 0-19588-610-0

Professional associationsEdit

Voices of multiplesEdit

  • Astraea's Web Resources and many links devoted to the idea of functional, healthy multiplicity.
  • Collective Phenomenon More articles and FAQs dispelling myths and promoting healthy, responsible multiplicity.
  • In Essence We Declare Example of a healthy self-identified multiple group's co-signed agreement to maintain responsibility and functionality.
  • The Layman's Guide to Multiplicity (non-disordered multiplicity resource, written and edited by multiples)
  • Livejournal: Multiplicity An online community in which many views of multiplicity are aired.
  • Pavilion Awareness taskforce for healthy/ functional multiplicity. Educate the public, media campaigns correcting misportrayals of multiples as helpless victims, crazed killers, etc.
  • Pilgrim's Journey A blog written by a young woman with Dissociative Identity Disorder.
  • Split Angels Info by a woman who considers her multiplicity to be a mental disorder, including biographies of many personalities.
  • Dark Personalities Mailing List An uncensored mailing list for multiples to discuss a variety of subjects.
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