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{{ClinPsy}}
  
{{ClinPsy}}
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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''') 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]].
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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 [[ICD|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.
   
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==History ==
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Those who recognize dissociative identity disorder as a psychological condition believe that it is characterized by the use of [[dissociation]] as a primary [[defense mechanism]]. A chronic reliance on dissociation as a means of defending against stressors in the environment causes the individual to experience their psyche/identity as disconnected (from their senses, for example) or split into distinct parts.
  
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[[Image:Vivé.jpg|right|thumb|One of ten photogravure portraits of Louis Vivé published in ''Variations de la personnalité'' by Bourru and Burot.]]
   
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Before the 19th century, people exhibiting symptoms similar to those were believed to be possessed.<ref name=Sad681>{{Harvnb |Sadock|2002| p=681}}</ref>
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Some psychologists and psychiatrists dissent from the manuals and regard the disorder as possibly [[iatrogenic]] or factitious. Some will accept it as a disorder, but prefer not to use terms like "defense mechanism", which they regard as an unscientific borrowing from [[Freudianism]]. See the article [[Defense mechanism]] for further discussion.
  
   
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An intense interest in [[spiritualism]], [[parapsychology]], and [[hypnosis]] continued throughout the 19th and early 20th centuries,<ref name="pmid7794202">{{cite journal |author=Atchison M, McFarlane AC |title=A review of dissociation and dissociative disorders |journal=The Australian and New Zealand journal of psychiatry |volume=28 |issue=4 |pages=591–9 |year=1994 |pmid=7794202 | doi = 10.3109/00048679409080782}}</ref> 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.<ref name="pmid12094818">{{cite journal |author=Rieber RW |title=The duality of the brain and the multiplicity of minds: can you have it both ways? |journal=History of psychiatry |volume=13 |issue=49 Pt 1 |pages=3–17 |year=2002 |pmid=12094818| doi = 10.1177/0957154X0201304901}}</ref> [[Hypnosis]], which was pioneered in the late 1700s by [[Franz Mesmer]] and [[Armand-Marie-Jacques de Chastenet, Marques of Puységur|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.<ref name="pmid7794202" />
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It is not clear what percentages of the psychological community accept, accept with reservations, or disagree with the previously noted positions.
  
   
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The 19th century saw a number of reported cases of multiple personalities which Rieber<ref name="pmid12094818"/> estimated would be close to 100. [[Epilepsy]] was seen as a factor in some cases,<ref name="pmid12094818" /> and discussion of this connection continues into the present era.<ref name="pmid6427406"/><ref name="pmid2725878"/>
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== Controversy ==
 
   
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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.<ref name="Borch-Jacobsen M 2000">{{cite journal |author= Borch-Jacobsen M, Brick D |title= How to predict the past: from trauma to repression |journal= History of Psychiatry |volume=11 |issue= 41 Pt 1|pages=15–35 |year=2000|doi=10.1177/0957154X0001104102 |pmid= 11624606 }} </ref> 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.
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This diagnosis is controversial. The main points of disagreement are:
  
   
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Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation.<ref name="putnam">{{cite book | last = Putnam | first = Frank W. | title = Diagnosis and Treatment of Multiple Personality Disorder | publisher = The Guilford Press | year = 1989 | location =New York | pages = 351 | isbn = 0-89862-177-1}}</ref> 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.<ref name="pmid2686473">{{cite journal |author=van der Kolk BA, van der Hart O |title=Pierre Janet and the breakdown of adaptation in psychological trauma |journal=Am J Psychiatry |volume=146 |issue=12 |pages=1530–40 |year=1989 |month=December |pmid=2686473 |doi= |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=2686473}}</ref> One of the first individuals diagnosed with multiple personalities to be scientifically studied was Clara Norton Fowler, under the [[pseudonym]] Christine Beauchamp; American [[neurology|neurologist]] [[Morton Prince]] studied Fowler between 1898 and 1904, describing her [[case study]] in his 1906 [[monograph]], ''Dissociation of a Personality''.<ref name="pmid2686473"/> Fowler went on to marry one of her analyst's colleagues.<ref name=Bethune>{{cite news| last = Bethune | first= B | title = What drove women mad? | work = [[Maclean's]] | date = 2007-11-26 | accessdate = 2009-02-18 | url = http://www.macleans.ca/culture/lifestyle/article.jsp?content=20071115_98997_98997 | publisher = [[Rogers Communications]] }}</ref>
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# Whether MPD/DID is a real disorder, or just a fad.
  
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# If it is real, is the appearance of multiple personalities real or delusional?
  
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# If it is real, should it be defined in [[psychoanalysis|psychoanalytic]] terms?
  
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# Whether it can be cured.
  
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# Whether it should be cured.
  
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# Who should primarily define the experience -- therapists, or those who believe that they are "multiple" (have multiple personalities)?
  
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# Whether it is invariably a disorder or simply a way of being.
  
   
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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.<ref name="pmid7794202" /> [[Sigmund Freud]] recanted his earlier emphasis on dissociation and childhood trauma.<ref name="pmid7794202" />
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In rough terms, believers in DID or MPD argue that children who are stressed or abused (especially [[sexual abuse|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 reports remembering only the times when he/she/it controlled the body, and claims [[amnesia]] for all other periods. People diagnosed with DID may exhibit erratic alterations of personality and may claim to "lose time".
  
   
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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.<ref name="pmid7004385">{{cite journal |author=Rosenbaum M |title=The role of the term schizophrenia in the decline of diagnoses of multiple personality |journal=Arch. Gen. Psychiatry |volume=37 |issue=12 |pages=1383–5 |year=1980 |pmid=7004385 |doi=}}</ref> 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.<ref name="putnam"/>
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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.
  
   
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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.<ref name="putnam"/> 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.<ref name="putnam"/>
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A third view is 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. Proponents of this view may generally hold the perhaps controversial belief that mental illness itself generally tends to be a [[culture-specific syndrome]], and that many cultures throughout history have had different models for integrating alternative mentalities into their social fabric, for example, as [[shaman]]s. Proponents of the "healthy multiple" position are common in online communities.
  
   
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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 story|short stories]] by [[Edgar Allan Poe]] had a formidable impact.<ref name="pmid12094818" /> 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.<ref name="putnam"/>
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== Recent history ==
  
   
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The highly influential book ''[[Sybil (book)|Sybil]]'' was published in 1974, which popularized the diagnosis through a detailed discussion of the problems and treatment of the pseudonymous [[Shirley Ardell Mason|Sybil]]. Six years later, the diagnosis of multiple personality disorder appeared in the DSM III.<ref name=Sad681/> Controversy over the iconic case has since arisen, with some calling Sybil's diagnosis the result of [[iatrogenesis#psychology|iatrogenic]] therapeutic methods<ref>{{cite journal | last = Rieber | first = R | year = 1999 | title = Hypnosis, false memory and multiple personality: a trinity of affinity | journal = History of Psychiatry | volume = 10 | issue = 37 | pages = 3–11 | doi = 10.1177/0957154X9901003701 | pmid = 11623821}} </ref> while others have defended the treatment and reputation of Sybil's therapist, [[Cornelia B. Wilbur]].<ref>{{cite news | last = Ritter | first = M | date = 1998-08-16 | title = Doubt Cast on Story of 'Sybil' | work = [[Associated Press]]}}</ref> As media coverage spiked, diagnoses climbed. There were 200 reported cases of DID as of 1980, and 20,000 from 1980 to 1990.<ref name="Adams 2003">{{cite web | last = Adams | first = C | year = 2003 | url = http://www.straightdope.com/columns/031003.html | title = Does multiple personality disorder really exist? | work = [[The Straight Dope]] | accessdate = 2008-01-22}}</ref> [[Joan Acocella]] reports that 40,000 cases were diagnosed from 1985 to 1995.<ref name="Accocella">{{cite book |author=Acocella, JR | authorlink = Joan Acocella |title=Creating hysteria: Women and multiple personality disorder |publisher=Jossey-Bass Publishers |location=San Francisco |year=1999 |pages= |isbn=0-7879-4794-6 |oclc= |doi=}}</ref> The majority of diagnoses are made in North America, particularly the [[United States]], and in [[English language|English]]-speaking countries more generally<ref name="Spanos 2001">{{cite book |author=Spanos, Nicholas P. |title=Multiple Identities & False Memories: A Sociocognitive Perspective |publisher=American Psychological Association (APA) |location= |year= 1996|pages= |isbn=1557983402 |oclc= |doi=}}</ref> with reports recently emerging from other countries.<ref name="pmid2589555"/><ref name="pmid1728191"/><ref name="pmid16877651"/><ref name="pmid11339321"/><ref name="pmid10831486"/><ref name="pmid17189745"/><ref name="pmid10080263"/>
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The debate over DID and MPD arose in the context of the furor over [[repressed memory|repressed and later recovered memories]] of childhood sexual abuse, the child sex abuse panic of the [[1980]]s, and associated stories of [[Satanic Ritual Abuse]]. In the U.S. (and to a much lesser extent in other English-speaking countries, like the [[United Kingdom|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.
  
   
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==Controversy==
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However, as the stories told by clients grew ever more bizarre, as the number of people claiming MPD spiked, and as public prosecutions of daycare workers began to seem to some like [[Salem witch trials]], the public at large grew less accepting and more hostile to stories of recovered memories, ritual abuse, and MPD.
  
   
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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.<ref name="pmid7794202">{{cite journal |author=Atchison M, McFarlane AC |title=A review of dissociation and dissociative disorders |journal=The Australian and New Zealand journal of psychiatry |volume=28 |issue=4 |pages=591–9 |year=1994 |pmid=7794202 |doi=10.3109/00048679409080782}}</ref><ref name="pmid15503730">{{cite journal |author=Piper A, Merskey H |title=The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept |journal=Canadian journal of psychiatry. Revue canadienne de psychiatrie |volume=49 |issue=9 |pages=592–600 |year=2004 |pmid=15503730 |doi=| url = http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2004/september/piper.pdf | format = pdf}}</ref> Even within North American psychiatrists there is a lack of consensus regarding the validity of DID.<ref name="pmid9989574">{{cite journal |author=Pope HG, Oliva PS, Hudson JI, Bodkin JA, Gruber AJ |title=Attitudes toward DSM-IV dissociative disorders diagnoses among board-certified American psychiatrists |journal=The American journal of psychiatry |volume=156 |issue=2 |pages=321–3 |year=1999 |pmid=9989574 |doi=}}</ref><ref name="pmid11441778">{{cite journal |author=Lalonde JK, Hudson JI, Gigante RA, Pope HG |title=Canadian and American psychiatrists' attitudes toward dissociative disorders diagnoses |journal=Canadian journal of psychiatry. Revue canadienne de psychiatrie |volume=46 |issue=5 |pages=407–12 |year=2001 |pmid=11441778 |doi=}}</ref> 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.<ref>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</ref> Criticism of the diagnosis continues, with Piper and Merskey describing it as a [[culture-bound syndrome|culture-bound]] and often [[Iatrogenesis|iatrogenic]] condition which they believe is in decline.<ref name="pmid15503730" /><ref name="pmid15560314">{{cite journal |author=Piper A, Merskey H |title=The persistence of folly: critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder |journal=Canadian journal of psychiatry. Revue canadienne de psychiatrie |volume=49 |issue=10 |pages=678–83 |year=2004 |pmid=15560314 |doi=}} [http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2004/october/piper.pdf Full Text]</ref> 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.
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== Contemporary views ==
  
   
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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 [[Diagnostic and Statistical Manual of Mental Disorders|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.
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There are numerous points of view on this issue. Notable positions include:
  
   
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===Over-representation in North America===
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==="Believers"===
  
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In a review,<ref name="Paris J 1996">{{cite journal |author=Paris J |title= Review-Essay : Dissociative Symptoms, Dissociative Disorders, and Cultural Psychiatry |journal= Transcult Psychiatry |volume=33 |issue=1 |pages=55–68 |year=1996|doi=10.1177/136346159603300104}} </ref> Joel Paris offered three possible causes for the sudden increase in people diagnosed with DID:
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# The result of therapist suggestions to suggestible people, much as [[Jean-Martin Charcot|Charcot]]'s hysterics acted in accordance with his expectations.
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# Psychiatrists' past failure to recognize dissociation being redressed by new training and knowledge.
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# Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria".
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Paris believes that the first possible cause is the most likely.
   
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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.
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The basic premise of the believers is that child abuse or childhood sexual abuse is trivialized and under-reported. Some people find it hard to believe that real mothers and fathers would abuse their children or allow them to be hurt; often, the community rejected claims of abuse victims who spoke up. Believers say that we must believe them, even when they say things which upset us. Otherwise, we are protecting the [[pedophilia|pedophiles]] who prey on children and who are confident that any children who do complain will not be believed.
  
   
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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 "[[Shirley Ardell Mason|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 B. Wilbur|Cornelia Wilbur]], to describe states of feeling with which she was unfamiliar.
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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.
 
   
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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<ref>{{cite news | url = http://www.nytimes.com/books/first/a/acocella-hysteria.html | title = Creating Hysteria by Joan Acocella | work = [[The New York Times]] | year = 1999}}</ref>) of what was once referred to as multiple personality. Dissociation is recognized as a symptomatic presentation in response to [[Psychological trauma|trauma]], extreme emotional stress, and, as noted, in association with [[emotional dysregulation]] and [[borderline personality disorder]]<ref>{{cite journal |author=Marmer S, Fink D |title=Rethinking the comparison of Borderline Personality Disorder and multiple personality disorder |journal=Psychiatr Clin North Am |volume=17 |issue=4 |pages=743–71 |year=1994 |pmid=7877901}}</ref>.
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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.
  
   
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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.)
  
   
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Prominent believers:
  
   
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== Contemporary views ==
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* 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.
  
   
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===Supporters of the therapy view===
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* E. Sue Blume, clinical [[social work|social worker]], author of ''Secret Survivors'' ([[1991]]).
  
   
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Those who believe MPD/DID is a real disorder generally contend that children who are stressed or abused (especially [[sexual abuse|sexually abused]]) may split into several independent personalities or [[ego]] states as a [[defense mechanism]]. [http://www.clinicalsocialwork.com/overview.html] 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.
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* Laura Davis and Ellen Bass, authors of ''The Courage to Heal'' ([[1988]]). Quotes from this book:
 
   
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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.
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:::" ... 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).
  
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:::" ... demands for proof are unreasonable" (p. 137).
  
   
 
===Critics===
  
===Critics===
   
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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.
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Those skeptical of DID say that humans often lie, exaggerate, and fantasize, and that indeed, [[subjectivity]] has been scientifically demonstrated in all personal histories, and that it is a mistake to demand uncritical belief in stories of child abuse, recovered memories, and multiple personality, especially when certain social rewards are given to those who so self-report. To do so is to invite misuse of the blank check given the story-tellers.
  
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The skeptical point of view is that, 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?
  
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* The [[McMartin preschool trial]]
  
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* The Fell's Acres trial
  
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* The Little Rascals trials
  
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These trials received much publicity and are still controversial. The McMartin 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 passage|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.
 
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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:
  
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* 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, Illinois|Chicago]] area hospital, Burgus discovered that she had 300 personalities and recovered memories of a long career as a [[Satanic Ritual Abuse|satanic priestess]] presiding over [[cannibalism|cannibal]] feasts. Eventually she rejected Braun's diagnosis and sued. In [[1997]], Braun's insurance company settled for $10.6 million (despite Braun's wish to take the matter to trial). He was sued by other patients and lost his medical licence for a time.
 
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Other such material has been collected by the False Memory Syndrome Foundation, founded in [[1992]] [http://www.fmsfonline.org].
 
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Critics 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]] [http://www.straightdope.com/columns/031003.html]. Per Joan Acocella, 40,000 cases were diagnosed from [[1985]] to [[1995]].
 
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Not only is DID centered in the U.S., it is centered in a few practitioners. Many mental health professionals claim that they have never seen a patient with DID. This concentration of diagnoses seems suspicious to critics.
 
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Critics 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 express themselves using the speech patterns of their "littles".
 
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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 critical point of view see:
 
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* ''Creating Hysteria'' by Joan Acocella, 1999.
 
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* ''Multiple Identities and False Memories'' by Nicholas Spanos, 1996.
  
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===Professionals who still find the DID diagnosis useful===
  
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Some professionals 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.
 
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They argue that DID is demonstrably not a [[histrionic personality disorder]], since psychological test profiles of individuals with DID differ from those of individuals with histrionic personality disorder. Furthermore, they say that sceptics are simply ignorant of the DID diagnostic criteria, and that better understanding of the criteria is demonstrably correlated with a decrease in scepticism.
 
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Mainstream opinion now says:
  
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* 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.
 
   
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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.
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* A therapist should work with "alters" if they come up spontaneously, but should not reward the patient for displaying them.
 
   
  +
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. [http://web.archive.org/web/20040216051717/http://www.fortea.us/english/psiquiatria/history.htm] 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 [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] until 1980, following the publication of the highly influential book [[Sybil (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]] [http://www.straightdope.com/columns/031003.html]. 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.
−
Mental health professionals and researchers working with dissociative disorders can join an organization called The International Society for the Study of Dissociation [http://www.issd.org]. ISSD has developed treatment guidelines for dissociative adults (now in their third revision, 2005) and children, available at their website. Earlier versions of the adult guidelines have been cited as a standard of care for DID in various legal contexts.
  
   
−
The concept of "defense mechanism" implies, to some, a [[psychoanalysis |psychoanalytic]] view of psychology. Many psychologists do not accept the psychoanalytic model. These practitioners would describe DID as a disfunction of identity and memory. They argue that [[dissociative amnesia]], [[dissociative fugue]], [[post traumatic stress disorder]] ([[PTSD]]), and [[obsessive compulsive disorder]] ([[OCD]]) are all mental disorders characterized by dissociation. The (psychiatric) DSM mentions neither PTSD nor OCD in its chapter on dissociative disorders -- a defect that should be remedied, in the view of these 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 multiplicity===
  
===Healthy multiplicity===
  +
{{main|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 have a single "self" (or, "be a singleton").
 
  +
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 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]] and other modernist writers). 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 [[Autism_rights_movement|autistic]] people, to speak for themselves and educate the public.
 +
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 [[Autism rights movement|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." Dr. Caul was a past president of ISSD.
 +
[[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 views===
⚫
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 [[shaman]]s, 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.
 
   
  ⚫
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 [[shaman]]s, people who claim to communicate with and be possessed by gods or spirits. Devotees visit the shaman, who may go into [[altered state of consciousness|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 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.
 
   
  ⚫
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.
−
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".
  
   
  +
Anthropologists Luh Ketut Suryani and Gordon D. Jensen believe that the phenomenon of trance-possession in [[Bali|Balinese]] society is the same as multiple personality in the West. [http://www.amazon.com/gp/product/0195886100]
−
* See [[Healthy_multiplicity|separate article]]
  
   
  +
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.
−
==Note on FMSF (False Memory Syndrome Foundation)==
  
   
  +
== Chronology of multiple personality and MPD/DID in the Western world ==
−
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.
 
   
  +
* ([[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.
−
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 [[the Netherlands|Dutch]] magazine. See a reprint of the interview here: [http://www.nostatusquo.com/ACLU/NudistHallofShame/Underwager2.html].
 
  +
* ([[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.
−
Underwager resigned from the FMSF that same year, while claiming that his views had been misrepresented.
 
  +
* ([[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.
−
Believers point to this embarrassment as an example of the true agenda of the FMSF. The FMSF would disagree. See this 1994 FMSF newsletter, which comments on the issue: [http://www.fmsfonline.org/fmsf94.603.html]
  
  +
* ([[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.
−
== MPD/DID chronology ==
  
  +
* ([[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.
⚫
* ([[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" translation available in English with a Forward by C. G. Jung ISBN 0691001014)
  
  +
* ([[1943]]) Stengel declares the condition of multiple personality to be "extinct."
−
* ([[1906]]) Morton Prince's book ''The Dissociation of a Personality''.
  
−
* ([[1954]]) Shirley Jackson's fictional book ''The Bird's Nest''.
 +
* ([[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]]''.
 +
* (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]]) movie version of ''The Three Faces of Eve''.
 +
* ([[1957]]) A movie version of ''The Three Faces of Eve'', starring [[Joanne Woodward]], is released.
−
* ([[1973]]) Flora R. Schreiber's book ''[[Sybil_(book)|Sybil]]''.
 +
* ([[1973]]) Flora R. Schreiber's bestselling book ''[[Sybil (book)|Sybil]],'' a novelized treatment of the life and therapy of [[Shirley Ardell Mason]], alias 'Sybil Dorsett' in the book.
−
* ([[1976]]) [[Sybil_(movie)|Film version]] of ''Sybil'', starring [[Sally Field]] in the title role.
 +
* ([[1976]]) A made-for-TV [[Sybil (movie)|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 [[Corbett H. Thigpen|Thigpen]] and [[Hervey M. Cleckley|Cleckley's]] book was a misrepresentation of her life.
−
* ([[1977]]) Chris Sizemore's ''I'm Eve''.
 
−
* ([[1980]]) Publication of ''Michelle Remembers''.
 +
* ([[1980]]) Publication of [[Michelle Remembers]].
−
* ([[1981]]) Publication of ''The Minds of Billy Milligan''.
 +
* ([[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''.
  
* ([[1986]]) Publication of ''When Rabbit Howls''.
−
* ([[1989]]) Grant Morrison's run on the fiction comic book ''Doom Patrol'' begins.
  
 
* ([[1995]]) Astraea's Web, the first Internet website to describe non-disordered and self-recognized multiplicity, goes online in September.
  
* ([[1995]]) Astraea's Web, the first Internet website to describe non-disordered and self-recognized multiplicity, goes online in September.
  ⚫
* ([[1998]]) Joan Acocella's ''[[The New Yorker|New Yorker]]'' article detailing the excesses of MPD therapy, ''Creating Hysteria,'' is published.
−
* ([[1996]]) Madison Clell's ''Cuckoo'' begins.
  
  ⚫
* ([[1999]]) Cameron West's book, ''First Person Plural: My Life as a Multiple'' is published.
⚫
* ([[1998]]) J. Acocella's ''[[New Yorker]]'' article detailing excesses of MPD treatments.
  
  +
* ([[2005]]) [[Robert Oxnam]]'s autobiography, ''A Fractured Mind,'' is published.
⚫
* ([[1999]]) Cameron West's book, ''First Person Plural: My Life as a Multiple''
  
−
* ([[2001]]) Deborah Bray Haddock's book, "The Dissociative Identity Disorder Sourcebook," a resource for therapists and clients about DID and its treatment
  
   
 
== See also ==
 
== See also ==
   
  +
* [[Dissociative identity disorder]]
  +
* [[Healthy multiplicity]]
  +
* [[Possession]]
 
* [[DID/MPD in fiction]]
  
* [[DID/MPD in fiction]]
 
* [[Personality disorder]]
  
* [[Personality disorder]]
Line 158: Line 120:
   
 
== References and external links ==
  
== References and external links ==
  +
==References==
  +
{{reflist|3}}
   
⚫
===Repressed/Recovered memories===
  
   
  +
===Clinical view===
⚫
* [http://dynamic.uoregon.edu/~jjf/whatabout.html] What About Recovered Memory?
  
  +
⚫
* [http://www.jimhopper.com/memory/] Recovered Memories of Sexual Abuse: Scientific Research and Scholary Resources
  
  ⚫
* [http://www.mental-health-matters.com/disorders/dis_details.php?disID=39 Mental Health Matters: Dissociative Identity Disorder]
⚫
* [http://www.brown.edu/Departments/Taubman_Center/Recovmem/Archive.html] The Recovered Memory Project: 96 cases of corroborated recovered memories of sexual abuse
  
  ⚫
* [http://www.sidran.org Sidran Foundation] A nonprofit organization disseminating information concerning the treatment of trauma.
⚫
* [http://www.istss.org/publications/ChildhoodTraumaRemembered.pdf Childhood Trauma Remembered: A report on the current scientific knowledge base and its applications] Published by International Society for Traumatic Stress Studies
  
  ⚫
* [http://www.manyvoicespress.com Many Voices] Resource site for abuse survivors, many of whom are multiple, looking for support and psychotherapy.
  ⚫
* [http://www.psychforums.com/forums/viewforum.php?f=210 Psych Forums: DID Forum]
   
 
===Skeptical viewpoints===
  
===Skeptical viewpoints===
   
 
* ''Multiple Identities and False Memories'' by [[Nicholas Spanos]], 1996, ISBN 1-55798-340-2
  
* ''Multiple Identities and False Memories'' by [[Nicholas Spanos]], 1996, ISBN 1-55798-340-2
  ⚫
* ''Creating Hysteria'' by Joan Acocella, 1999, ISBN 0-78794-794-6
 
* [http://www.fmsfonline.org False Memory Syndrome Foundation]
  
* [http://www.fmsfonline.org False Memory Syndrome Foundation]
−  
 
* [http://www.astraeasweb.net/plural/forensic.html Multiple Personality Disorder in the Courts] View of a senior British forensic psychiatrist. British psychiatrists, on the whole, do not believe in the existence of multiple personality disorder as a psychiatric diagnosis.
 
* [http://www.astraeasweb.net/plural/forensic.html Multiple Personality Disorder in the Courts] View of a senior British forensic psychiatrist. British psychiatrists, on the whole, do not believe in the existence of multiple personality disorder as a psychiatric diagnosis.
 
* [http://www.skepdic.com/mpd.html Essay from the ''Skeptic's Dictionary'']
  
* [http://www.skepdic.com/mpd.html Essay from the ''Skeptic's Dictionary'']
  +
  ⚫
===Repressed/Recovered memories===
  +
  ⚫
* [http://dynamic.uoregon.edu/~jjf/whatabout.html What About Recovered Memory?]
  ⚫
* [http://www.jimhopper.com/memory/ Recovered Memories of Sexual Abuse: Scientific Research and Scholary Resources]
  ⚫
* [http://www.brown.edu/Departments/Taubman_Center/Recovmem/Archive.html The Recovered Memory Project: 96 cases of corroborated recovered memories of sexual abuse]
  ⚫
* [http://www.istss.org/publications/ChildhoodTraumaRemembered.pdf Childhood Trauma Remembered: A report on the current scientific knowledge base and its applications] Published by International Society for Traumatic Stress Studies
  +
  +
===Cross-cultural views===
  +
  +
* ''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 associations===
  
===Professional associations===
   
−
* [http://www.issd.org] International Society for the Study of Dissociation
 +
* [http://www.issd.org International Society for the Study of Dissociation]
   
 
===Voices of multiples===
  
===Voices of multiples===
 
* [http://www.astraeasweb.net/plural/ Astraea's Web] Resources and many links devoted to the idea of functional, healthy multiplicity.
  
* [http://www.astraeasweb.net/plural/ Astraea's Web] Resources and many links devoted to the idea of functional, healthy multiplicity.
−
* [http://www.birch.diary-x.com Birch Grove] Insight into the daily life of a healthy multiple household.
 
 
* [http://www.dreamshore.net/amorpha/ Collective Phenomenon] More articles and FAQs dispelling myths and promoting healthy, responsible multiplicity.
  
* [http://www.dreamshore.net/amorpha/ Collective Phenomenon] More articles and FAQs dispelling myths and promoting healthy, responsible multiplicity.
 
* [http://www.karitas.net/courts/in_essence/agreement.html In Essence We Declare] Example of a healthy self-identified multiple group's co-signed agreement to maintain responsibility and functionality.
  
* [http://www.karitas.net/courts/in_essence/agreement.html In Essence We Declare] Example of a healthy self-identified multiple group's co-signed agreement to maintain responsibility and functionality.
 
* [http://www.karitas.net/blackbirds/layman The Layman's Guide to Multiplicity] (non-disordered multiplicity resource, written and edited by multiples)
  
* [http://www.karitas.net/blackbirds/layman The Layman's Guide to Multiplicity] (non-disordered multiplicity resource, written and edited by multiples)
−
* [http://www.kinhost.org/wiki/Main/ManualTOC Multiplicity: The Missing Manual] a wiki manual written by multiples for multiples, with the intention of building coping mechanisms and strategies for healthy multiplicity.
  
 
* [http://www.livejournal.com/community/multiplicity Livejournal: Multiplicity] An online community in which many views of multiplicity are aired.
  
* [http://www.livejournal.com/community/multiplicity Livejournal: Multiplicity] An online community in which many views of multiplicity are aired.
  ⚫
* [http://www.karitas.net/pavilion Pavilion] Awareness taskforce for healthy/ functional multiplicity. Educate the public, media campaigns correcting misportrayals of multiples as helpless victims, crazed killers, etc.
⚫
* [http://www.manyvoicespress.com Many Voices] Resource site for abuse survivors, many of whom are multiple, looking for support and psychotherapy.
 
⚫
* [http://www.mental-health-matters.com/disorders/dis_details.php?disID=39 Mental Health Matters: Dissociative Identity Disorder]
  
⚫
* [http://www.karitas.net/pavilion Pavilion] Awareness taskforce for functional multiplicity. Educate the public, media campaigns correcting misportrayals of multiples as helpless victims, crazed killers, etc.
  
 
* [http://www.healthdiaries.com/blogs/pilgrim/ Pilgrim's Journey] A blog written by a young woman with Dissociative Identity Disorder.
  
* [http://www.healthdiaries.com/blogs/pilgrim/ Pilgrim's Journey] A blog written by a young woman with Dissociative Identity Disorder.
  ⚫
* [http://www.splitangels.org/ Split Angels] Info by a woman who considers her multiplicity to be a mental disorder, including biographies of many personalities.
⚫
* [http://www.psychforums.com/forums/viewforum.php?f=210 Psych Forums: DID Forum]
  
  ⚫
* [http://lists.topica.com/lists/darkpersonalities Dark Personalities Mailing List] An uncensored mailing list for multiples to discuss a variety of subjects.
−
* [http://www.seankreynolds.com/misc/exgirlfriends/mpd.html Sean Reynolds' allegedly true story] of a relationship with a girl who suffered from [[Dissociative Identity Disorder]]
  
  +
⚫
* [http://www.sidran.org Sidran Foundation] A nonprofit organization disseminating information concerning the treatment of trauma.
  
  +
⚫
* [http://www.splitangels.org/ Split Angels] Wilburian DID info by a woman who considers her multiplicity to be a mental disorder, including biographies of many parts.
  
  +
⚫
* [http://lists.topica.com/lists/darkpersonalities/prefs/info.html Dark Personalities Mailing List] A mailing list for multiples with an emphasis on Empowered Multiplicity.
  
   
 
[[Category:Dissociative disorders]]
  
[[Category:Dissociative disorders]]
   
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{{enWP|Multiple personality controversy}}
  
{{enWP|Multiple personality controversy}}

Latest revision as of 13:59, 1 February 2014

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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

File:Vivé.jpg

One of ten photogravure portraits of Louis Vivé published in Variations de la personnalité by Bourru and Burot.

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]

Controversy

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 America

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

Supporters of the therapy view

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.

Critics

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 multiplicity

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 views

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

  • (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

References and external links

References

  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. Cite error: Invalid <ref> tag; name "pmid7794202" defined multiple times with different content
  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
  5. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid2725878
  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
  17. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid1728191
  18. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid16877651
  19. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid11339321
  20. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid10831486
  21. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid17189745
  22. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid10080263
  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 view

Skeptical viewpoints

Repressed/Recovered memories

Cross-cultural views

  • 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 associations

Voices of multiples

  • 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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