The Dissociative identity disorder reference article from the English Wikipedia on 24-Jul-2004
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Dissociative identity disorder

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In psychiatry, Dissociative Identity Disorder (DID) is the current name of the condition formerly listed in the Diagnostic and Statistical Manual of Mental Disorders as Multiple Personality Disorder and Multiple Personality Syndrome. The International Statistical Classification of Diseases and Related Health Problems continues to list it as Multiple Personality Disorder.

Multiplicity is often used to describe wider behaviours than DID—in other words, it includes the presence of separate selves which are not part of a psychiatric disorder. In the widest sense it may include concepts such as voluntary possession trance religions, demonic possession and two-spirits. Indeed, in several cases, doctors have resorted to exorcisms in order to treat DID. [1], [1] Some Christian fundamentalist religious groups which practice deliverance activity routinely attempt to exorcise multiples.

The very existence of DID is questioned by some doctors and scientists. The growing consensus among most doctors and scientists is that DID exists, but that it is an iatrogenic ("caused by doctors") illness that is generally created by suggestion or self-suggestion. The ISSD treatment guidelines indicate that DID should be considered an error in thinking on the part of the client, who believes that aspects of her personality have split off into distinct persons; therapy focuses on encouraging the client to see herself as a single, "whole" person. A few psychiatrists continue to claim that it is a severe illness that cannot be created in adult life, brought on by extreme abuse in childhood.

Table of contents
1 Theory of Dissociative Identity Disorder
2 History of multiplicity
3 Multiplicity as a social phenomenon
4 DID in fiction
5 References and external links

Theory of Dissociative Identity Disorder

The primary criterion for the diagnosis of DID is the presence of two or more separate selves within the same body, which may have very different ways of acting, thinking and speaking, and may be of different gender identities, ethnicities or sexual orientations. Depending on the severity of the condition, one personality may not recall incidents that happened when another personality was predominant. Generally, one or two personalities assume the role of frontrunner, performing most tasks in the everyday world, although this does not appear to indicate that they are especially more developed or more "real".

MPD or DID is most commonly diagnosed in people who are, typically in recovered memory therapy, found to be the victims of severe repeated trauma (usually child abuse) very early in life. Whether this abuse (often claimed to be religious in character, sometimes satanic ritual abuse) actually happened in the majority of cases or whether false memories were induced by the therapist is subject of much debate. In the recovered-memory movement of the 1980s and 90s, therapists often refused to believe clients who reported childhood abuse incidents which did not include more extreme features. Clients were pushed and prodded to "remember" more brutal and graphic abuse; they were told they'd "never get well" until they did. The movement culminated in a tidal wave of scandal and lawsuits which discredited both recovered memory and multiple personality among clinicians, academics, and the general public.

DID therapists believe that in an effort to shield themselves from trauma, clients have effectively split their mind into two parts—the person who was abused, and the rest of the self, who was dissociated from the traumatic event and protected from its effect. Over time, and with repeated traumas, they become adept at masking the true self. In effect they become human chameleons in an attempt to protect themselves from anything that might harm their psyche further, and later, to keep anyone from discovering their secret. Presumably, the victims will suffer from various general symptoms (such as depressions, sleeplessness and headaches) in later life. The therapist then has to uncover the split personalities and help them share the suppressed memories in order to restore balance.

Again, these theories have come under fire from modern information. In classical MPD, the original personality is shattered, usually forming a group of 5 archetypes, which are then further subdivided by later abuse. Late-onset DID usually involves a much simpler separation of the primary personality into two or more subsets. The pattern formed by classical MPD involves a set of Jungian archetypes of Host, Defender, Child, ISH (Internal Self Helper) and Opposite, and appears to be consistent in enough clinical cases to suggest something about the etiology. Independent or self-identified multiples frequently do not follow this pattern.

History of multiplicity

The existence of multiplicity was until recently a topic of much debate within the psychological community. Reports of individuals who seemed to display more than one discrete self date back to the 19th century, and some have speculated that cases of 'possession' described in earlier centuries, including in the Bible (Mark 5:1-21, for instance) were actually cases of multiplicity. 'Dual personality' was closely associated with Spiritualist mediumship in the 19th and early 20th centuries, as some believed that the different selves were actually spirits who had taken up residence in the medium's body, generally by invitation. Early psychoanalysts attempted to attribute multiple personality to a variety of causes, including manifestation of unconscious desires, head injuries (Boris Sidis), and social oppression (Dr. Theodore Fluornoy). As in Jung's theories of personality, the true self was thought to be hidden and denied while a more socially acceptable self was presented to the world-at-large. Women of intellectual bent who desired educations or careers instead of becoming baby machines were one obvious example of Flournoy's oppression theory; men who wanted to be, say, ministers instead of businessmen (e.g., Ansel Bourne) were also thought to be susceptible to MPD.

Psychoanalyst Morton Prince, who later published a book on his experiences in treating Sally Beauchamp, a multiple client, believed that multiplicity was due to the disintegration of an original, unified personality into separate pieces. He translated desaggregation, a word coined by the French analyst Pierre Janet, as 'dissociation,' and used it to refer to the process by which the original personality was supposed to break apart. Although he did not attempt to theorize on a universal cause for dissociation, he believed that multiplicity needed to be cured by integrating all the selves into one personality, not necessarily the "original". In his work with Miss Beauchamp, he actually chose the personality he deemed the most pleasant as the "real" self, and worked with her to try to kill the other selves. Integration as death is a recurring theme in accounts by multiples about their own experiences in therapy.

Several popular accounts of multiplicity, most fictionalized to some degree, were published during the first half of the 20th century, the most famous being The Three Faces of Eve by Corbett Thigpen and Harvey Cleckley. Thigpen claimed to have integrated all the selves of 'Eve,' a multiple client, and the book was so popular it was later made into a movie. Several decades after the book's publication, the real 'Eve,' Chris Costner-Sizemore, came forward to report that much of the book was a fabrication by Thigpen; although she really was multiple, by her own account, she never actually integrated until much later, working with a different therapist.

The actual diagnosis of 'Multiple Personality Disorder' did not exist until the 1970s, when Sybil, the most famous modern account of multiplicity, was published. 'Sybil,' whose real name was Shirley Mason, was a patient of Freudian analyst Cornelia Wilbur. Wilbur treated Mason for over a decade utilizing a variety of methods from ordinary talk therapy to hypnosis and sodium pentothal. She believed that her client's multiplicity had been caused by severe physical abuse and sexual abuse in childhood, which had caused her original personality to 'split off' separate selves. Many of the selves performed the function of enduring abuse for her, while others embodied pleasant memories, or sad but non-abusive events such as the death of her grandmother.

In Wilbur's view, based on Pierre Janet's work, all multiples consisted of an original, depleted self and the many personalities who had dissociated from it -- always as a result of childhood trauma. In order to restore the patient's original self, it was necessary for the client to remember all the childhood traumas which had caused the 'splits,' and then integrate all the personalities; only then could the patient live a full and productive life.

Wilbur later went on to specialize in treating multiples, continuing to enforce her view that all multiples had a history of severe trauma in childhood and could not live functionally without recovering their traumatic memories and becoming integrated. She believed that it was routine for multiples to lack a communal memory and to be unable to remember things done by other selves. The diagnosis Multiple Personality Disorder was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders, and several popular, often highly-embellished and fictionalized case histories of multiples were published throughout the 1980s, all after the model of 'Sybil.'

Dr. Wilbur claimed repeated successes in integrating her flock of MPD clients. However, medical staff who worked with her at her Open Hospital for Multiple Personalities in Lexington, Kentucky reported that her clients would often pretend to integrate because it was what they knew Dr. Wilbur wanted. A demanding, charismatic woman, Wilbur could be quite the termagant when crossed; one learned quickly to give her what she wanted, or else. She seems as well to have been deeply conflicted in the matter of Shirley's integration; she'd have liked to see her "healthy," but as a multiple, she'd continue to garner attention. Friends and hospital staff report that Shirley was definitely multiple, that she never really integrated and remained multiple until her death from breast cancer in 1998.

Allegations of iatrogenesis

Robert Rieber of the John Jay College of Criminal Justice in 1998 examined tapes regarding the Mason case and came to the conclusion that the multiple personalities were confabulation induced in the patient by her therapist, who, in sessions which included the use of drugs (mostly sodium pentothal), assigned names to Shirley's moods or emotions, while dismissing any attempt by the client to deny her multiplicity. Critics charge that this allegation of "being in denial" is used to force patients to go along with a therapist's psychological model, be it satanic ritual abuse with subsequent dissociation or alien abduction memory (a similarly widespread phenomenon).

In Shirley Mason's case, memories of severe physical abuse were also "recovered": Her mother allegedly filled her bladder with ice-water to stop her from urinating, and then tied her to the piano and proceeded to play at top volume. Shirley also reported her mother sodomizing her with a buttonhook (used to fasten old-fashioned high-button shoes) and burying her in a corncrib where she nearly smothered to death. In reality, little evidence for most of the reported abuse was ever found, although contemporaries recall Shirley's mother as a bizarre woman, possibly schizophrenic, who kept Shirley in a "vise lock" and never allowed her any freedom [1]. Some DID advocates argue that this type of emotional and mental abuse could have been traumatic enough to cause multiplicity. It certainly would have affected Shirley's mental health, whether she was actually multiple or not.

Dr. Herbert Spiegel, a therapist who treated Shirley for a few weeks while Wilbur was on vacation, also concluded that Shirley's multiplicity was induced. He noted that Shirley seemed perfectly capable of expressing her emotions or explaining her past without her different selves needing to be present; and that the idea that the selves existed came primarily from Wilbur, not from Shirley. However, Shirley is also known to have delivered a variety of conflicting stories about her multiplicity over the years; she told Dr. Leah Dickstein of Lexington, Kentucky that "every word in the book is true". If she was multiple, it's likely that some of her people were open to the idea of multiplicity while others disdained it.

The diagnosis, which had always been a subject of much debate, became highly controversial in the mid-1990s. After approximately a decade of popularity among therapists and talk-show hosts, the recovered memory movement fell into disrepute. Clients began to report in increasing numbers that they had been misdiagnosed with multiple personalities, and led to believe that they had experienced traumas in childhood which had never actually occurred, particularly including satanic ritual abuse. Many of the patients who remained in therapy decompensated instead of feeling better, which led many psychologists to conclude that multiplicity was usually or always iatrogenically induced through a combination of social and therapeutic influences. The diagnosis MPD was changed to Dissociative Identity Disorder in the fourth edition of the DSM in an effort to rid the condition of the exotic, tabloidish ambience with which it had been imbued. The International Society for the Study of Dissociation guidelines caution professionals not to respond to the different selves or address them by name, but to approach the client as a single, whole person who experiences herself as a set of splintered parts of a single consciousness, encouraging integration.

Another interpretation is merely that some people are inherently multiple and attempting to treat them with "integration therapy" is detrimental to their mental health. Even some classic MPD multiples such as Truddi Chase who believe they split due to abuse feel they now function more successfully as a group, and refuse integration, seeing it as a form of murder. Some professionals agree with their clients that functionality is more important than whether or not the client sees himself as multiple. Dr. David Caul, who treated Billy Milligan, 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."

A classic case of a questionable diagnosis was the Hillside Strangler case in the US. Kenneth Bianchi, an accused serial killer who allegedly strangled multiple women in Los Angeles, was diagnosed at his court-ordered psychiatric evaluation as having MPD. However, Chris Costner-Sizemore, the original Eve, was called in as a consultant, and after observing Bianchi for some time, voiced her opinion that he was not really multiple. Later investigation showed that Bianchi's behavior was not in fact consistent with the MPD diagnosis. This is commonly attributed to the joint effects of suggestion (iatrogenesis in clinical terms) and deliberate deception from Bianchi (malingering).

Multiplicity as a social phenomenon

If Sybil-type MPD/DID is rare or iatrogenically induced, alleged multiplicity is still a phenomenon worth studying. The existence of, or belief in the existence of, more than one self in one body is as of yet not very well understood. With the advent of the Internet, where anonymity is at least theoretically possible, increasing numbers of self-acknowledged multiples who have never been diagnosed or in therapy have come forward to report that they are living healthy lives without need of integration. Not all have a history of childhood abuse, let alone sexual abuse; many report not only having clear memories of their childhood, but having been multiple for as long as they could remember. Since they do not suffer from the amnesic or dangerous behavior that often characterises the clinical model, such multiples have rarely come to the attention of therapists, having had no need for their intervention.

In addition, many healthy multiples have called into question the concept of integration of selves. Several people who knew Shirley Mason reported that despite the statements made in 'Sybil,' she, like Eve, remained multiple even after her supposed integration. Some believe that true integration is impossible, or at least impractical, for genuine multiples. It remains to be seen whether the scandals and lawsuits of the 1990s will prevent serious research from being done on healthy self-identified multiples, or from non-Wilburian paradigms of multiplicity being studied and considered.

Because such multiples do not experience their condition as disordered or sick in any way, some have proposed that the diagnosis of DID be removed from the DSM entirely, or revised to classify multiples who have difficulty communicating and sharing memories and/or wish to integrate. It has occasionally been suggested in these communities to move the diagnosis into the category of neurological, rather than psychological, reducing the emphasis on integration and normalization therapy and shifting the focus to helping them better interact in daily life. There is a growing movement toward multiplicity independence and liberation from the therapeutic mold, very much like that found in some autism communities.

Because of the known risks associated with classical, pathological MPD/DID, most critics demand that therapists who induce multiple personalities in patients by creating false memories and encouraging their patients to assign names and characters to different emotional states when no evidence of multiplicity existed prior to therapy, should no longer be allowed to practice. Interestingly, critics of MPD/DID therapy and self-identified natural/healthy multiples share many of the same criticisms of the traditional MPD/DID paradigm. These include the emphasis on recovering abuse memories which may or may not be real, the status associated with victimhood and dysfunctionality, and the blaming of "other personalities" for irresponsible or criminal behaviour.

DID in fiction

The idea of multiple personalities has been popularized by many bestselling books and some movies. The first novel to feature multiple personality prominently was The Birds' Nest, in 1954, by Shirley Jackson, which was made into a forgettable 1957 movie called Lizzie. Interestingly, the movie version of Three Faces of Eve, starring Joanne Woodward-- which was released in the same year-- drew heavily on Jackson's work to a point where some consider Jackson to have been plagiarized. The book about Sybil was turned into a 1976 TV movie. The 1994 mystery Color of Night, starring Bruce Willis, the 1996 movies Primal Fear and Shattered Mind, and the 2003 thriller Identity also feature multiple personalities in fictional crime scenarios and explore the idea of responsibility for another personality's actions. Various movies, including Never Talk to Strangers and Session 9, and episodes of popular TV shows such as X-Files, Psi Factor and Judging Amy, have used the now-cliche idea of multiples with a hidden "killer personality" for cheap drama and thrills. Touched by an Angel goes so far as to imply that multiples are actually demon-possessed.

In comic books, DID is a feature of a number of characters. The most visible examples are the 1980s versions of the Incredible Hulk and the Batman supervillain, Two-Face. Batman himself was portrayed as something of a dual personality in the Dark Knight series. The 1970s DC backup feature Rose and the Thorn depicted gentle Rose and feisty crimefighting Thorn, who was out to avenge the murder of Rose's father. Rose had no idea that Thorn shared her body. In the early 1990s, Superman was injured and spent some time as multiple. He didn't realise he was Clark Kent, nor, as Clark, did he know he was Superman. Crazy Jane of the Doom Patrol is deliberately and in some detail based on Truddi Chase. In the popular Japanese manga MPD Psycho, a police detective tracking down a mad killer discovers he himself is multiple, and fears that the clues point to one of the people in his system as the murderer.

Marvel superheroine Aurora from Alpha Flight is a character who is actually diagnosed with DID. Like Rose and the Thorn, a conservative self dominates during Aurora's normal, day-to-day life, and a more adventurous self is responsible for her nightly excursions as a costumed hero.

See also:

References and external links