Multiple personality controversy

The existence of multiple personalities within an individual personality is diagnosed as Dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Prior to the publication of the DSM-IV, it was termed multiple personality disorder (MPD). The International Statistical Classification of Diseases and Related Health Problems (ICD) continues to list it as Multiple Personality Disorder. Neither term (dissociative identity or multiple personality) should be confused with schizophrenia, although the media often incorrectly use the term split personality to describing each.

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Recent history

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

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

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

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

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

Contemporary views

Supporters of the therapy view

Those who believe MPD/DID is a fact rather than a fictive 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.^[5]. There is insufficient understanding of consciousness to be able to explain how a novel split occurs in a previously undivided mind and how it is maintained in the mind. Psychoanalytic theorists believe a schizoid phase of development occurs in childhood, which may have encouraged this view of traumatic splitting. It is not clear what differentiates those children who split from those who do not under comparable types of stress.

An alternative view is that a developmentally appropriate multiplicity of selves, became arrested or fixed in place by the repeated shocks of sadistic abuse and established themselves as independent entities rather than grow normally into a cohesive self. According to these views, the primary function of these separate ego states is then to hold traumatic memories in a secure neural network, keeping them out of the consciousness of the original self. This frees the person to continue functioning in daily life as if nothing had happened. Some of the alternate selves, also called "alters," take turns controlling the body. Some take responsibility for learning at school, or for work and career and others for seeing the doctor for mysterious illnesses or injuries, some self-inflicted. Sometimes each alter reports remembering only the times when they were 'out' and in conscious control, and report amnesia for all other periods. This is particularly alarming for one claiming this affliction, when coming upon inexplicable entries in a diary, meeting strangers claiming a familiarity or withdrawals from bank accounts.

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

This model is a better fit with the current understanding of Complex post-traumatic stress disorder (C-PTSD), as described by van der Kolk, et. al (2005). ^[6] and traumatic grief in childhood ^{[7] [8]}.

Some therapists contend that the goal of treatment for a person identifying with the diagnosis of DID is to recover all the memories of trauma held by various selves, through hypnosis, guided visualization, dream analysis, EMDR, conflict resolution and other techniques, and then integrate the alters into a cohesive self. Others, realizing the enormity of that task believe that the work is more like decades of multicultural conflict resolution, an ongoing process of mediation between separate selves, which eventually become self-sustaining.

Some therapists 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 or forensic truth. Others believe the reports are fragmented segments that coincide with the orderly way in which memory is laid down across and between the senses, from different sensory points of view.

A critical psychology view is that therapists only see high functioning multiples (with the wherewithal to pay for therapy) who were sadistically abused as children, whilst there are other types without psychiatric disorder or dysfunction who don't come to their attention. Those supporting that view believe in human neurodiversity or evolutionary variation in brain wiring that gives rise to different sensitivities to the inner workings of consciousness.

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. Drs. Paul McHugh and Herbert Spiegel are among the leading critics of the DID paradigm, and have made their views known in articles and television interviews.

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, some critics have focused on studies citing the fallibility and flawed nature of human memory, the weaknesses of hypnosis as a tool for recall, and on disproving claims of the accuracy of recovered memories.^[9] The work of psychologist Elizabeth Loftus, who specializes in human memory, is usually cited to support this conclusion.^[9] A more lengthy review of the normal fallacies of memory is given by Nicholas Spanos in his sociocognitive model.^[10]

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.^[10] Prior to the 1950s, cases of dual personality and multiple personality were occasionally reported and treated as curiosities in the Western world.^[11] The 1957 publication of the book The Three Faces of Eve, and the popular movie which followed it, revived the American public's interest in multiple personality. The diagnosis of Multiple Personality Disorder, however, was not included in the DSM until 1980, following the publication in 1974 of the highly influential book Sybil. As media coverage spiked, diagnoses climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990.^[12] According to Joan Acocella, 40,000 cases were diagnosed from 1985 to 1995.^[1] The DID diagnosis is supposedly centered in North America, particularly the United States, and in English-speaking countries more generally.^[10] There is some evidence that the majority of diagnoses are made by only a few practitioners.^[13]

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

Other researchers assert that the present scientific evidence is inadequate to support that “suggestive influences allegedly operative in psychotherapy can create a major psychiatric disorder like MPD per se” and that “there is virtually no scientific support for the unique contribution of hypnosis to the alleged iatrogenic creation of MPD in appropriately controlled research.” ^[14]

Healthy multiplicity

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

Some people who hold this view believe that the unity of the self is an illusion and that everyone is fundamentally multiple, an opinion some claim is similar to the beliefs of William James ^[15] 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. ^[16]

Truddi Chase, author of the best-selling book When Rabbit Howls, is one believer in healthy multiplicity. Although she described the multiplicity as originating from abuse, she claims to live as a group of selves who rejected integration and function in mutual cooperation. ^[17]

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

• (1546) Paracelsus reportedly wrote an account of a woman who had amnesia about an alter personality who stole her money ^[18]
• (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.^[19]
• (1816) Dr. Samuel Latham Mitchel described the case of Mary Reynolds, first published in the 1816 edition of "Medical Repository". Mary experienced a severe convulsion, becoming blind and deaf for five weeks, followed by amnesia and double consciousness ^{[20] [21]}.
• (1838) Antoine Despine describes a case of dual personality in "Estelle," an 11-year-old girl.^[22]
• (1887) to (1896) Eugene Azam, a professor of surgery interested in hypnotism, described the case of Felida X who exhibited three different personalities ^{[23] [24]}.
• (1906) Morton Prince's book The Dissociation of a Personality describes his work with multiple personality patient Clara Norton Fowler, alias Christine Beauchamp.
• (1943) E Stegnel declared the condition extinct ^[25]
• (1954) Morton Prince published the case of Chris Costner-Sizemore in his journal later renamed as 'The Journal of Abnormal Psychology' ^[26].
• (1954) Shirley Jackson's book The Bird's Nest, a fictional story of multiple personality, is published.
• (1954) Thigpen & Cleckley's book The Three Faces of Eve, loosely based on the therapy of Chris Costner-Sizemore, is published, reviving the American public's interest in the subject of multiple personality.
• (1957) A movie version of The Three Faces of Eve, starring Joanne Woodward, is released.
• (1973) Flora R. Schreiber's bestselling book Sybil, a novelized treatment of the life and therapy of Shirley Ardell Mason, alias 'Sybil Dorsett' in the book.
• (1976) A made-for-TV film version of Sybil is produced, starring Sally Field in the title role.
• (1977) Chris Costner-Sizemore publishes an autobiography, I'm Eve, alleging that Thigpen and Cleckley's book was a misrepresentation of her life.
• (1980) Publication of Michelle Remembers.
• (1981) Daniel Keyes' book The Minds of Billy Milligan is published, based on interviews with Billy Milligan, some of his therapists, lawyers and family members.
• (1986) Publication of When Rabbit Howls by autobiographical author Truddi Chase.
• (1995) Astraea's Web, the first Internet website to describe non-disordered and self-recognized multiplicity, goes online in September.
• (1996) Publication of Rewriting the Soul by Ian Hacking.
• (1998) Joan Acocella's New Yorker article detailing the excesses of MPD therapy, Creating Hysteria, is published.
• (1999) Cameron West's book, First Person Plural: My Life as a Multiple is published.
• (2005) Robert Oxnam's autobiography, A Fractured Mind, is published.

References

See also

• Multiplicity (disambiguation)
• Multiplicity of consciousness and the emergence of self
• Radical Psychology Network
• Soteria
• DID/MPD in fiction
• Possession
• Recovered memory therapy
• Repressed memory
• Sexual abuse
• Satanic ritual abuse