Multiple personality controversy

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.

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.

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.

It is not clear what percentages of the psychological community accept, accept with reservations, or disagree with the previously noted positions.

Controversy
This diagnosis is controversial. The main points of disagreement are:


 * 1) Whether MPD/DID is a real disorder, or just a fad.
 * 2) If it is real, is the appearance of multiple personalities real or delusional?
 * 3) If it is real, should it be defined in psychoanalytic terms?
 * 4) Whether it can be cured.
 * 5) Whether it should be cured.
 * 6) Who should primarily define the experience -- therapists, or those who believe that they are "multiple" (have multiple personalities)?
 * 7) Whether it is invariably a disorder or simply a way of being.

In rough terms, believers in DID or MPD argue that children who are stressed or abused (especially 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".

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.

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 shamans. Proponents of the "healthy multiple" position are common in online communities.

Recent history
The debate over DID and MPD arose in the context of the furor over repressed and later recovered memories of childhood sexual abuse, the child sex abuse panic of the 1980s, and associated stories of Satanic Ritual Abuse. In the U.S. (and to a much lesser extent in other English-speaking countries, like the 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.

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.

Contemporary views
There are numerous points of view on this issue. Notable positions include:

"Believers"
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 pedophiles who prey on children and who are confident that any children who do complain will not be believed.

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.

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.

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.)

Prominent believers:


 * 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.


 * E. Sue Blume, clinical social worker, author of Secret Survivors (1991).


 * Laura Davis and Ellen Bass, authors of The Courage to Heal (1988). Quotes from this book:


 * " ... 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).


 * " ... demands for proof are unreasonable" (p. 137).

Critics
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.

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?


 * The McMartin preschool trial
 * The Fell's Acres trial
 * The Little Rascals trials

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 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.

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:


 * 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 area hospital, Burgus discovered that she had 300 personalities and recovered memories of a long career as a satanic priestess presiding over 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.

Other such material has been collected by the False Memory Syndrome Foundation, founded in 1992.

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. Per Joan Acocella, 40,000 cases were diagnosed from 1985 to 1995.

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.

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".

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:


 * Creating Hysteria by Joan Acocella, 1999.


 * Multiple Identities and False Memories by Nicholas Spanos, 1996.

Professionals who still find the DID diagnosis useful
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.

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.

Mainstream opinion now says:


 * 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.


 * A therapist should work with "alters" if they come up spontaneously, but should not reward the patient for displaying them.

Mental health professionals and researchers working with dissociative disorders can join an organization called The International Society for the Study of Dissociation. 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 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.

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 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 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.

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 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. This could be seen as a transition from dysfunctional to functional multiplicity.

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.

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".


 * See separate article

Note on FMSF (False Memory Syndrome Foundation)
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.

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 Dutch magazine. See a reprint of the interview here:. Underwager resigned from the FMSF that same year, while claiming that his views had been misrepresented.

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:

MPD/DID chronology

 * (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)
 * (1906) Morton Prince's book The Dissociation of a Personality.
 * (1954) Shirley Jackson's fictional book The Bird's Nest.
 * (1954) Thigpen & Cleckley's book The Three Faces of Eve.
 * (1957) movie version of The Three Faces of Eve.
 * (1973) Flora R. Schreiber's book Sybil.
 * (1976) Film version of Sybil, starring Sally Field in the title role.
 * (1977) Chris Sizemore's I'm Eve.
 * (1980) Publication of Michelle Remembers.
 * (1981) Publication of The Minds of Billy Milligan.
 * (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.
 * (1996) Madison Clell's Cuckoo begins.
 * (1998) J. Acocella's New Yorker article detailing excesses of MPD treatments.
 * (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

Repressed/Recovered memories

 * What About Recovered Memory?
 * Recovered Memories of Sexual Abuse: Scientific Research and Scholary Resources
 * The Recovered Memory Project: 96 cases of corroborated recovered memories of sexual abuse
 * Childhood Trauma Remembered: A report on the current scientific knowledge base and its applications Published by International Society for Traumatic Stress Studies

Skeptical viewpoints

 * Multiple Identities and False Memories by Nicholas Spanos, 1996, ISBN 1-55798-340-2
 * False Memory Syndrome Foundation


 * 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.
 * Essay from the Skeptic's Dictionary

Professional associations

 * International Society for the Study of Dissociation

Voices of multiples

 * Astraea's Web Resources and many links devoted to the idea of functional, healthy multiplicity.
 * Birch Grove Insight into the daily life of a healthy multiple household.
 * 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)
 * Multiplicity: The Missing Manual a wiki manual written by multiples for multiples, with the intention of building coping mechanisms and strategies for healthy multiplicity.
 * Livejournal: Multiplicity An online community in which many views of multiplicity are aired.
 * Many Voices Resource site for abuse survivors, many of whom are multiple, looking for support and psychotherapy.
 * Mental Health Matters: Dissociative Identity Disorder
 * Pavilion Awareness taskforce for 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.
 * Psych Forums: DID Forum
 * Sean Reynolds' allegedly true story of a relationship with a girl who suffered from Dissociative Identity Disorder
 * Sidran Foundation A nonprofit organization disseminating information concerning the treatment of trauma.
 * Split Angels Wilburian DID info by a woman who considers her multiplicity to be a mental disorder, including biographies of many parts.
 * Dark Personalities Mailing List A mailing list for multiples with an emphasis on Empowered Multiplicity.

Dissoziative Identitätsstörung & Dissociatieve identiteitsstoornis & Dissosiatiivinen identiteettihäiriö