Multiple Personality Disorder (MPD), or, as it is referred to in most recent version of the manual DSM-IV, Dissociative Identity Disorder, is a genuine psychiatric disorder. However, the numbers of cases of MPD are far higher in North America than in any other part of the world. Many suspect that this surplus of MPD cases is the product of American culture and over-indulgent psychiatrists and psychotherapists.
There have long been reports of individuals who seemed to have "someone else" inside their body. Possession was the most common explanation for such behavior. Prayer, exorcism, and occasional burning at the stake were the methods used to resolve it. The classical literature of psychiatry has also contained reports of disturbed individuals who seemed to change from one personality into another without recollection of having done so. It has been conceded that certain individuals, particularly ones severely traumatized as children, can split deep inside themselves and subconsciously create alternate personalities within which to find refuge. However, this psychological phenomenon was always considered extremely rare. It was only after "The Three Faces of Eve" was published in 1957, and "Sybil" in 1973, that the Multiple Personality ball really started rolling. When MPD was accepted as a genuine psychiatric illness in the Diagnostic & Statistical Manual of Mental Disorders version III in 1980, all hell broke loose.
In a 2004 review for the Canadian Journal of Psychiatry, the American psychiatrist, Dr. August Piper, remarked that more MPD cases were discussed in the medical literature in the five years after inclusion in the DSM-III than in the preceding two centuries. Between 1980 and 1986, more than 6000 patients in the United States were diagnosed with the disorder. Champions of the disorder, such as psychiatrist Colin A. Ross, began to claim that MPD was rampant. He surmised that at least half of the exotic dancers in Winnipeg, Manitoba suffered MPD. He further asserted that five percent of college students and one percent of all North Americans suffered MPD and needed intensive psychotherapy for it. As a point of reference, the lifetime prevalence of Bipolar Affective Disorder in the United States is only about four percent.
Most psychiatrists believe that the diagnosis of MPD has gotten entirely out of hand, and it isn't merely due to the unexpectedly large number of patients being diagnosed with the illness. Equally puzzling has been how the numbers of personalities have multiplied within the minds of the victims. Whereas Eve had three personalities, and Sybil 16, patients with MPD began to report seemingly endless lists of personalities lurking inside. Personalities began to propagate like locusts. The DSM defines MPD as "the presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self." While admitting that the number of identities might range from two to more than 100, the manual noted that half of all cases involve individuals with 10 or fewer alternate identities. Yet, reports of patients with hundreds of separate alter personalities became routine. For example, Dr. Richard P. Kluft, a psychiatrist specializing in the treatment of MPD at the University of Pennsylvania, reported in a 1988 paper that one of his patients had over 4000 "alters".
The types of alters being reported have further stretched common sense. In 1989, Dr. Kate Hendrickson and her colleagues from the University of New Mexico described five patients in whom one or more alter personalities were animals. In one patient's case, "Any reference to sex, being bad, or feeling shamed made her feel as if she "turned into" a dog. When these issues were discussed in therapy, the patient began acting like a dog and spoke in German." One might suspect the woman fancied herself a German Sheppard, though the specific breed of dog was not mentioned in the text. Other therapists have reported alters identified as lobsters, chickens, gorillas, unicorns, rabbits, robots, Mr. Spock, aliens, and God.
It is not pleasant reading the stories of such individuals. If the histories are accurate, then some experienced horrifying abuse at the hands of their parents. Others suffer delusions and thought disorders bizarre enough to warrant diagnoses of schizophrenia rather than MPD. Still, the question remains as to what degree leading questions and indulgences of vivid imaginations have prompted the alternate "personalities" to come into being.
Some therapists make a point of calling out alters to identify themselves in each therapy session, which would tend to encourage invention of ever more hidden personalities. The sufferers of Multiple Personalities also appear to feed off each other's imaginations. Websites and Internet discussion groups for "multiples" abound, and sufferers take pride in how many alter personalities populate their minds. Pseudoscientific jargon flows freely in sites aiming to provide a technical basis for the illness and snare "multiples" for cutting edge psychotherapy. One site explained that, "alter personalities ... may form around "strange attractors" in the psychobiological field of an individual attempting to escape or heal traumatic stress in a self-organizing way. It is possible that through dissociation, the person is attempting to heal in a self-organizing way, but the transformative process gets "stuck" at the classical stage of fragmentation, which then recreates itself through the dynamics of "infinite nesting" and "self-iteration." This is pure baloney.
In medicine, it is almost always the most severe cases that first bring attention to and define forms of illness. It is only later that milder, less obvious forms of the illness are found to exist. This phenomenon gives rise to the old maxim that, "Diseases become more benign with time". However, in the case of MPD, the opposite has been true. It was relatively mild cases that first defined the illness, with more complicated, dramatic, and bizarre examples of the illness being reported with each passing day. It is reasonable to assume that more elaborate forms of MPD have evolved from mutual encouragement and nothing less than competition among self identified "sufferers" of the illness. This is furthered through the complicity of well-meaning but overly indulgent mental health professionals.
Psychiatry is a unique branch of medicine. A person can believe that they suffer a severe heart condition, yet be entirely mistaken. On the other hand, if a person firmly believes that they suffer a severe psychiatric condition, they are invariably correct. They may not be suffering the condition they think they are suffering, but their suffering is nonetheless real and deserves treatment. In many of the individuals who believe themselves to be suffering MPD, this error in self-understanding was introduced by the professionals who should have been there to clarify rather than obscure the problem. Both philosophically and psycho-therapeutically, it is more reasonable and parsimonious to view a patient with "Multiple Personalities", as having a single, very dysfunctional personality. To focus on or, God forbid, seek out "alters" is to be distracted by the manifestations of the illness rather than its true nature. To do so does disservice both to the patient and to the field of psychiatry in general.
Multiple Personality Disorder and other culture bound psychiatric conditions are discussed in Dr. Mendelson's new book, "The Great Singapore Penis Panic and the Future of American Mass Hysteria".
The human mind is capable of astounding things- things that we are yet unable to comprehend as of currently. Will you please explain to me what makes us 'sentient?' What makes us dominate the world and see all other species as sub-human? Will you please provide such proof and citations as to not be questioned by a single person or having the slightest fallacy?
The human mind is not yet within human understanding. Therefore, how might you claim that multiples are any less real than you? How might you claim that they are 'making it up?' I am well aware that some may fake the condition; however, I do not ascribe to the belief that they would so convincingly be able to consistently portray this under continuous observation.
Now, why aren't there more cases in other places? Perhaps people wish not to be forcibly institutionalized, doubted, or ostracized. Perhaps some believe that they do not need to mention it because of societal pressures. Perhaps some are like Kristina. We did not want her to know of our presence because it might complicate things. Thus, we 'kept her in the dark' for years, hiding and subtly helping her. She now knows, and has gained more strength of character from it. Never have we seen this lifestyle as detrimental to our health or functionality. -John, Median
Let's be sure to ID real cause of the discrepancy in diagnosis rates between countries. It may be that in North America we have developed a culture where victims of abuse or sufferers of mental illness are more able to access services and seek treatment.
I agree that there are therapists and doctors who have probably caused a form of iatrogenic multiplicity and that there are websites and email lists that may encourage some people to think they are multiple. The thing is, most of those people give up after a few months or years - and probably have some other kind of mental health issue. Also, the Internet is not confined to North America.
Just as the validity/truth of memories explored in therapy in one individual's therapy does not reflect on the truth of another's, I think it's going a bit too far to imply that multiplicity doesn't exist at all, or is so rare as to be insignificant.
A few other statements disturb me in your post. For example, the statement that MPD becomes more bizarre over time. Have you surveyed professionals who are treating multiples to see if this trend in greater numbers of alters is actually the case? Or are you too just looking at the net to confirm your bias?
It sounds like an interesting book and I look forward to reading it.
DID is a real condition with a long history of documentation and recognition by experts in the field.
Some cases are very strange, sometimes to an extent that suggests mis-diagnosis or even fraud.
Therefore, professionals should act as if DID does not exist, and treat those who apparently have it as though nothing of the sort is going on.
The premises are reasonable, but the conclusion is ridiculous. Imagine applying this reasoning to any other psychiatric condition. Say, a doctor judges that Attention Deficit Disorder is overdiagnosed, and that some people seem to be making money off of these mistaken diagnoses. Our hypothetical doctor then concludes that doctors and teachers should pretend ADD doesn't exist and assume that, no matter what a student says, she can't possibly be having actual trouble paying attention, there must be something else wrong with her to make her say that. It's a ridiculous over-reach.
Meanwhile, the language used to describe multiples here is very troubling. Words like victim and sufferer sound sympathetic, but the effect is reduced when the words appear in skeptical quotation marks. Throw in words like "bizarre" and (incredibly) "locusts," and the language stops sounding sympathetic and starts sounding marginalizing and bigoted. I don't think anyone could print an article comparing people with, say, autism or depression to destructive swarming insects and be taken seriously, but apparently some people think it's acceptable to write that way about multiples.
Way back when I thought I might well be multiple, there happened to be an ongoing debate on how to classify multiplicity. The dispute centered around whether or not anyone could "really" have more than one personality. The end result was the current state of affairs in the countries that use the DSM: That it was in fact a delusion.
This led me to ask, how do we know that it is a delusion? I immediately looked for research into personality formation. Or indeed, some useful guideline that might actually underpin the debate. If we are going to discuss whether multiplicity is a delusion or a disorder, surely there must be some foundation for the discussion?
Zip. Zero. Nada. Bupkis. Square root of bugger-all. NO foundation at all. So this is theology, not psychology. And it does explain why the leading lights in the field do WORSE than placebo.
This was the point at which I decided that the worst thing I could possibly do would be to seek professional help. You see, the only thing worse than being patronized by a skeptic - gods, consider how such patronizing dismissal must feel to someone seeking treatment - is being at the mercy of a TRUE believer. Google "Spring Shadows Glen."
I'm a functional multiple. But pay no mind to me, or others who have and will clear their throats. In France, they don't believe in us. Irrefutable, sir!
I've heard of people being convinced they were multiple, or told to assign names and personalities to different mood states, but for us it's never been anything like that. The difference between the two of us is extremely obvious, a switch is very jarring and on top of that, we're able to interact with each other.
I don't think that the number of reported cases varies based on people deluding themselves into thinking they're multiple when they're not, so much as how many think that a psychologist might actually care, or be willing to help.
A comment earlier spoke of a French psychologist saying "we don't believe in MPD in France." So what's to wonder about for a discrepancy in numbers? If you had a condition your doctor didn't believe in, would you tell them? Even if you did, it wouldn't be reported as MPD.
Multiplicity has been recorded throughout history. Even though malpractice has occurred, let's not be so quick to dismiss the entire experience. The denial we face from friends, family, therapists, and society really does not need to get any worse.
Every functional multiple group I've known has hid their multiplicity from their employers, most have hid from their families. The stigma of being known as multiple is extraordinary - this article seems to imply that it's the other way around.
Personally, I don't understand how anyone can so wholly discount another's experiences, even if they do seem a little out there to you. If that woman's mind needs to have a dog in it, then so be it; let it go.
As for the "illness" and its "true nature," what makes you think it is so much more healthy for someone with D.I.D. to integrate into one personality?
Most other countries do not have our intense and varied media experiences. Americans sitting in front of the boob-tube absorb large doses of horror-movies, weird behavior models, and in-depth goofiness. And with the writers doing such great jobs at filling out the details of the most obnoxious personalities, the avid viewer (couch potato, etc.) could easily get caught up in imitation.
We might be seeing an advanced case of hypochondria in this multiple-personality disorder explosion. And of course, the American obsession with the freaky prevents a lot of people from saying, "This is just too silly and rehearsed to make sense."
As a teacher who has some acting experience, I believe that "getting into character" is not difficult for people to do. My kids are great at playing certain characters, doing the dialogs, and extending the persona of characters they watch in the movies or TV shows. They can play with multiple personalities, but they don't *have* multiple personalities.
Kudos to the author for pointing out that fads in diagnosis do not reality make.
Mood disorders, particularly Bipolar, are unfortunately diagnosed incorrectly, as you say.
Good training in diagnoses involve many, many hours of good observation and performing a thorough medical and social history.
In her case thinking such as "You aren't there for me" especially with very strong emotional force and reinforcement can't possibly be good for her psyche. The effect on the unconscious would be of a sort of splitting. Thinking along lines "I'll never think about this again" "I have to go somewhere else in my mind"and "It has nothing to do with me" could also be likely contributors.
Conscience may be completely ignored by anyone who acts on urges to engage in morally wrong or destructive behaviors in the particular sort of emotional atmosphere under discussion, also very damaging to the psyche and a likely contributor to the disocciative state.
I would think any examination that produces understanding helps anyone dealing with someone with the disorder. I realize that only in cases where the "personalities" can be first identified by the individual and finally integrated can there be healing, and then only if the individual desires that outcome.
When they don't want help we see cases like Jared Loughner.
Before I knew it, she and I were in a cop car going to a psychiatric hospital. I did not talk to her about the specifics of what she had said on the way, but when she recounted the story to the psychiatrist, it was obvious she was not recounting anything that would sound like MPD, as portayed by "Sybil".
It happened that the shrink was French and doing advanced work at the teaching hospital where we had taken the child. She called me out of the room and we talked. At the conclusion, she said, "you know Americans believe in MPD, but we do not in France." Seemed like a perfectly rational comment to me.