multiple personality

multiple personality

multiple personality, a very rare psychological disorder in which a person has two or more distinct personalities, each with its own thoughts, feelings, and patterns of behavior. The personalities often are direct opposites and dominate at different times, with abrupt transitions triggered by distressful events or memories. Each may be entirely unaware of the other but aware of unexplained gaps in remembered time. In psychiatry the condition is known as dissociative identity disorder. The term "split personality," denoting schizophrenia, refers to an unrelated disorder in which the split (separation) is between thought and feeling.

Multiple personality was first recognized and described by the French physician Pierre Janet in the late 19th cent. Public awareness of the disorder increased in contemporary times after a case was the subject of The Three Faces of Eve (1957). In the 1980s and early 90s, such factors as recognition of child abuse, public interest in memories recovered from childhood (whether of actual or imagined events), allegations of so-called satanic ritual abuse, and the willingness of many psychotherapists to assume a more directive role in their patients' treatment, led to what came to be regarded as a rash of overdiagnoses of multiple personality.

The cause of multiple personality is not clearly understood, but the condition seems almost invariably to be associated with severe physical abuse and neglect in childhood. It is believed that amnesia, the key to formation of the separate personalities, occurs as a psychological barrier to seal off unbearably painful experiences from consciousness. The disorder often occurs in childhood but may not be recognized until much later. Social and psychological impairment ranges from mild to severe. The primary treatment is psychotherapy to help the individual integrate the separate personalities.

See study by J. Acocella (1999).

formerly multiple personality disorder

Rare condition indicated by the absence of a clear and comprehensive identity. In most cases two or more independent and distinct personality systems develop in the same individual. Each personality may alternately inhabit the person's conscious awareness to the exclusion of the others, but one is usually dominant. The various personalities typically differ from one another in outlook, temperament, and body language and might assume different first names. The condition is generally viewed as resulting from dissociative mental processes—that is, the splitting off from conscious awareness and control of thoughts, feelings, memories, and other mental components in response to situations that are painful, disturbing, or somehow unacceptable to the person experiencing them. Treatment is aimed at integrating the disparate personalities back into a single and unified personality.

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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). Both the International Statistical Classification of Diseases and Related Health Problems (ICD) and Diagnostic and Statistical Manual of Mental Disorders list the condition in their taxonomies of mental disorders, as MPD and DID respectively.

The diagnosis of DID has been heavily debated in the last hundred years. Opinions vary greatly on the topic of DID. In recent years it has become discussed as to whether DID exists and is caused by repeated and severe abuse or whether patients have been simply copying symptoms either they've read about in fictional accounts or that a therapist asked them about while attempting to diagnose them for this condition. Among those who believe such a condition exists there is the additional controversy of whether it should be considered a mental illness or not.

Contemporary views

DID is a controversial diagnosis with some researchers considering it a culture bound, iatrogenic condition though this idea is not universally accepted. The DSM is explicit about the controversy over the condition.

Diagnoses of DID peaked in the mid 1990s and have since declined sharply, a pattern described by Pope et al. as "a brief period of fashion".

Supporters of the therapy view

Reports of DID are often confirmed by objective evidence and people responsible for these acts might be prone to distort or deny their behavior. The DSM currently treats dissociative amnesia, dissociative fugue, and DID as mental disorders characterized by dissociation. Those who believe that multiple personality is a real phenomenon usually assume that it is a mental disorder, originating in children who are stressed or abused (especially sexually abused). It is presumed that such children may split into several independent personalities as a defense mechanism. DID is attributed to the interaction of overwhelming stress, insufficient childhood nurturing and an innate ability to dissociate memories or experiences from consciousness. Prolonged childhood abuse is believed to be a factor in DID, with a very high percentage of patients reporting documented abuse. DID has been described by Pearson as a severely lasting dissociative response to overwhelming and normally traumatic antecedents and results from childhood trauma. DID has also been found to have consistent diagnostic features.

Some researchers assert that the present scientific evidence is inadequate to support that the suggestive influences in psychotherapy can cause DID and argue that there is little scientific support for hypnosis alone creating DID. One supporter of DID has argued that specialists do not influence their clients to make an increased number of personalities or to develop additional diagnostic criteria. D. Brown has argued that McHugh's publications questioning whether DID exists are "speculation" and claims that McHugh has insufficient clinical experience with DID patients to comment upon the diagnosis. Gleaves states that the research on DID does not support the ideas that DID is a construct of either psychotherapy or the media (the sociocognitive model), but that there is a connection between DID and childhood trauma and that treatment recommendations that follow from the sociocognitive model might be harmful due to the fact that they ignore the posttraumatic symptomology of people with DID.

There is insufficient understanding of consciousness to be able to explain how a novel split would occur in a previously undivided mind and how it would be maintained in the mind. Psychoanalytic theorists believe a schizoid phase of development occurs in childhood, which may have encouraged this view of traumatic splitting. There has been nothing found to explain why children who are later diagnosed with multiple personalities would split from those who do not undergo comparable types of stress.

Dissociative identity disorder is diagnosed in 3 to 4% of people in hospitals for other mental health disorders and a large number of patients in treatment facilities for substance abuse.

Critics

Some psychologists and psychiatrists regard DID as being iatrogenic or fictitious, or contend that true cases are extremely rare and that the majority of reported cases are iatrogenic. Drs. Paul McHugh, Herbert Spiegel, A. Piper, H. Merskey 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 and that repression of memories is a common defense against childhood sexual abuse and linked to multiplicity. 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. The work of psychologist Elizabeth Loftus, who specializes in human memory, is usually cited to support this conclusion. Some of Loftus's work, however, has been critiqued in terms of the applicability of its conclusions A more lengthy review of the normal fallacies of memory is given by Nicholas Spanos in his sociocognitive model.

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. 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. According to Joan Acocella, 40,000 cases were diagnosed from 1985 to 1995. The DID diagnosis is most common in North America, particularly the United States, and in English-speaking countries more generally. The majority of diagnoses are made by only a few practitioners. There is a controversy around the accuracy of DID reports, as memories of childhood might be able to be distorted and DID patients are easy to hypnotize and are very vulnerable to suggestion in certain situations.

Healthy multiplicity

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. Groups which experience blackouts between personality switches can function by referring to jointly owned calendars, datebooks and lists.

Some take the position that multiplicity can arise in a variety of ways, from being born naturally multiple to dissociating due to trauma; but that regardless of origins, a group of selves can cooperate and function well in tasks of daily living.

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. 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.

Some therapists have found that these allegations derive from a moral panic. 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.

People diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially during their childhood.

A few accused criminals, especially murderers, have claimed one of their "alters" committed a crime and used the diagnosis as a defense. Hillside Strangler Kenneth Bianchi was among the most notable. Dr. Colin Ross was convinced Bianchi was a multiple: however, Chris Costner-Sizemore, brought in to observe Bianchi, stated that in her opinion he was not.

The most recent case on record of an MPD criminal defense was the 1994 trial of Lori Scheirer, a Pennsylvania woman who confessed to a murder because one of her "alters" advised her to do so. She did not say that an "alter" had committed the murder. Scheirer had given enough details to police that she could reasonably be a suspect; but subsequently, she announced that she had made up the entire confession in order to gain attention. Scheirer and other family members related bizarre episodes of memory loss, stating that she looked and acted like totally different people at different times. Her disorder was speculated to have been caused by years of sexual, emotional, and physical abuse, as is usual with MPD claims. Two psychiatrists testified for her defense, one arguing that she had MPD, the other stating that she did not. The defense appeared to work to some extent; she was acquitted.

Chronology

  • (1546) Paracelsus reportedly wrote an account of a woman who had amnesia about an alter personality who stole her money
  • (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.
  • (1838) Antoine Despine describes a case of dual personality in "Estelle," an 11-year-old girl.
  • (1887) to (1896) Eugene Azam, a professor of surgery interested in hypnotism, described the case of Felida X who exhibited three different personalities.
  • (1906) Morton Prince's book The Dissociation of a Personality describes his work with multiple personality patient Clara Norton Fowler, alias Christine Beauchamp.
  • (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.
  • (1989) Frank Putnam's Diagnosis and Treatment of Multiple Personality Disorder, is published.
  • (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.
  • (2007) Richard Baer's Switching Time: A Doctor's Harrowing Story of Treating a Woman with 17 Personalities, is published.

See also

References

Further reading

External links

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