Dissociative identity disorder
(DID) is one of the more problematic diagnostic categories in the psychiatric
compendium, not least because of its rise to prominence, perhaps ignominy, on
the back of some of the most bizarre claims associated with any discipline
seriously claiming scientific status. DID is the diagnosis that now attends
those reported examples of individuals who accommodate, within a single body, a
number of identities, or identity fragments (parts). Formerly known as Multiple
Personality Disorder, DID was the fastest growing disorders of the latter quarter
of the 20^th century. It has become increasingly common for people to
report numerous identities, usually under the careful guidance of a sympathetic
practitioner. Therapists report almost exponential growth in the number of
cases, and the number of identities (alters) observed within a single person,
with one estimate reaching 4000. Cases are concentrated in regions where
commitment to DID is high, indicating either enlightened diagnosis or
susceptibility to diagnostic fads.

The 1980s in particular saw an
epidemic of DID. At its most extreme it involved accusations of Satanic Ritual
Abuse (SRA), a practice many times more frequently alleged than proved. One of
its principal protagonists, Colin Ross, continues to promulgate this theory,
linked to a theory of institutionalized mind control sponsored by the CIA.
Acknowledging that the huge increases in DID reported since the 1980s are
attributable, in part, to gullible patients and credulous therapists, Ross
nevertheless estimates that 10% of reported cases are likely to be real. Quite
how he arrives at such a precise figure is unknown, especially as there has
never been any first hand evidence of such cults. Writing on this page in 2002,
about the theories of Colin Ross in
his book Bluebird, Dr. Benjamin Beit-Hallahmi commented that
"the fringes of psychiatry, where ideas about ‘mind control’ and Satanism
proliferate, are actually quite wide, and sometimes reach pretty close to its
center".

The American Psychiatric Association has played its part. In response
to well founded criticisms of the sexist nature of notions such as
hysteria, it has sought to validate experiences of abuse by creating categories
to explain their effects. An alternative position is to regard the production of a narrative of fragmented subjectivity as an
active engagement with previously denied and silenced autobiographical
experience. It must seem more than a little ironic to those feminists
who challenged the gender bias of the psychiatry to see psychiatrists, now
armed with the legitimizing language of
the DSM, building whole empires on the basis of highly dubious diagnostic
categories and practices. But if the psychiatric literature is deeply
divided about the nosological status of DID, even darker clouds lurk on the
horizon. Philosophers have questioned the ethical status of treating the
disorder as it involves the death of what is, at least by some accounts, one or
more entity with a claim to moral status. DID is not only a contentious
category, its treatment is also controversial.

Got
parts? An insider’s guide to managing life successfully with dissociative
identity disorder is a book written not by a person, but a System, ATW, who is an amalgam of personalities and
parts. ATW is 44, a single college graduate of indeterminate gender, with a
long history of abuse, who has achieved an acceptance of the complexity of life
as a System. The book is a guide to living for people with DID. It has a breezy
tone; and is informally presented and accessible.

Systems are encouraged to have their alters map their individual
histories; alters are urged to acknowledge each other’s existence, respect each
other, and to celebrate the System’s diversity. The moral scheme urged on the
System is curiously similar to middle class values; respect for diversity,
sexuality, intolerance of exploitation, love and cherish its young parts. There
are practical tips too, such as creating a safe space, scheduling as daily
meeting of the parts, having the alters talk things through under the influence
of a moderator. Individual alters behaving badly may need to be placed in
‘lockdown’; a psychological correctional facility created by the System. There
is advice about health care, time management, personal organization. I almost
expected tips on car maintenance. Much of this section reads like a self help
manual for a life under pressure. The following two sections focus on therapy
and the effects of trauma, all couched in the language of Systems. Then there
is a section on relationships, including advice on sexuality. Most people could
learn a lot from the common sense advice offered. The book concludes with
encouragement to persevere, and with a list of resources for life with DID.

There is no emphasis in ATW’s book on integration, a therapeutic
outcome that would see a single entity emerge as ‘the person’, albeit at the
expense of other alters. ATW’s approach reflects that of Truddi Chase, a DID
‘victim’ who chooses to have her alters live in a harmonious community, rather
than have one identity subsume the others. Like anyone offering advice for a
successful life in the face of adversity, ATW cautions against expecting any
magical solutions, and urges others to manage stress, negotiate with
professionals, exercise moderation etc.

The creation of DID was in part an acknowledgement by mainstream
psychiatry of the damaging effects of trauma, and the possibility that many
people diagnosed with psychosis may in fact be experiencing post traumatic
stress responses, most notably dissociation. There are many treatment models
that recognize the role of trauma in psychosis, and especially in dissociative
experiences, without inventing a new diagnosis. Just what is gained by reifying
the phenomena associated with abuse as a mental illness is less than clear. It
certainly places therapists in a powerful position to speak on the issue, and
to prescribe treatment. All power to ATW and others living with the diagnosis
of DID. If society, and psychiatry, can offer no more than the creation of a
hollow category as a condition for accessing support, then there can be little
objection to the development of self help resources. But it is my hope that in
the not too distant future DID will be recognized for what it is: the
reification of an iatrogenic illness.

©
2005 Tony O’Brien

Tony O’Brien RN, MPhil is a lecturer in
mental health nursing at the University of Auckland, New Zealand: a.obrien@auckland.ac.nz

Categories: Psychology