Despite, or maybe because of, more
so many reports in the literature the nature, indeed the plausible existence of
dissociative states, or more commonly multi-personality disorders is still
hotly debated. It is not just a quiet academic conjecture, it is something that
raises passionate responses both to defend the most puzzling of conditions and
to deny them entirely. The psychiatric community has rarely been in agreement
about these presentations and the controversy continues. It is for these
reasons among many others that Robert Reiber’s history of the subject is
welcome, although it is a little unclear why he should speak of bifurcation
when so much of what he discusses is more than a two-way split.

While they provide a great deal of
fascination for the general public — one needs only to think of the popular
confusion with schizophrenia or the cinematic representations — they also
divide clinicians, researchers and theorists. How do clinicians actually treat
someone who presents in this way? How do researchers identify what is and is
not the true character of the presentation? How do theorists explain the etiology?

Reiber attempts to locate the history
of the idea of dissociative states (and their various noms de mal) in a
social context that owes much to popular hypnotism, Freudian and
pseudo-Freudian psychodynamics and concepts of identity. If more than one
personality can exist in the same body, what exactly is a personality? And is
our personality in any way what can be said to be the essence of our self? He
asks, as has been asked before, "Where have all the hysterics gone?" "Where
are all those seminal cases that Freud brought so vividly to the public and
scientific imagination?" Have they all disappeared? Why, if these were
real at one time do they not seem to appear at another? Is the whole diagnostic
category a social rather than psychiatric phenomenon?

The answer, according to Reiber, is
that they are still to be found filed under DID (Dissociative Identity
Disorder) but they are by no means as common, or perhaps as significant as may
have once been believed. Reiber asserts that the diagnosis, while valid, has
been rather exaggerated and co-opted by the non-scientific community often for
sensationalism alone. The cases make for exciting reading. They sell newspapers
and magazines and were almost staple TV chat show fodder. They sound bizarre
and fascinating. But are they true? And does that matter?

Reiber has to negotiate the tricky
territory of the personal account and the reliability of memory. As with the
notion of repressed memory, which often seems to involve scenes of satanic abuse,
devil worshipping, lots of naked dancing and what the churlish might suggest
are more likely to be the products of a fevered adolescent imagination than a
sober clinical report, DIDs may hinge on a willingness to believe rather than a
need to be convinced. This does not negate the distress that many people may
feel, but it does suggest that DID may have more metaphorical worth than
empirical status.

As he works through his argument he
considers some of the most famous and discussed cases: "Sybil" in particular.
This, it will be remembered is the account by Flora Schreiber, a journalist and
not a psychiatrist, of a woman who possessed (note the word) sixteen separate
personalities, and her "psychiatric adventures" and psychoanalysis. Sybil
and her psychiatrist, Cornelia Wilbur were engaged in therapy for sixteen years
(perhaps one for each personality) after which time she was said to have been
able to integrate them and exercise some level of conscious control. Reiber
gives a thorough account of the history and background of the case, which was
quite sensational at the time, and while much of the outline may be generally
known there are many fresh insights and less familiar details. He presents new
material, and these add considerably to knowledge of the field. These are
strong sections and encourage the reader to return to original sources and
reconsider what is really known and what a faulty memory may say.

Reiber does not dwell over much on
some of the mythologies involving multiple personalities as others have done. He
does not really examine the metaphorical aspects of DID as a description of
experience. He does not look into other cultures in detail, and examine, as
psychiatric anthropologists may do, the symbolic expression of many
personalities within one body. He draws the connection of thought and social
constructs from nineteenth century hysteria to the controversies of repressed
memory, but does not always consider the value of the diagnosis to the status
of the therapist. It may well be that such a phenomenon as DID, which rarely
seems to respond to a quick intervention or medication, has benefits for the
special one who cares; who cares and understands like no one else. It has been
said that if you cannot be recognized for your own importance, you may have to
invent it yourself. Could DID be a case in point? Will DID survive into the
next DSM?

In some ways, after a well-paced
account of the social and intellectual history of DID, Reiber rather sits on
the fence. He suggests that although it is real enough, it is not common. The
explanatory model for DID still seems a little wooly and experiential rather
than something that would help a clinician understand and care for someone, or
predict or prognosticate. Perhaps no one can offer a reason why DID should
affect some people because there is no reason. Perhaps asking for a reason is
asking the wrong question. If it is a response to trauma, why is it not more
common? Does it serve a purpose? Is it a protective reaction gone bad?

On reflection, a reader is likely
to feel better informed and most likely stimulated by some of the questions
Reiber poses. It is less certain that the answers he gives will be as
satisfying, but that should not detract from the book nor deter a reader. It
asks good questions and keeps the reader asking them long after the book is
laid aside.

© 2006 Mark Welch

Mark
Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of
Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre
for Nursing & Mental Health

Categories: Psychology, Philosophical