Multiple Personality Disorder/DID

[Art Vandelay]

It seems to me that it unethical for the physician to tell the police confidential information. Also, do you know what the woman said to the police? Did she claim that the man physically forced her to have sex? Was there other evidence of rape?

 

[shalomsteph]

Art--My information is all second hand. There was no "physical evidence" of a rape--it could have been consentual. There was sperm, but this was the next day. Mostly, she was concerned about getting Plan B.

Apparently, she told the police she was forcibly raped. They required a rape kit, and she then said that she would only do one through her regular doctor. So she told the dr that "one of her personalities consented,and one did not consent, and the one that did not consent was raped."

My friend, doing the rape kit, is also obligated to report all evidence to the police. So confidentiality is waived in a situation such as this.

 

[Art Vandelay]

What I don't get is if the personality that consented was in control, why would he have to force her? If the personality that consented wasn't in control, then presumably the guy was aware of it. Seems to me that either the woman is lying, or the guy is. I don't see why the issue of MPD is relevant.

As far as confidentiality is concerned, was the woman informed of this rule?

 

[shalomsteph]

What I don't get is if the personality that consented was in control, why would he have to force her? If the personality that consented wasn't in control, then presumably the guy was aware of it. Seems to me that either the woman is lying, or the guy is. I don't see why the issue of MPD is relevant.

As far as confidentiality is concerned, was the woman informed of this rule?

As for confidentiality, I don't know if she was told. Knowing my friend, she was.

The woman reported it as a rape to the police. I assume it was reported as a date rape type thing, since neither one says there was physical force involved. The guy says it was completely consentual, and it wasn't until AFTER they had sex that she "freaked out". SHE claimed that although one personality initially consented, a different personality later did not consent and this personality "felt violated", even though this personality did not "come on the scene" until later. BOTH agree that this happened after they had sex and he asked her to leave.

I agree that this sounds more like Borderline Personality Disorder, but her diagnosis is DID/MPD.

Anyway, I guess this is one reason why one night stands are a bad idea...

 

[Flange Desire]

...I hope you're not serious. You do know there are civilized nations on other continents, right?

This would be begging the question anyway.

Your point is a good one.

Some would believe that there is no (civilized) world outside the US;
and yet MPD, satanic ritual abuse, recovered memory syndrome, and ufo abductions are all clearly documented as recent US inventions.

Curious corundrum aint it?
(just need to beat my 'there is a world outside the US' drum occasionally)

 

[Art Vandelay]

I assume it was reported as a date rape type thing, since neither one says there was physical force involved.

If there was no force, then how was it a forcible rape? What does force have to do with whether it was date rape?

SHE claimed that although one personality initially consented, a different personality later did not consent and this personality "felt violated", even though this personality did not "come on the scene" until later.

What I'm not getting is what she told the cops. Did she tell the cops that one personality consented and another didn't?

 

[luchog]

...I hope you're not serious. You do know there are civilized nations on other continents, right?

This would be begging the question anyway.

No, the remark was meant mostly facetiously.

But...

Civilized != non/anti-religious. Religion and religious tradition takes a much greater role in non-Western nations than is often recognized. Moreso than in most first-world nations. Even in officially atheist China, religion is an extremely powerful force. And multiple personality is hardly a "Western" disorder. There are plenty of examples throughout, for example, Japanese history; although they're usually described in religious terms. And many examples of the more extreme type of "mediums" and "spiritualists" are clear cases of some sort of mental illness, including DID.

Of course, there are a non-trivial number of people in the US and Europe who are of such an extremist religious bent that they see many psychological, and even psychiatric, disorders as spiritual/demonic in nature, and treat them as such.

Of course, dismissal of disorders as simply a "weakness of the mind" or "hysteria" or merely a put-on is nothing new. Even disorders such as schizophrenia, now known to have a physical eitiology, were very recently seen as purely mental, being created by "schizophrenogenic" parents. Even psychiatric textbooks propounded the view that was caused by mothers who were "overanxious, obsessive, domineering and had a warped sex life".

 

[luchog]

Your point is a good one.

Some would believe that there is no (civilized) world outside the US;
and yet MPD, satanic ritual abuse, recovered memory syndrome, and ufo abductions are all clearly documented as recent US inventions.

No, not really they're not. The phenomena are persistent throughout history and across cultures; they've simply been given different names in different periods and locations. Where we now talk about "Alien Abduction", we used to talk about abduction or enchantment by "fairies", "djinn", etc. Where we now talk about DID and other mental illnesses, we used to talk about evil magicians (witches, shamans, etc.) casting spells to ensorcell the mind; and demon-, fox-spirit-, djinn- etc.-possession or influence. Where we see "recovered memory", others have seen "past lives",

It's only in the very recent history (less than a hundred years) that we've begun to get a basic understanding of the mechanics of the brain and consciousness; and the nature of eitiology of various forms of mental illness. Barely a hundred years ago, schizophrenia was considered a purely psychological disorder, rather than physical one.

 

[ReFLeX]

No, the remark was meant mostly facetiously.

But...

Civilized != non/anti-religious. Religion and religious tradition takes a much greater role in non-Western nations than is often recognized. Moreso than in most first-world nations. Even in officially atheist China, religion is an extremely powerful force. And multiple personality is hardly a "Western" disorder. There are plenty of examples throughout, for example, Japanese history; although they're usually described in religious terms. And many examples of the more extreme type of "mediums" and "spiritualists" are clear cases of some sort of mental illness, including DID.

First of all, this still assumes that DID is the underlying cause of your observations. Also, we need not talk about history when we have diagnoses of DID in the present. The Merck Manual says:

Dissociative identity disorder appears to be a rather common mental disorder. It can be found in 3 to 4% of people hospitalized for other mental health disorders and in a sizable minority of people in drug abuse treatment facilities.

Source
So why don't we see this in Japanese or Australian psychiatric hospitals?

Thirdly, then, what ARE your historical examples, so that we can determine why they couldn't simply be attributed to schizophrenia or something likewise.

 

[ReFLeX]

Alas, psychiatry is nothing but a social construction. Actual illnesses are shunted over to neurology.

The line blurs every day, as psychiatric disorders continually turn out to have subtle physiological sources.

 

[Melendwyr]

Even disorders such as schizophrenia, now known to have a physical eitiology,

At the risk of hijacking the thread:

There is no such known physical etiology for schizophrenia. There are no physical tests for schizophrenia. We cannot even confirm that the diagnostic category of "schizophrenic" includes only one condition instead of many.

There are many neurological conditions with known physical etiologies. Parkinson's Disease, for one. Please present whatever you believe is known about the physicla etiology of Schizophrenia.

 

[Jeff Corey]

I have to agree. The correlation with enlarged venticals (also seen in other disorders) and smaller thalamuses in no way allows diagnosis of schizoprenia. When I was an aide in the pre Thorazine days, I was struck by the wide range of behaviors these people exhibited.

 

[epepke]

I agree that this sounds more like Borderline Personality Disorder, but her diagnosis is DID/MPD.

At this point I wonder if I was clear.

My belief is that when people are diagnosed with DID/MPD or some other disorders, including some of the facticious disorders and Munchausen's Syndrome by Proxy, that the underlying disorder is really BPD.

Of course, that's my belief, but it is consistent with what I've been able to glean from discussions with psychiatrists.

I want to be very clear about this. I think that the DSM is still pretty primitive, and it will eventually turn out that there are far fewer disorders than it describes. For instance, I am guessing that bipolar mood disorder will in time come to be seen to be linked to seizure disorders.

Diagnosis of mental disorders is still rather primitive, with nothing resembling an etiology in most cases.

 

[Art Vandelay]

The line blurs every day, as psychiatric disorders continually turn out to have subtle physiological sources.

Of course, all disorders ultimately have some physiological source.

 

[luchog]

First of all, this still assumes that DID is the underlying cause of your observations. Also, we need not talk about history when we have diagnoses of DID in the present. The Merck Manual says: Source

I'm not sure i necessarily agree with Merck that the number is that high. My guess would be closer to half of that. I do know several people, however, that show classic characteristics of severe DID; only one of whom has ever seen a therapist. I've also noticed that DID and PTSD diagnoses seem to be more or less concurrent.

The disorder appears to have been first described as a discrete class of phenomena during and after WWI, and was part of the DSM-1, classed as a "hysterical personality disorder". The earliest clear description was in Germany in 1791.

So why don't we see this in Japanese or Australian psychiatric hospitals?

We don't?

A brief Google search turned up:
http://www.sidran.org/refs/ref4.html
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-1819.1998.00394.x
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10084343&dopt=Abstract
http://www.siari.co.uk/Dissociation...ociative-identity-disorder-in-adults-2005.htm
http://www.empty-memories.nl/abstra...www.fortea.us/english/psiquiatria/history.htm

Many historical descriptions of "demon" or "spirit" possession (particularly many of the Greek examples) bear strong resemblance to currently DID diagnoses. And it's highly likely that some "true" mediums, ie. those who were not intentionally deceptive charlatans, may have been DID sufferers as well.

It's generally accepted by DID researchers that many cases have been incorrectly diagnosed as schizophrenia; often "atypical" schizophrenia, in part because of the lack of response to normal treatments. The key difference now know is the lack of "affect" abnormalities characteristic of schizophrenia.

There is no such known physical etiology for schizophrenia. There are no physical tests for schizophrenia. We cannot even confirm that the diagnostic category of "schizophrenic" includes only one condition instead of many.

Sorry, that was poor wording. While the actual mechanism itself is still incompletely understood; the evidence for a physical etiology and genetic predisposition is clear. Particularly since schizophrenic and schizotypal disorders follow a distinct onset and development pattern, and significant changes in cerebral functioning have been measured. Unfortunately, I don't have an online source, and all of my print references are in storage. (I really need to get a bigger apartment so I can have all this crap closer to hand.)

But PET scans appear to show distinct functional abnormalities in the limbic system and frontal lobes. Should the actual mechanism be determined, that would provide a clear way to separate schizoid disorders from dissociative ones.

http://www.studentbmj.com/issues/00/12/news/443a.php

 

[Soapy Sam]

Custom and legal structure assumes 1 body= 1 person.
Split brain research (Dement et al) implies otherwise to a limited extent.
There clearly are situations where one part of the brain "knows" something another part has no access to.
So far as I know , such situations are all artificially contrived in the lab.
For legal purposes we must suppose someone with access to his senses is aware of what he is doing .
Is there any objective way to differentiate between someone who claims he is not the personality who did something from someone who has merely changed his mind about what he wanted? Failing such a test, it's hard to see how we could take the former claim seriously.

ETA- Jeff Corey just reminded me it was Roger Sperry, not William Dement, who pioneered split brain surgery.

 

[Melendwyr]

Sorry, that was poor wording. While the actual mechanism itself is still incompletely understood; the evidence for a physical etiology and genetic predisposition is clear.

Genetic predisposition, yes, but we have no idea what's responsible. Evidence for a physical etiology, no.

Particularly since schizophrenic and schizotypal disorders follow a distinct onset and development pattern, and significant changes in cerebral functioning have been measured.

"Significant changes in cerebral functioning" encompasses almost anything. If the changes are consistent, and detectable, that would constitute a way to physically test for schizophrenia. There is no physical test for schizophrenia - ergo, your statement is grossly misleading at best.

But PET scans appear to show distinct functional abnormalities in the limbic system and frontal lobes.

Which vary wildly from patient to patient, and from moment to moment. A functional abnormality says nothing about the ultimate cause of the problem - a phobic's rapidly beating heart is a functional abnormality, but there's nothing wrong with the heart.

Should the actual mechanism be determined, that would provide a clear way to separate schizoid disorders from dissociative ones.

You're assuming that a mechanism would indicate such a distinction.

More to the point, you're simply accepting as axiomatic that these conditions have distinct physical etiologies, then accepting that certain broad and extremely vague assertions define those etiologies. That's poor reasoning and poor science.

 

[Melendwyr]

Of course, all disorders ultimately have some physiological source.

Quibble with words. All behavior ultimately has some physiological sources - that does not mean that malfunctioning is due to malfunctioning physiology.

 

[Art Vandelay]

It seems to me that you'r the one quibbling. How do you distinguish between a "real" disorder, and someone just making bad choices? Some cases are more clear cut than others, but it seems to me that eventually you're going to get into arbitrary categorization.

 

[luchog]

Custom and legal structure assumes 1 body= 1 person.
[...]
Is there any objective way to differentiate between someone who claims he is not the personality who did something from someone who has merely changed his mind about what he wanted? Failing such a test, it's hard to see how we could take the former claim seriously.

A better question is, why is it necessary to differentiate?

There is nothing about it that would reduce culpability for an act such as, say, a murder, rape, or armed robbery. Even if a "different personality" committed the violent act, it's still that person that committed the act, and still requires a response. At the very least, they should be treated like any other violent, mentally ill individual. From what I've read, Billy Milligan got off rather easier than he should have, IMO.

I don't buy the woo-woo claim that the different identities are individual, discrete persons in their own right; the evidence simply doesn't support it, nor does my own personal experience. They are all aspects of the same person; merely exaggerated.

Ultimately, that's the nature of most psychological disorders: normal, common behaviours exaggerated to pathological levels.