Multiple Personalities - Only in America?

And this is the problem wit hlaundry lists of research, you don'y know what you are citing and who is citing whom, I chose this one
:http://www.trauma-pages.com/a/vanderk2.php
Dissociation & the Fragmentary Nature of Traumatic Memories: Overview & Exploratory Study

"Summary: 46 adults with in depth interviews. Of the 36 with childhood trauma, 42% suffered significant or total amnesia at some time. Corroborative evidence was available for 75%."

Actual quote I found:
Of the 35 subjects with childhood trauma, 15 (43%) had suffered significant, or total amnesia for their trauma at some time of their lives. Twenty seven of the 35 subjects with childhood trauma (77%) reported confirmation of their childhood trauma- from a mother, sibling, or other source who knew about the abuse, from court or hospital records, or from confessions or convictions of the perpetrator(s). We did not ask them to produce records to prove that this confirmation actually existed.


So these are the issues I have with the study and it is a reasonable exploratory study.

It is hardly an 'in depth interview', it is a most a 'cursory interview':
1. Sample bias: newpaper solicitation
2. There is not a differential scale for the significance of the amnesia, duration of the amnesia or anything other than that one statement. I think I read that they did not do a differential.
3. It was a two hour interview and they did try to establish some metrics which is good, they used standard tests which is good. However they did NO differential assesment, we know nothing about the co-morbidity of any other conditions at ALL. So the conclusions are missing a HUGE piece of information.
4. This is a very small explaoratory study with little internal validity checking.

So in this one biased (self selecting) and small sample they found a prevalence for amnesia which is unrated and unscaled, no differentials were preformed. No history of intervention appears in the data. It appears to have been a small exploratory study. And they appear to have been interested in the sensory modality of the memories.

No conclusions may be made about the level of amnesia in trauma survivors as a general population, such a finding is not sufficient to say anything about a general population of truama survivors.

There is ABSOLUTELY no discussion of 'repression'.
 
Ok, I read "attribution". But I still like this cartoon. http://www.haverford.edu/psych/ddavis/p109g/fslip.jpg
And I want to add that there is a large boner of contention that arises between the clinical psychologists and the experimental psychologists who do research about memory. The clinicians tend to buy into the Freudian repression smegma and the experimentalists, who actually know how to study memory, don't.
The psychiatrists are another kettle of pices. They have less training in the design of experiments than most MA psych students.
 
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Maia -- I think it would be helpful for me to say what, as a layman, I am seeing in this thread. You are saying, "It's in the DSM! And this test is shown to be valid," and the question being raised is, Are the perspectives that underlie the decisions of how to validate the test, and to distinguish this group of symptoms as a disease, valid?

That is, in the case of a chemical imbalance in the liver enzymes, you can clearly define what is wrong. There is a laundry list of common symptoms, but there are other conditions with the same symptoms, and not all cases present the same way. The defining aspect of diagnosis is to check the liver enzymes, which will be out of whack in this way for cause A, and differently for cause B. What is inherently challenging about the DSM is that it takes the position that the symptoms define the disease. If you develop a test to find people with a given constellation of symptoms, then it will find them; but that does not mean that what you are finding is a disease, per se. They could have differing causes of the same symptoms.

In treating a physical ailment, it is sometimes necessary to try a treatment for one possible cause, and if that doesn't work, try treating another--if there is no definitive test to separate those causes. You ascertain which condition is causing the symptoms by performing treatment that relieves the symptoms, and then conclude, Oh, it was this. What is the equivalent for DiD/MPD?

How do you tell a 'real' MPD (DiD) case from a 'misdiagnosed' case? I think you will have to acknowledge, well, there isn't really a way to tell, because your diagnostic criteria are symptoms, not causes. And the underlying mechanisms postulated for MPD--that there are 'traumatic memories' that are not recalled but still impact the individual, and that 'separate personalities' can be created--are not without substantial argument as to whether they in fact exist, or exist in sufficient degree to create the behaviors / symptoms described.

Since it is demonstrable that memories can be created or altered -- Loftus is hardly the only person working in that area, but the "Bugs Bunny" experiment comes to mind -- it would seem reasonable to have an abundance of caution before assuming that any 'recovered' memories are accurate. That there are certain therapists that make large numbers of diagnoses of this kind of disorder--and a large fraction of their patients are diagnosed with it--is in and of itself grounds for concern. It raises the question of experimenter bias.

Further, there is the question of, What value does this diagnosis serve? That is, how is checking off this code as opposed to another one on the billing sheet going to impact treatment? The presumption that someone must have a traumatic, repressed memory is going to generate probing (in other words, leading) questions that can generate false impressions in a desperately ill person seeking help. Until and unless it can be demonstrated that such a phenomenon exists and a mode of treatment exists for that illness that is non-harmful and effective, there may be more harm than good in putting the MPD label on anyone.

One of your large posts said, among other things, that the diagnostic interview had NO false positives, and virtually no chance of false negatives. That is a strong indication that the standard of comparison is extremely subjective. (Even physical tests for, say, antibodies to particular substances have larger margins of error than that!) The question of how to determine what does and does not comprise a particular mental illness is always challenging, because of the absense of objective criteria for most impacts. There is no biochemical signature, no reliable flag that will be one way for Diagnosis A, and the other for Diagnosis B.

Any time a diagnosis is based upon a practitioner's assessment of a questionnaire (that was created by someone who was trying to fold a constellation of symptoms into a presumed disease), there is a risk of over-diagnosis. Given that there is a demonstrable link between high-profile public presentations of MPD and a following wave of diagnoses, it is clear that some fraction of the presumed cases are iatrogenic. The question is how to determine what that fraction is.

Taking the perspective, "This is a valid diagnosis and it's just ridiculous to question it" is neither skeptical nor scientific. When certain physical ailments were presumed to be due to an imbalance of humours, and bleeding was prescribed, the symptoms were real; but the questioning of what the cause(s) of the symptoms might be, and whether or not the treatments actually worked, led to real medicine.

As a point of interest, do you believe that people are actually abducted by aliens and subjected to various tests, then returned to their beds or cars without anyone seeing it? Abduction-believing psychologists exhibit similar clustering of which practitioners make the diagnosis, and show similar spikes in diagnosis after large media focus events. If the DSM listed "UFO Abductee Trauma" as a diagnosis, would you defend it simply because it was in the DSM? Or because an 'abductee questionnaire' was shown to identify people that those practitioners agreed were abductees?

I am not saying that MPD is necessarily bogus; but I am asking you to consider what you would deem grounds to consider that it might be.

Yours, Miss_Kitt
 
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Now, as for the rest of it... is anyone but me ever going to come up with any APA citations for anything??? Here we go...

First of all, whenever people are actually asked questions such as "Millions of people! Wow! Any citations for that?" they tend to say things like "Citations? Uh..." Then, when they're asked "What are your actual sources for statements such as "All those memories which didn't exist until the psychoanalyst helped "recover" them, are most likely just false memories, planted during those session and repeated and explored until they got fixed and detailed. Yet people went to jail for those fantasies" they tend to say things like "Um, I don't know" or "I heard a story somewhere." When asked, "Do a couple of high-profile stories about nut cases actually prove that this is happening everywhere to everybody?" they tend to say, "Well, I don't know... " or finally "Weren't there all these studies which proved that fake memories about being abused could be planted in people's heads?" However, the truth is that there were not. The truth is that there was one original study, and that this is the one which almost everyone is thinking about. This is the one in which the author, Elizabeth Loftus, actually claimed that the study's results proved this exact conclusion, and I'm surprised nobody has brought it up yet.

Maia, if you want to ask for citations, just ask for citations. Otherwise the above is either a huge ad-hominem circumstantial, or... well, there's a name in DSM for when you take your own imagination that seriously, too. Because that's what you do there: answer to your own strawmen.

The truth is that there were _plenty_ of studies for how memory works, and none shows any evidence of the freudian bullcrap at all. It's not just one study, it's several studies that point out that memory just doesn't work that way.

Memories don't get locked in magical vaults, where you just need to find the secret combination to have them coming back in vivid detail, but genuinely fade away and get distorted.

Creating false memories is as simple as asking a leading question. If you want citations, try the Alfred Binet study as early as 1900 on children: yep, asking misleading questions actually distorted their memories. Stern, around the same time frame, produced the same result. People asked to remember an event staged in front of the class, had their memories distorted by just asking them leading questions. Or try Semon's theory of engraphy and ecphory, beginning of the 20'th century too, which although largely ignored at the time, was validated later.

Even Freud himself, after getting precisely that theory of repressed memories of sexual abuse in childhood started in 1896, turned away from it later and filed it under later confabulation and imagination. In 1910 he wrote about childhood memories that they are "only elicited at a later age when childhood is already past; in the process they are altered and falsified, and are put into the service of later trends, so that generally speaking they cannot be distinguisghed from fantasies". Even to him it was dawning that he isn't recovering any genuine memories, and maybe even that he's just seeing how suggestible people are.

I could quote later studies too, but the point is: it was known that early that memory isn't a photographic thing, but something imperfect, distortable and fading. There is no magic vault where memories get locked away. It's not how memory works.

And it goes all the way to studies like Akado and Stark in IIRC 2005, which not just found the same case of memories being distorted by later information, but actually used MRI to show it happening.

It's not just one study, but a freaking century of evidence mounting.

Also nowadays we know about cognitive dissonance, and that, for example, just being asked to write something down or expound some point of view contrary to your own views, actually changes your mental model in that direction.

We also know from polling studies done by companies that make a living with accurate polling, that even the phrasing affects how people will answer. "Yes" tends to get answered more than "no", all else being equal, so "should we stop war?" produces more peace-longing answers than "should we continue war?" Or that even the order of the options matters, people tend to pick those at the top more. ETA: but generally it boils down to the more general fact that people tend to answer what they think you want to hear. Even the slightest hint that one answer would be more acceptable than the other, creates a provable skew in that direction.

It's that trivial to get people to say what they think you want to hear, and enough repetition will actually change their memories in their brains. And that's been the scam of the 20'th century in a nutshell.

And, yes, that's where the "millions" comes from. Every single person who's had "memories recovered" in the last century, has basically had false memories planted in their head.
 
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I will slog through all the abstract but i notice something:
occurance of the word 'recover' :68
occurance of the word 'recall': 30
occurance of the word 'amnesia': 11
occurance of the word 'repress': 7
occurance of the word 'alter': 0


So here is the deal I do not doubt the disassociative label as a meaningful label, nor do I doubt that people with truama will avoid the memories , but such notions as alters, blocked memories, I do not agree with.
 
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You rang?
I am skeptical about the whole repressed memory concept

I'm _very_ skeptical about it. I'm still trying to read about a mechanism that allows the brain to "forget" a traumatic experience. I don't know about you, but I tend to remember the important and painful things MORE.
 
Not to mention those that do happen and are likely to be overlooked because of all this mess.

Aye. Good point.

Hell, I have a co-worker who invents memories as she goes along, filling the blanks with invented stuff without even realising it.

The sad truth is that we all do that at various times and to various extents. In various studies which asked people to describe a picture they've been asked to remember, the more time had passed, the more details everyone got wrong or filled in with stuff from other (only vaguely related) memories or just invented. Without even realizing it. Human memory just is that fallible.
 
Memory is that way to begin with, there are some theories that memory is not stired but partly stored and then reconstructed, then there are normal issues of confabulation.

Now there are many studies that show peopel who report childhood truama can have the events confirmed by another person. (I think 60%-78% is fairly common), so people do have memories of truama. And they are often somehwat accurate.

I do not dispute that in teh least.

It is mechanisms of repression and 'recovery' I have issues with. Many people will just begin to face the memories they have avoided, especially when presented with a memory trigger.

However hypnosis, regression and the like are bogus.
 
1. Well, even that kind of correlation isn't without its faults. E.g., if both me and grandma have memory of some early trauma that happened to me... is it really my memories, or just retrofitting into images what she told me?

I'm asking that as a genuine question. I have two memories from below 3 years old, both of something which I suppose to a small child can be impressive like heck, though nothing I could sue anyone for. E.g., getting scared silly of the first toy that moved on its own when I wanted to grab it: they had brought me a real cat this time.

The trouble is, I shouldn't have memories from that early. Both are correlated via grandma, who can't stop telling those stories to everyone who'd listen. For the longest time I would have taken it as that they're genuine memories, and grandma is witness that they're true. But now I'm asking in all earnesty: are they really my memories, or just something I heard her saying so often that it even became retrofitted into images?

Is it possible that _some_ of those correlated events are actually confabulation?

I remember from anthropology that, for example, in several cultures, a woman's power is (or used to be) more or less what she can get by manipulating her sons against her husband. I'll take that as an example setting. Is it possible that some of those sons, after hearing all those stories about how their father is bad and does bad stuff, actually start remembering it as their own memory? And blimey, look, it even correlates perfectly with mom's stories.

2. Well, other than that, as far as I can tell we're disagreeing very little actually.

I don't dispute that some memories of earlier trauma exist. But it seems to me like those memories of traumatic events, which then do get correlated with someone else that remembers them, are memories that never got lost in the first place. I don't think they're completely forgotten stuff, that only came back after a hypnosis session or after 100 hours at the therapist.

That's really the ones I have a problem with, and which I keep calling false memories: the memories that one had zero recollection of, until some modern day shaman waved his wand and said his magic words, and then *WHAM* there it is in all its colour and detail. One moment you're just a mildly stressed accountant, and your worst recollection from childhood is tripping and scraping a knee, and 50 therapy sessions later you remember in vivid detail being sodomized by dad and his dog. And it even turns out that repressing that memory was the source of all your stress and problems.

If only memory actually worked that way...
 
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Memory is that way to begin with, there are some theories that memory is not stired but partly stored and then reconstructed, then there are normal issues of confabulation.

Now there are many studies that show peopel who report childhood truama can have the events confirmed by another person. (I think 60%-78% is fairly common), so people do have memories of truama. And they are often somehwat accurate.

I do not dispute that in teh least.

It is mechanisms of repression and 'recovery' I have issues with. Many people will just begin to face the memories they have avoided, especially when presented with a memory trigger.

However hypnosis, regression and the like are bogus.

Yes, that's what I was talking about.
 
When I was studying for my psychology degree I took a course in abnormal psychology. The prof. once mentioned that true multiple personality disorder was so rare that a psychiatrist would be lucky to come across a single case in his or her career, and would write a paper about it.

Leon
 
Maia, if you want to ask for citations, just ask for citations.
Please. I would like to see some from, well, everyone. I'm sorry, but saying "millions of people" and having no citations is just not the best way to make a very reasonable argument. It doesn't look verifiable. So how about making specific citations now? I want to read those studies. I do want to be respectful because I think that's the only way to have a discussion here, but honestly, talking about "millions of people" without backing it up in any way in that post... I think you have to see how silly that really did sound. And if your grandma corroborated memories from when you were below the age of 3, well, I don't know any reason why an intelligent person would have been totally incapable of having any memory at all before that age. Does anyone else know?

I'm very familiar with Freud's unfortunate change of opinion about the nature of memory, and also with his vastly different earlier work with Breur (1893). And please, can we avoid things like the story about the psychiatrist in the class? Anecdotes prove anecdotes. That's it.

DD, when I get some time, I'll go back over that article you mentioned. I went over the Elizabeth Loftus article problems in GREAT detail and tried to hit all the high points as far as the methodological problems with it, and they are fatal. I just don't see the same problems with the van der Kolk article, but I will analyze it in depth when I get time.

Now, the entire point of the substantive criticism of the Loftus article-- the criticism which is not based on the extremely severe methodological problems with her work, and also upon the fact that she misrepresented her results to the media by saying that she had a higher success rate at convincing people of false memories than she did and that it much easier to convince them than it was-- is that even considering these differences, which are important in themselves, there is a massive difference between convincing people of memories that are either irrevelant or of modest importance, and of memories that are traumatic. It's all in the section where I dissected her article, which is the first part, and so is the reference to the 1995 study which was unable to implant a traumatic memory in subjects. The crucial difference between the Loftus study and other studies about memory, as I said in the post, is that Loftus was the only one I've ever heard or read of who actually and literally claimed that her study proved that it was easy to implant memories of child abuse in people. This is why there's a world of difference between "past memories are not perfect" and "well, anyone can be convinced to believe they were severely abused in the past." That's why seeing that other researchers are working in the field of memory study, and Loftus is working in something that she also calls that, is conflating two things together that aren't the same. Now, as far as why she does the work she does, it's clearly not necessary to know it in order to point out the severe flaws in her work. But in case anybody wondered why Loftus decided to do this study only after going to a lecture about how memories of abuse were all fake and suggested by therapists and media reports, everyone should at least know that Loftus is an apologist for the "False Memory Syndrome Foundation." She has an agenda.

Now, more about the dissociative disorders specifically... The Structured Clinical Interviews are the gold standard diagnostic tools used for all mental illnesses and disorders in the DSM. The SCID-D has passed the same reliability tests as all the other versions, and it's done a better job than most of them. So that's a big part of the problem right there-- if it doesn't work for the dissociative disorders, then do we throw out all the SCI's? Do we say that we can't diagnose anybody for anything-- depression, anxiety, bipolar disorder, schizophrenia, nothing? But it goes a little further than that.

The dissociative disorders as a whole are one of the very few classes that have shown their validity through taxometric research, not dimensional research. Depression is dimensional. You take the Beck Depression Inventory; it's a self-administered test. If you come out at a certain scale-- well, truthfully, you really are probably depressed, although I don't think people should be given antidepressants just on the basis of that, and of course they often are. (They should get the SCI for depression, which certainly doesn't always happen!) The Dissociative Experiences Scale, however, is a screening scale and can't possibly tell anybody if they have a dissociative disorder. You either have a dissociative disorder, or you don't. You can't be "just a little bit dissociative." You can have daydreaming, spacing out, getting lost in a book or movie, being a space cadet so that you're not listening to anyone, etc., but these are not dissociation, and this is another example of how I think that there's unfortunately so little public education about the DD's, because people do tend to think that this is true. But that's what taxometric research tends to show; it's a disorder that's either there, or it isn't. (There's a short version of the DES, called the DES-T (taxon), that has eight questions; essentially, if you don't have a dissociative disorder, it's very unlikely that you'll answer yes to even one of those-- but that's REALLY not a screening instrument!)

Now, the UFO question is a little silly, as I think we all know. There are certainly some nut cases who actually believe in this kind of thing, but in order to come within light-years of making it into the DSM, an "abductee questionaire" would have to prove every type of validity, to begin with (as the first of about a zillion tests, frankly.) Diagnostic instruments aren't randomly chosen. I will post more about this later with lots of references.
But that's why I included all the different ways in which the different screening instruments and diagnostic instruments for dissociative disorders (ALL dissociative disorders as a class, not just DiD) had indeed shown validity. I spent a lot of time putting that together earlier this year (it wasn't published, unfortunately, but hope springs eternal!), because I take this topic very seriously.

Anyway, more later about the validity of the DD's as a category.

In the meantime, here's some info about types of validity:

EXTERNAL VALIDITY
External validity is about generalization: To what extent can an effect in research, be generalized to populations, settings, treatment variables and measurement variables?
External validity is usually split into two distinct types, population validity and ecological validity, and they are both essential elements in judging the strength of an experimental design.

INTERNAL VALIDITY
Internal validity is a measure which ensures that a researcher’s experiment design closely follows the principle of cause and effect.

“Could there be an alternative cause, or causes, that explain my observations and results?”

TEST VALIDITY
Test validity is an indicator of how much meaning can be placed upon a set of test results.

Criterion Validity
Criterion Validity assesses whether a test reflects a certain set of abilities.


Concurrent validity measures the test against a benchmark test, and high correlation indicates that the test has strong criterion validity.


Predictive validity is a measure of how well a test predicts abilities. It involves testing a group of subjects for a certain construct, and then comparing them with results obtained at some point in the future.


Content Validity
Content validity is the estimate of how much a measure represents every single element of a construct.


Construct Validity
Construct validity defines how a well a test or experiment measures up to its claims. A test designed to measure depression must only measure that particular construct, not closely related ideals such as anxiety or stress.


Convergent validity tests that constructs that are expected to be related are, in fact, related.


Discriminant validity tests that constructs that should have no relationship do, in fact, not have any relationship. (also referred to as divergent validity)

FACE VALIDITY
Face validity is a measure of how representative a research project is ‘at face value,’ and whether it appears to be a good project.

ETA: link: that reference

More refs later...

Breuer, J. & Freud, S. Studies on Hysteria. (1955). (J. Strachey, Trans.) London: Hogarth Press. (Original work published 1893)
 
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I'm very familiar with Freud's unfortunate change of opinion about the nature of memory, and also with his vastly different earlier work with Breur (1893). And please, can we avoid things like the story about the psychiatrist in the class? Anecdotes prove anecdotes. That's it.

Heh. So an actual study and a published work is just an "anecdote" if it doesn't fit your pet woowoo? You can't be serious.
 
When I was studying for my psychology degree I took a course in abnormal psychology. The prof. once mentioned that true multiple personality disorder was so rare that a psychiatrist would be lucky to come across a single case in his or her career, and would write a paper about it.

Leon
No, that's an anecdote. That's what I meant. And I'm trying to be civil and respectful here.
 
As far as I remember, any of Freud's "case studies" were not much better than your aunty's anecdotes about night air being poisonous and wouldn't qualify as "research" at all today. Viz, little Hans, who feared horses because of his Oedipal complex leading to castration anxiety. Freud never interviewed Hans, he relied on Hans's father's testimony,or as we term it today, hearsay. From this, Fraud spun the story that Hans was afraid of horses because they had large schvantenstupers, just like dear old dad.
 

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