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Post-Traumatic Stress Disorder
Mental Disorders

by A.T.W.
Loving Healing Press, 2004
Review by Tony O'Brien RN, MPhil on Dec 22nd 2005

Got Parts?

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 20th 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