Are the Primary Causes of Multiple Personality Disorder Psychiatrists and Psychotherapists?

Multiple Personality Disorder (MPD), or, as it is referred to in most recent version of the manual DSM-IV, Dissociative Identity Disorder, is a genuine psychiatric disorder. However, the numbers of cases of MPD are far higher in North America than in any other part of the world. Many suspect that this surplus of MPD cases is the product of American culture and over-indulgent psychiatrists and psychotherapists.

There have long been reports of individuals who seemed to have "someone else" inside their body. Possession was the most common explanation for such behavior. Prayer, exorcism, and occasional burning at the stake were the methods used to resolve it. The classical literature of psychiatry has also contained reports of disturbed individuals who seemed to change from one personality into another without recollection of having done so. It has been conceded that certain individuals, particularly ones severely traumatized as children, can split deep inside themselves and subconsciously create alternate personalities within which to find refuge. However, this psychological phenomenon was always considered extremely rare. It was only after "The Three Faces of Eve" was published in 1957, and "Sybil" in 1973, that the Multiple Personality ball really started rolling. When MPD was accepted as a genuine psychiatric illness in the Diagnostic & Statistical Manual of Mental Disorders version III in 1980, all hell broke loose.

In a 2004 review for the Canadian Journal of Psychiatry, the American psychiatrist, Dr. August Piper, remarked that more MPD cases were discussed in the medical literature in the five years after inclusion in the DSM-III than in the preceding two centuries. Between 1980 and 1986, more than 6000 patients in the United States were diagnosed with the disorder. Champions of the disorder, such as psychiatrist Colin A. Ross, began to claim that MPD was rampant. He surmised that at least half of the exotic dancers in Winnipeg, Manitoba suffered MPD. He further asserted that five percent of college students and one percent of all North Americans suffered MPD and needed intensive psychotherapy for it. As a point of reference, the lifetime prevalence of Bipolar Affective Disorder in the United States is only about four percent.

Most psychiatrists believe that the diagnosis of MPD has gotten entirely out of hand, and it isn't merely due to the unexpectedly large number of patients being diagnosed with the illness. Equally puzzling has been how the numbers of personalities have multiplied within the minds of the victims. Whereas Eve had three personalities, and Sybil 16, patients with MPD began to report seemingly endless lists of personalities lurking inside. Personalities began to propagate like locusts. The DSM defines MPD as "the presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self." While admitting that the number of identities might range from two to more than 100, the manual noted that half of all cases involve individuals with 10 or fewer alternate identities. Yet, reports of patients with hundreds of separate alter personalities became routine. For example, Dr. Richard P. Kluft, a psychiatrist specializing in the treatment of MPD at the University of Pennsylvania, reported in a 1988 paper that one of his patients had over 4000 "alters".

The types of alters being reported have further stretched common sense. In 1989, Dr. Kate Hendrickson and her colleagues from the University of New Mexico described five patients in whom one or more alter personalities were animals. In one patient's case, "Any reference to sex, being bad, or feeling shamed made her feel as if she "turned into" a dog. When these issues were discussed in therapy, the patient began acting like a dog and spoke in German." One might suspect the woman fancied herself a German Sheppard, though the specific breed of dog was not mentioned in the text. Other therapists have reported alters identified as lobsters, chickens, gorillas, unicorns, rabbits, robots, Mr. Spock, aliens, and God.

It is not pleasant reading the stories of such individuals. If the histories are accurate, then some experienced horrifying abuse at the hands of their parents. Others suffer delusions and thought disorders bizarre enough to warrant diagnoses of schizophrenia rather than MPD. Still, the question remains as to what degree leading questions and indulgences of vivid imaginations have prompted the alternate "personalities" to come into being.

Some therapists make a point of calling out alters to identify themselves in each therapy session, which would tend to encourage invention of ever more hidden personalities. The sufferers of Multiple Personalities also appear to feed off each other's imaginations. Websites and Internet discussion groups for "multiples" abound, and sufferers take pride in how many alter personalities populate their minds. Pseudoscientific jargon flows freely in sites aiming to provide a technical basis for the illness and snare "multiples" for cutting edge psychotherapy. One site explained that, "alter personalities ... may form around "strange attractors" in the psychobiological field of an individual attempting to escape or heal traumatic stress in a self-organizing way. It is possible that through dissociation, the person is attempting to heal in a self-organizing way, but the transformative process gets "stuck" at the classical stage of fragmentation, which then recreates itself through the dynamics of "infinite nesting" and "self-iteration." This is pure baloney.

In medicine, it is almost always the most severe cases that first bring attention to and define forms of illness. It is only later that milder, less obvious forms of the illness are found to exist. This phenomenon gives rise to the old maxim that, "Diseases become more benign with time". However, in the case of MPD, the opposite has been true. It was relatively mild cases that first defined the illness, with more complicated, dramatic, and bizarre examples of the illness being reported with each passing day. It is reasonable to assume that more elaborate forms of MPD have evolved from mutual encouragement and nothing less than competition among self identified "sufferers" of the illness. This is furthered through the complicity of well-meaning but overly indulgent mental health professionals.

Psychiatry is a unique branch of medicine. A person can believe that they suffer a severe heart condition, yet be entirely mistaken. On the other hand, if a person firmly believes that they suffer a severe psychiatric condition, they are invariably correct. They may not be suffering the condition they think they are suffering, but their suffering is nonetheless real and deserves treatment. In many of the individuals who believe themselves to be suffering MPD, this error in self-understanding was introduced by the professionals who should have been there to clarify rather than obscure the problem. Both philosophically and psycho-therapeutically, it is more reasonable and parsimonious to view a patient with "Multiple Personalities", as having a single, very dysfunctional personality. To focus on or, God forbid, seek out "alters" is to be distracted by the manifestations of the illness rather than its true nature. To do so does disservice both to the patient and to the field of psychiatry in general.

Multiple Personality Disorder and other culture bound psychiatric conditions are discussed in Dr. Mendelson's new book, "The Great Singapore Penis Panic and the Future of American Mass Hysteria".