The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder. Part I. the Excesses of an Improbable Concept

Article excerpt

Objective: To examine the concept of dissociative identity disorder (DID).

Method: We reviewed the literature.

Results: The literature shows that 1) there is no proof for the claim that DID results from childhood trauma; 2) the condition cannot be reliably diagnosed; 3) contrary to theory, DID cases in children are almost never reported; and 4) consistent evidence of blatant iatrogenesis appears in the practices of some of the disorder's proponents.

Conclusions: DID is best understood as a culture-bound and often iatrogenic condition.

(Can J Psychiatry 2004;49:592-600)

Information on author affiliations appears at the end of the article.

Highlights

* The literature on dissociative identity disorder (DID) contains logical inconsistencies and internal contradictions. It conflicts with known facts and settled scientific principles.

* DID cannot be reliably diagnosed.

* The diagnosis of DID often leads to clinical deterioration in patients.

Key Words: iatrogenesis, childhood trauma, multiple personality disorder, dissociative identity disorder

When ideas go unexamined and unchallenged for a long time . . . they become mythological, and they become very, very, powerful.

EL Doctorow

With the recent appearance of several critical articles and books, the concepts of dissociative amnesia and dissociative identity disorder (DID) have suffered some significant wounds (1-5). Between 1993 and 1998, the principal dissociative disorders organization lost nearly one-half of its members (1). In 1998, Dissociation, the journal of the dissociative disorders field, ceased publication. A paper published in 2000 examined the weaknesses in the dissociative amnesia construct (6). Various dissociative disorder units in Canada and the US (for example, in Manitoba, Illinois, Pennsylvania, and Texas) have been closed down. US appellate courts have repeatedly refused to accept dissociative amnesia as a valid entity (6), and several ardent defenders of dissociative disorders faced criminal sanctions, malpractice lawsuits, and other serious legal difficulties.

Nevertheless, despite the significant harm these concepts have wrought in North America, some Canadian and US practitioners continue to support, and practise according to, dissociative disorder concepts (7-9). Further, these North American countries export the concepts. In India, for example, the cinema has influenced the production of dissociative signs (10), and 4 recent papers demonstrate a recurring interest in spreading awareness of DID to other countries (11-14).

We examine the following deficiencies of the DID literature (Note 1): its logical inconsistencies, its internal contradictions, and its conflict with known facts and settled scientific principles. We hope herein to respond to Ross's assertion that critics of DID "never review the literature adequately; argue exclusively at an anecdotal, ideological level; make massive overgeneralizations without discussing relevant papers published in leading journals; and [never make] a detailed analysis of methodological problems in dissociative research" (15, p 228). To keep this article to a manageable length, we have chosen to discuss just 6 of the many areas in the DID literature that reveal especially striking deficiencies.

Weaknesses in the Claim of Trauma

The posttraumatic model of DID holds that DID is a naturally occurring defensive response to repeated and overwhelming childhood trauma, especially sexual and physical abuse (2,16,17). According to this model, severely traumatized children dissociate (that is, mentally compartmentalize) their painful experiences and repress (that is, become amnesic for) these experiences. Dissociation and repression supposedly keep memories of the trauma out of their awareness, because allowing them into consciousness would cause intolerable psychic distress (18-20). Over time, as more and more painful experiences occur and become linked by a common affective state, these compartmentalized and split-off aspects of the child's mental life allegedly form "alters" (that is, alternate personalities or personality states) (2,21,22). …