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

Abstract

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

The Scientific Status of Childhood Dissociative Identity Disorder: A Review of Published Research

“…Advocates of a posttraumatic explanation of DID claim that it is the sequela of severe childhood abuse [5], but this etiological explanation has been the subject of intense criticism [6,7,8]. Skeptics find numerous reasons to doubt the validity of DID, but an often-repeated problem with the diagnosis is that childhood cases are rare [6,7]. Despite strong claims about childhood DID on both sides of the issue, no systematic review of childhood DID cases exists in the literature.…”

“…An alternative etiological approach, the sociocognitive model (SCM), is built around skepticism toward the validity of DID [7,8]. According to the SCM, DID is explained by individuals enacting a social role.…”

“…A resolution between the etiological models has not emerged in the literature – in fact both sides appear to have declared victory [5,7] – but research on childhood DID could provide answers to research questions stemming from the etiological debate. For example, Lilienfeld et al [6] stated that cases of childhood DID occurring before treatment and before the possibility of learning the role of multiple personality would critically harm the validity of the SCM.…”

Mental Disorder and the Indirect Construction of Social Facts

“…It has been pointed out that social environment or cultural formation may have an impact on access conditions to health care systems (U.S. Department of Health and Human Services, 2001) and on how patients express their experiences (American Psychiatric Association 2013, Section: Cultural Evaluation); recent data suggest that there is cultural variation among the ways in which people experience their conditions, and that the cultural background has an impact on how clinicians weigh the relevance of symptoms in the diagnostic process. Moreover, for at least some disorders, it has been suggested that cultural formation may even have an impact on the development of the disorder, not in the sense that cultural formation may cause severe trauma-or stressor-related disorders (as it might very well do), but in the sense that it "offers" certain ways of having a mental disorder (this is, in a nutshell, part of Hacking's point (1995), a cognate of which has also been discussed by Piper and Merskey 2004). 1 In yet another spirit, some psychiatrists and philosophers have argued that the evaluation of a condition as a disorder is a normative affair, and that the norms in question are often social norms.…”

Reply

“…The authors do not seem to question my findings that most cases of childhood DID are diagnosed using clinical judgment and that most cases of childhood DID emerge from a small number of researchers and clinicians. Skepticism about DID is largely founded on (a) the apparent low prevalence of childhood cases, (b) the potential for iatrogenesis, and (c) the questionable validity of diagnosis [3,4], and I appear to have accurately concluded in the review that childhood DID research does little to ameliorate these concerns. …”