A note from the Editor: After publication of the following article by Christine Forner in ISSTD News, Feb 2019, the authors of the article she critiques have contacted ISSTD. They have reflected upon the Christine’s article and in particular the question Christine Forner poses: ‘What if they (those who deny the existence of DID) are wrong?’ After considering this question, the authors made the decision to take their own article off line. They have also asked that we remove the mention of their names in our article. As a gesture of goodwill to the authors we have decided to remove their names. We thank them for taking their article offline. The rest of Christine’s article remains intact. We apologise that without the link to the original article some of the meaning may be lost. Nevertheless we feel we need to keep Christine’s article here and believe it is an important step for our field that Christine’s article has had a positive result.
Dear Members, As we prepare for our biggest conference ever, a conference where some of the leading minds of our field present, discuss and further develop their work, I am reminded that our field, despite all this, can still be grossly misunderstood. Often this attack presents as far less scholarly than the standards our field would expect. We are in a huge upward swing in terms of membership numbers, interest in our teachings, volunteer effort and commitments, and our brand new, and very shiny web site. We are co-authors for the APA Division 56 treatment guidelines and a version of our treatment guidelines are part of the Accident Compensation Corporation (an organization that provides treatment for those with complex trauma) in New Zealand. Many of our members were highly involved in the Australian Royal Commission into Institutional Responses to Child Sexual Abuse recommendations for education and treatment. We have credibility, sound research and validity. When I read articles that criticize and devalue all of the hard work that our members have contributed over the last 35 years I find myself frustrated and yet extremely proud of the ISSTD. However, after a great deal of consideration I felt moved to address this issue after reading a recent article. I have just read this article:
“Dissociative Identity: Disorder or Literalized Metaphor? Re-examining the former Multiple Personality Disorder”. Click Here to Read
This is the type of misleading information that makes DID seem controversial, when it is not. Beliefs are not science. The pseudo controversy is not coming from those who are educated professionals in this field of mental health. People who have spent time researching and treating complex trauma and dissociation, a natural human response to overwhelming trauma and neglect, are responsible and ethical practitioners and researchers. Although the authors of the article present the disorder as ‘controversial’ only one position in the alleged ‘controversy’ is clearly explained. It is telling that of the three quotes they use to start the article, not one is from a leading researcher or clinician who believes DID exists. This creates an impression that such qualified researchers and clinicians do not exist.
This article is not about exploring an alleged controversy. It is a position statement from authors who firmly endorse one side of the ‘controversy’. There are some facts that this article does not address. Most of the world’s leading trauma experts understand that when an infant or child is abused, the whole identity system is affected, along with everything else. In as simple a definition as one can make, this is the fundamental injury of DID/DD. The system of the infant or child is so hurt that a sense of self or identity cannot grow as it should—or, for some people who, under normal, safe conditions might create imaginary friends, because of the trauma, use that skill to develop other ways of being in order to manage overwhelming trauma. This article does not take into account or address the hard scientific evidence found in brain scans, nor the body of research that has been around for over 150 years, nor the many critical academic studies that have been conducted in the last 40 years, which demonstrate the validity and realities of this treatable disorder (Brand, et al., 2016; Dorahy, et al., 2014).
In quite an astonishing misrepresentation of history the authors write: “The birth of dissociative identity disorder as a psychiatric diagnosis aligns closely with the fraudulent Satanic ritual abuse panic of the 1980s.” This completely misrepresents the long history of this disorder in psychiatric practice for over 100 years, across the globe. (North, 2015; Ross, 2013; Van der Hart & Dorahy, 2009). The authors seem to assume that DID clients really have BPD, but they do not account for the very distinct fact that a dissociative mind is very different than a BPD mind, which is different than a mind that has PTSD. There are studies that show distinct brain patterns in individuals with DID that cannot be faked, duplicated, or replicated by others (Reinders, et al., 2018). The large body of research into DID has built a case that passed the scientific rigors required to get into the DSM. It is not a simple task to get into the DSM, with a team of researchers often taking many years to demonstrate the validity of a disorder.
It is worth noting that DID (with all its previous names) has been described in DSM since its inception, as well as in ICD almost as consistently. Many other ‘disorders’ have not stood this rigorous test of time. When it comes to their description of therapists who work with DID, I’ve had to ask myself where they got their information from that lead them to make their assumptions. I cannot help but wonder if they might be getting information or bias from the Hollywood version of DID. It is as if they are taking what they know from Hollywood, and assuming that this is what professionals in this field are doing too. Their portrayal of clients may be similarly mis-informed. The incorrect, Frankenstein-ed, images of DID and DD on TV and in movies are wrong, and this myth does actually cause real harm. The largest question I would pose to the authors is: “What if you are wrong”?
The field of Trauma and Dissociation has examined itself, over and over again, because of beliefs and articles like this, to ensure that what we are doing is clinically and ethically sound. I can only hope that those doubting this disorder are similarly cognisant of the risk of them being wrong, of the damage this would cause people with DID. I am a therapist who has specialized in this disorder for over 20 years. I am often one of only a small few who has had the patience, tolerance, ability and training to treat people with DID in my city. What would be the consequence of shaming and discrediting me to a client with valid DID? People with DID are often profoundly uncared for, lied to and victimised by criminals who have a vested interest in people not believing in DID.
Most clients that I have seen, who have a history of being victims of organized crime, child pornography or other trafficking situations, all describe that the criminals/perpetrators knew about DID and used it to their advantage. The criminals, who I would venture are not searching through PubMed or Google Scholar to gather research, know that DID is a valid thing. The exception is that they use it to hurt others and protect themselves. Most of us have to follow a code of conduct and ethics and, within most codes of conduct/ethics, we are specifically instructed to keep personal belief systems out of and separate from our duty to care and our responsibility to cause no (more) harm.
Therefore, how ethical is it to ignore the disorder, or worse, shame the people with this disorder and insult those who are experienced and educated in the field of trauma? No unfounded belief should take precedence over scientifically sound information. My gut reaction is to be upset, but after self refection I am, in part, okay with these gross inaccuracies, as they give us the opportunity to examine what it is that we do. These articles hold the field up to a higher standard of validity and care. This higher standard has lead us to know, with a great deal of certainty, that what we “know” is solid. Be proud, share this information and as the years pass, the voice of those with DID/OSDD/USDD will be mainstream. For me this will be a great time as the voice of Survivors will be understood and they can be cared for in the manor that they should be.
Brand, B.L., Sar, V. Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A. & Middleton, W. (2016). Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harvard Review of Psychiatry, 24(4): 257–270. doi: 10.1097/HRP.0000000000000100.
Dorahy, M.J., Brand, B.L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., Lewis-Fernández, R. & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402–417, DOI: 10.1177/0004867414527523
North, C.S. (2015). The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations. Behavioural Sciences, 5, 496-517; doi:10.3390/bs5040496
Reinders, A., Marquand, A., Schlumph, Y., Chalavi, S., Vissia, E., Nijenhusi, E., Dazzan, P., Jancke, L., & Veltman, D., (2018) Aiding the diagnosis of dissociative identity disorder: pattern recognition study of brain biomarkers. The British Journal of Psychiatry, 1-9. doi: 10.1192/bjp.2018.255 Ross, C.A. (2013) Commentary: The Rise and Persistence of Dissociative Identity Disorder, Journal of Trauma & Dissociation, 14:5, 584-588, DOI:10.1080/15299732.2013.785464
Van der Hart, O, & Dorahy, M.J. (2009). History of the Concept of Dissociation (pp 3 – 26). In Dell, P.F. & O’Neil, J.A. Eds (2009) Dissociation and the Dissociative Disorders: DSM V and Beyond, New York, Routledge.