Psychological Background | jcarlsmith | August 30, 2012

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Psychological Background

by jcarlsmith Show/Hide
This playlist provides materials that lend insight into the psychological dimensions of Dissociative Identity Disorder. It includes diagnostic criteria, first-person descriptions of the disorder, a section of a documentary about DID, and a summary of the debate surrounding multiplicity during the past decades. Of course, given the vastness of the literature on DID, the psychological picture offered by this playlist is extremely limited. The goal is not to plumb the depths of DID's history, or to resolve debates about its nature and diagnosis. Rather, it is to offer a glimpse of the complexity of this multifaceted disorder, and to help make concrete the legal and philosophical puzzles it poses — puzzles that will be explored in more depth later in the module. EDIT PLAYLIST INFORMATION DELETE PLAYLIST

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  1. 1 Show/Hide More Official Diagnostic Criteria for Dissociative Identity Disorder

    These are the official diagnostic criteria for Dissociative Identity Disorder, as outlined in the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

    (last accessed 9/30/12)

    Notes:
    Take a minute to fill out the diagnostic worksheet provided by the <span class="caps">APA</span> (under the tab labeled &#8220;severity&#8221;). How frequently do you manifest symptoms associated with <span class="caps">DID</span>? Keep your answers in mind as you are introduced to people with diagnosed cases of <span class="caps">DID</span> later in the module. Are we all &#8220;multiple&#8221; to some extent? Or are there genuinely sharp distinctions between standard fluctuations in personality on the one hand, and <span class="caps">DID</span> on the other?
  2. 2 Show/Hide More First-person Descriptions of DID
    Original Creator: jcarlsmith
    Notes:
    This mini-playlist provides written, first-person descriptions of <span class="caps">DID</span>. The goal is to offer a sampling of the diverse ways in which <span class="caps">DID</span> manifests, and to help the reader begin thinking about the legal relevance of how exactly we conceive of the experience (or experiences) of <span class="caps">DID</span>.
    1. 2.1 Show/Hide More Billy Milligan
      Notes:
      Milligan's description emphasizes the separation between the different identities involved in <span class="caps">DID</span>. The host identity simply disappears, an alter takes over for a while, and then the host re-appears somewhere else having &#8220;lost that time.&#8221; As we'll see, however, this is by no means a universal experience of the relationship between the host personality and the alters. In other cases, different personalities can be co-conscious, they can communicate, and they can coordinate their responses to situations. As you move through the module, keep in mind the manner in which our conception of the relationship between the alters affects our conception of their criminal responsibility.
    2. 2.2 Show/Hide More Anonymous
      Notes:
      Note the difference between this description and the one Milligan gives. Milligan claims total separation between the identities &#8212; an utter absence of consciousness, and then a re-appearance at a different time. The anonymous &#8220;survivor,&#8221; however, suggests that at times he or she is &#8220;watching&#8221; her body, but unable to control it. That is, she remains conscious, but at some kind of distance from her standard capacity for agency.
    3. 2.3 Show/Hide More John Woods
      This is an article written by Judith Armstrong, a psychologist assigned as an expert witness in the trial of a man — John Woods — whom she had diagnosed with DID. Mr. Woods had killed his girlfriend, Sally, during an argument about her faithfulness. Read Section IV: The Interview (pp. 212-216). In it, Dr. Armstrong conducts separate interviews with the three alters involved in the crime.
      Notes:
      This is the lengthiest of the descriptions given thus far, and it reveals the complexity of the dynamics that develop between the alters. Note, for example, that Ron &#8220;overhears&#8221; what John is saying to Sally (p. 213); that Donnie knows who Dr. Armstrong is because &#8220;that information got<br /> passed around&#8221; (p. 214); that Donnie wants to &#8220;ask&#8221; Ron what is going on, but Ron &#8220;won't talk to him&#8221; (p. 214); that Donnie tries to impress Ron and John by jumping off a balcony (p. 215); that John and Donnie both think that Ron is &#8220;usually right&#8221; (p. 215 and p. 216). All of this suggests not just internal communication and co-consciousness, but an intricate network of relationships and power dynamics operating amongst the alters.
  3. 3 Show/Hide More Barb's Life
    This is a documentary about three different people with DID. The whole film is fascinating, but the section to focus on starts at 38:37 and runs through the end of the film, about 20 minutes. It introduces you to Barb – a woman with multiple personality disorder -, her family, and a number of her alters.
    Notes:
    The alter named &#8220;Cary,&#8221; introduced at 50.23, is of particular interest, since Cary is one of the alter who often does illegal and destructive things when she is &#8220;out.&#8221; For example, towards the end of the film, Cary has written $1500 worth of bad checks to pay for a reckless shopping spree. Barb has no memory of the incident, but her husband needs to take out a loan in order to pay for them. This is exactly the type of situation in which multiples in the court system often find themselves. As you watch, note your initial reactions: to what extent does it seem to you that Barb is responsible for Cary's actions? Also note the manner in which Cary speaks about her own situation. &#8220;How would you feel if you were in my position? I'm stuck here. I don't have a life.&#8221; (53:11) An alter asking for empathy raises interesting questions. What is it like to &#8220;be&#8221; an alter? Is that even a sensible question, separate from the question of what it is like to &#8220;be&#8221; Barb?
  4. 4 Show/Hide More Skepticism about DID
    Notes:
    <p>Controversy over <span class="caps">DID</span> in the psychiatric community is longstanding, and the kind of skepticism about <span class="caps">DID</span> that Tozman and Padis express remains relatively common. Skeptics point to a number of factors that could raise questions about DID's legitimacy. First, the diagnoses of <span class="caps">DID</span> has undergone significant changes in the past half-century. Prior to 1970, there had only been about 100 cases of <span class="caps">DID</span> reported worldwide (Schacter, Gilbert, and Wegner). However, in the latter decades of the 20th century, the number of reported cases skyrocketed. Maldonado &amp; Butler (1998), for example, estimate that between .5% and 1% of the general population now suffers from the disorder. What accounts for this rapid increase? Skeptics suggest that increased publicity around the disorder (for example, the 1957 film The Three Faces of Eve) has led to conscious or un-conscious simulation, and that eager psychotherapists &#8211; using a combination of suggestion, hypnosis, and expectation &#8211; have created symptoms of <span class="caps">DID</span> in their clients or elicited false reports of child abuse or <span class="caps">DID</span>-like behavior. These doubts are buttressed by the fact that childhood trauma and abuse is common around the globe, particularly among people of low-income, yet <span class="caps">DID</span> is diagnosed most frequently among middle-class north americans (Acocella, 1999).</p> <p>In response to such skepticism, believers in <span class="caps">DID</span> point to the relative success of <span class="caps">DID</span> treatments in eliminating symptoms in patients who did not response to treatment for bi-polar disorder or schizophrenia (see Saks, 402). They point to studies independently verifying the correlation between child abuse and <span class="caps">DID</span> (without reliance on the patient's memories), the relative consensus in the psychiatric community about the symptoms and treatment of <span class="caps">DID</span> (as evidenced by its inclusion in <span class="caps">DSM</span>), and recent evidence that <span class="caps">DID</span> may not be as bound to North America as previously supposed (Sar, Yargic and Tutkun (1996)).</p> <p>There is much to be said on both sides, and debate about <span class="caps">DID</span> will likely continue well into the future. For the purposes of this module, however, we need not resolve the debate here. Few skeptics about <span class="caps">DID</span> deny the existence of the disorder in its entirety. Rather, they tend to question its frequency and its status in relation to other disorders like schizophrenia. Thus, even if <span class="caps">DID</span> is significantly over-diagnosed, the legal questions this module investigates will still be raised by the minority of cases in which the diagnosis is accurate. Moreover, if the reader is unwilling to grant the legitimacy of even a single case of <span class="caps">DID</span>, he or she can view the central purpose of this module as a hypothetical: if <span class="caps">DID</span> were a real disorder, how would the legal system need to handle it? But such caveats are, at least in my view, relatively unnecessary, given the implausibility of supposing that every single case of <span class="caps">DID</span> has been faked, created by therapy, or mis-reported.</p> <p>Sources:<br /> Acocella, Joan (1999). Creating Hysteria: Women and Multiple Personality Disorder. New York: Jossey-Brass.<br /> Saks, Elyn (1991). Multiple Personality Disorder and Criminal Responsibility, 25 U.C. Davis L. Rev. 383.<br /> Maldonado, J. R., Butler, L. D., &amp; Spiegel, D. (1998). Treatments for dissociative <br /> disorders. In P. E. Nathan &amp; J. M. Gordon (Eds.), A Guide to Treatments that <br /> Work (pp. 423-446). New York: Oxford University Press.<br /> Sar, V., Yargic, L., &amp; Tutkun, H. (1996). Structured interview data on 35 cases of dissociative identity disorder in Turkey. American Journal of Psychiatry, 153 (10), 1329-1333. <br /> Schacter, D. S., Gilbert, D. T., &amp; Wegner, D. M. (2008). Psychology. New York: Worth.</p>
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May 21, 2013

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