Do Fads Ever Die?

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To the EditorDr Joel Paris’s article, The Rise and Fall of Dissociative Identity Disorder, in the December issue of the JNMD is timely. The multiple personality disorder/dissociative identity disorder (MPD/DID) craze within psychiatry and clinical psychology that crested in the 1990s, and that was discredited in courts of law, has shown regenerative signs that need a prompt rebuke.Crazes—particularly medical crazes—follow the course Penrose (1952) described in his book On the Objective Study of Crowd Behavior. A few enthusiasts start a craze as did the followers of Cornelia Wilbur and Sybil with this one. A craze catches on by attracting susceptible followers, usually by means of “scientific” claims about illuminating ideas and new mechanisms that ultimately lead to clinical and public confusion and an immunity to its allure in most other physicians. The craze then retreats, only to return when the veteran enthusiasts presume that “the dust has settled” and, perhaps, the old ideas and methods can work their magic again.Dr Paris correctly notes that as long as official psychiatry credits categories such as MPD/DID, where a theoretical conception is embedded in the criteria, then “the way of return” for “repressed and recovered memory therapy” stays open. Simply look at the “criteria” for dissociative amnesia in DSM-IV, in which the psychological symptoms that have the same behavioral, artifactual nature as the physical symptoms of conversion disorder are given a diametrically opposite interpretation—that is, assumed to be genuine rather than pseudoimpairments of faculties. This mistaken view about the nature of the condition is at the root of these enterprises.Critics of Dr Paris’s article ignore his basic arguments and expend effort identifying “scientific, peer-reviewed literature” about childhood traumas and adverse experiences that they claim he overlooks. However, the issue is not “science”; it is “practice.” The practices derived from the MPD/DID scientific presumptions have produced countless casualties among patients treated and families affected. A chaos of claims, counterclaims, court judgments, financial settlements, and general discredit of psychiatric coherence depicts the history of the early and mid-1990s, when this craze hit its peak. Recovered memory therapy became a byword for psychiatric mistreatment in many circles—both professional and lay.No one can deny the casualties and the chaos, although some champions of MPD/DID have tried. Let me list a few that, being on the public record, can be consulted by any party reflecting on and wondering about the relevance of Dr Paris’s article.The craze-initiating text Sybil, describing a patient with MPD (who was suspected, by an experienced psychiatrist, to be a “game playing hysterical patient with role confusion”; Borch-Jacobsen, 1997), was based, Nathan (2011) reveals, upon a fraudulent misdirection of practice and opinion. However, Sybil is hardly the worst example or the person who suffered the most from this kind of treatment.The Donna Smith case, fought out in the courts of Maryland, displayed the efforts of psychiatrists to send an innocent man to prison on the basis of the false recovered memories of his vulnerable daughter evoked into MPD with hypnosis and Amobarbital-advanced suggestions. For these wrongful practices—when the daughter retracted her memories and was discovered to have Graves’s disease—the psychiatrist and his hospital paid a large financial settlement for damages to the family. The popular press revealed many of the grim details (Taylor, 1994).

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