So You Want To Talk About Multiple Personalities?

I’ve gotten a few requests over my blogging time to talk about multiple personality disorder. I’ve (half) jokingly told friends that this post would garner me a great deal of upset commenters but here it is. 

Important Note: My opinions on the scientific validity of this disorder DO NOT reflect any belief that identified ‘multiples’ or sufferers of DID aren’t suffering, don’t deserve to be treated, or should be in any way, shape or form ridiculed, belittled, or treated poorly. Full stop.

So, I totally spoiled it with the disclaimer, but here it goes.

I don’t think Dissociative Identity Disorder/Multiple Personality Disorder is scientifically valid as a diagnosis.

…and since this is a fairly prevalent feeling in the psych community, I’m less worried about the Internet is Forever ™ problem.

Sybil: a book, a movie, and a tale of really unethical psychology.

DID?

While there’s some reports of people exhibiting something like multiple personalities as early as the 17th century, but the diagnosis didn’t take off in popularity until the 20th century. It’s entry into pop culture is strongly linked to Sybil, a book about one (real) woman who appeared to have sixteen personalities. It was a popular book, run in newspapers, and cited as one of the main factors in the sudden upswing of DID/MPD diagnoses. Sybil and her therapist are no longer alive, but much  criticism surrounds it. (See below)

DID/MPD was called Hysterical Neurosis, Dissociative type in the second iteration of the DSM. By DSM III it was Multiple Personality Disorder, and DSM IV made both significant changes to the criteria and the name, creating Dissociative Identity Disorder (DID).  However, because of the prevalence of MPD in current literature/horror movies/culture, I’ll use DID/MPD.

In general, DID/MPD is characterized as having multiple distinct personalities or identities (this is the second required criteria for diagnosis). These are called ‘alters’. Usually, though not always, there’s a central personality that’s often treated as the “real” one. That identity is usually depressed or anxious.

 

So. Sybil.

Sybil is the pseudonym for Shirely Mason, the client of psychoanalyst Cornelia Wilbur.  Mason didn’t come to her therapist because she had DID/MPD–her presenting problems were anxiety and memory loss. Then, after seeing Wilbur, suddenly, BAM, she had sixteen personalities.

Do I sound suspicious? I am.

Though the client files are sealed, multiple analyses of the taped sessions have said that Wilbur herself encouraged Mason to develop alters…and offered her money for talking about her different personalities. How did those personalities appear? Wilbur, who gave many drugs to her clients (including some very highly addictive psychotropics), gave Mason sodium thiopental and heard her mention other identities under the drug’s influence.

Sketchy? Most definitely. If that wasn’t damning enough, Mason wrote later that she had made the alters up.

Relevant reading: Remnants: The Last Stand of the Satanic Ritual Abuse Movement.

Who gets diagnosed? Who is diagnosing?

Of course, Sybil/Shirely Mason being a the result of unethical practice doesn’t negate that multiple personalities could exist. So what else do we know?

Those with DID/MPD diagnoses are often reported as having severe trauma in childhood. Data on this isn’t actually very clear, because many of the psychologists to originally diagnose MPD/DID believed in repressed memories and used really unscientific techniques to ‘retrieve’ them (This was around the time of the satanic abuse cases). Current research doesn’t support the idea of this sort of trauma repression.

DID/MPD patients also score very highly in measures of ‘hypnotizabilty’–a specific measure of being suggestible…and anywhere between ‘many’ and ‘most’ practitioners who diagnose DID/MPD use hypnosis to determine if their clients have multiple personalities. Hypnosis: not a methodologically sound form of diagnosis.

And those practitioners? They’re a specific subset of  psychologists, and they appear to get a statistically improbable number of clients who turn out to have DID/MPD. Of course, this could be a result of skeptic practitioners under diagnosing, right? Absolutely.

However as many as 70% of those with MPD/DID diagnoses appear to have borderline personality disorder (BPD). That’s high enough to suggest something more than simple co-occurence, which has lead to suggestions that professionals are using the idea of multiple personalities to explain the impulsivity and rapid emotional changes of BPD. Further, when the diagnosis of schizophrenia was introduced, there was a sudden crossover from those with MPD/DID to schizophrenia. Is it possible that those who believe in the DID/MPD diagnosis are just more likely to categorize BPD or schizophrenia as multiple personalities?

Relevant Reading: Dissociative Identity Disorder: A Controversial Diagnosis

The North America Problem. Is this a cultural diagnosis?

North America has the highest rates of DID/MPD diagnoses in the world. It’s also the place where multiple personalities are most familiar to the population at large. While this doesn’t mean the diagnosis is invalid, it casts, shall we say…aspersions. Secondly, when DID/MPD became a popular diagnosis in the 80’s, we also saw a sudden increase in the average number of alters, from 2-3 to an average of approximately 15. Hmmm.

Memory crossover in alters.

We’ve learned a lot about memory in the years since MPD/DID gained traction.We know, for instance, that repeated exposure to neutral (or even nonsense) words will result in faster recognition of those words.

(This can be tested by giving participants a series of possible categories for nonsense words and letting them learn by trial-and-error which word matches which category. For instance, in Trial One, James may match word Njdhsuf to Category A. When the result is NO, he is unlikely to try Category A for word Njdhsuf in Trial Two. By Trial Three, he may know that word Njdhsuf goes with Category C. If he is retested a short time later, James will sort the familiar nonsense words into their correct categories at higher rate than random chance, even if he feels as though he is guessing.)

Those diagnosed with DID/MPD report distinct personalities and identities, almost always reporting autobiographical amnesia (alters report knowing nothing of other alters or of what was done when the client was in a different identity) between personalities, one. So in a test like the one described above or similar, you would expect to see that if James is one identity, when he became an alternate identity, he would show no memory of the nonsense words, and sort them into correct categories at rates that resembled random chance. That’s not been shown to happen*. (This study also showed that indirect measures of behavior and ERP–which could be grossly oversimplified as how your neurons fire–found recognition in one identity of neutral words learned in different identity.) This study tested emotionally loaded words and found the same.

Okay, so what about autobiographical information? Though patients may have a central organizing identity, most report their personalities know nothing of other personalities. Objective tests have utterly failed to validate this. Though I strongly encourage reading this entire study about autobiographical memory in those with MPD/DID, here’s some relevant sections  [bolding is mine]:

Consistent with previous studies, transfer between identities on the memory task occurred even for negative material, despite patients reporting amnesia for this material, learned in another identity state. Transfer across amnesic barriers in DID also occurs for conditioned emotional information. Testing DID participants, Huntjens et al. administered an evaluative conditioning procedure that confers a positive or negative connotation on neutral words. In a subsequent affective priming procedure, participants displayed transfer of this newly acquired emotional valence to the amnesic identity (i.e., transfer of emotional material between identities).

Our findings are consistent with the results of other studies involving objective laboratory tasks indicating intact inter-identity memory functioning in dissociative identity disorder. In most studies, researchers test memory within the same experimental session shortly after learning. In contrast, we tested memory after a 2-week delay, thus increasing the ecological validity of our study. However, the results do conflict with the reports of amnesia between identities, suggesting that the subjectively experienced absence of autobiographical knowledge about other identities is quite self-convincing.

These findings become particularly important in cases like these**.

So what about people who appear to be multiples***?

I don’t have a great answer to this. Right now, therapy for DID/MPD seems to focus on integration: bringing all facets together into a single identity. There’s some pushback from self-identified multiples on this idea, many of whom feel that they’re not sick or broken, and that therapy treats them as such. I don’t really disagree, if they feel that they’re coping well. Forcing someone into therapy rarely goes well, and except in instances of danger to self or others, I’m all about the hands-off approach.

In the long term? I think we need to remove Dissociative Identity Disorder from the DSM. Like other diagnoses (*cough* Transvestic Fetishism *cough*) it seems to be the theory of a small contingent of scientists with little support in the community. When this dies as a cultural meme, I believe we’ll see a similar decrease in diagnostic popularity and even symptomology.. (We’re also seeing a sharp decline in scientific interest.)

——–

A great deal of the links and understanding that were required for this blog would not have been possible without Ed Cara, who you can find on twitter and blogging at The Heresy Club.

*Upon reflection this isn’t quite accurate. A few case studies have suggested autobiographical amnesia. However, I’m going to go with the majority of evidence found in studies that used controls (and simulators–people pretending to have amnesia) and larger pools of participants.

**Though DID/MPD has been a staple of the horror genre and several sensational trials, please don’t make the mistake of thinking DID/MPD is linked to being violent.

***This seems to be the preferred term in my reading of multiples’ writings (another popular term is ‘systems’). I’ll take correction and change this if I’m wrong.

Moderating Comments, Normalization & Anonymity

I was on this panel at SkepTech! You can read my prepared thoughts here.

Notes:

-I improperly conflated psuedonymity with anonymity in the last third of the talk. Those are different things. I think pseudonymity (like Gravatar, Disqus, etc. offer) is one of the nice middle ground ways we can keep an eye on commenters across mediums.

-I stick with my remarks about wanting assorted -ist comments to be off my posts in the first place. Normalizing bad behavior perpetuates the problem. Removing awful comments in my little corner of the internet is one way I try to prevent normalization.

-I was a bit more wordy than I wanted–I’m lucky to have avoided the nerf gun.

What do you think? What did we leave out? 

Psychometrics: Using and Abusing

Look, SkepTech already has my favorite talk up!

Stephanie talks about psychometry: the way we measure concepts in psychology. It’s the intersection of statistics and psych, and I dearly love it. I was particularly happy about her answers to questions about fMRI’s and [my question] what we should keep fixing in how we measure intelligence.

SkepTech

…was spectacular.

-There were many more panels than I’d seen at previous cons. I don’t usually love panels, but I’m very supportive of this system if it means introducing new voices. (Olivia James, one of the first-timers, got spontaneous applause on multiple occasions throughout the Real World Activism panel. Damn.) We talk a lot about this being a young movement, a movement that anyone can join and become a part of. That’s only true so long as we work to find new speakers and leaders–otherwise you have an old guard and where’s the fun in that?

Safe Space

-Safe space hangout zone! I took advantage of this often. After three hours of class and a six hour drive to Minnesota, the conference looked like Introversion: Advanced Mode. The zone (lots of open area with clusters of seats and windows, located behind the tabling space) was perfect. Either by coincidence or design, it was out of the flow of con traffic, meaning no forced interactions, and quiet. Conversations were relaxed and participation wasn’t required–I spent a good deal of time listening to brilliant people arguing.

-And did I mention the panels? I love when panelists disagree–and the organizers tried to make it happen. Panels are exciting when there’s a debate, when sides are chosen and audiences divided. And there were! (Our moderator threatened us with a nerf gun. Never a dull moment.)

-The Wall O’ Tweets! It wouldn’t be a con without live-tweeting, and SkepTech had a simple way of letting audiences see what and who were tweeting. The setup was simple: TweetDeck, one projector, and judicious use of filters to collect relevant tweets. Very occasionally this was distracting–some speakers were sidetracked or interrupted by laughter at tweets they couldn’t see. Other speakers and panels incorporated tweets and tweeted questions into their presentation.

BHRvKw1CIAATcC-

Olivia won the contest–and got a plush sperm cell.

-(Plush) microbes! There’s nothing like “Thanks for that talk. As a gift, we’d like to give you gonorrhea!” Each moderator and speaker got a different one–as did the winner of the Twitter contest.

A wonderful weekend–and here’s to hoping for a SkepTech 2.

Photo credit: Geeks Without God

Monday Miscellany

SkepTech was glorious! (Summary incoming this evening). The anonymity panel was just plain fun, Stephanie gave an amazing talk about psychometrics, and I was happy to be around such enthusiastic, brilliant people.

Also, after one week of interning, I’ve mostly figured out how blogging fits in; expect one or more smallish posts each day during the week. I don’t have time to fully develop and publish post by a reasonable time on weekday evenings, so those will be for weekends.

Until then, links!

Ozy on medicalizing mental variation. Go read all of it.

Heina on fauxminism.

Fauxminism is the curious phenomenon where people think that featuring, talking about, or even just being a woman is an inherently feminist act and thus renders the person and/or act(s) in question irreproachably progressive with regards to matters of gender. What makes someone a fauxminist is not any particular action or choice that they make or take, but their dogged insistence that anything they do must be feminist because they are a woman or have involved a woman without taking into account how those actions affect the lives of other women. They tend to say things like ”Criticizing another woman? Jeez, that isn’t very feminist of you” and “Support all ladies no matter what they do (even if that’s hindering other ladies)!” in response to feminist critiques of anything even marginally involving a woman.

Navigating masculinity as a black transman.

—–

How was your weekend? Did you make it to any of the many conferences? Write anything good? Self-promote below!

 

SkepTech: Anonymity on the Internet

Like Miri, I’m going to be at SkepTech…[checks calendar]…holy crap, tomorrow!

And lucky me, I’m going to be on a panel about anonymity on the internet, moderated by the lovely Chana.

This panel will explore the conflict between online anonymity and harassment. In a world where absolute freedom is practically possible, what shall be permitted? Anonymity is a double-sided coin; it can be a great generator of content, activism, and community, but also provides a safe space for blatant racism, sexism, homophobia, hate speech, and death threats. Is moderating any more “self-policing” than the violent comments policing who creates content? How far should self-policing go—should we go troll hunting into meatspace, causing commenters to face serious, “real life” repercussions? How far is too far, or not far enough?

I have a couple of thoughts–but mostly I want to hear yours. This isn’t a subject I’ve given much direct thought. I obviously spend a lot of time on the internet, but I rarely comment on blogs. Mainly, I interact with commenters by either…
1) Pruning the terrible ones.
2) Reading the really insightful ones and passing out shiny internets.
And the occasional 3) Reminding people that I’m Kate, and not Ashley*.

So, in no particular order:

I don’t think anonymity is quite so much the question as whether or not the moderation policy fits the goal of the site. When it fits, you have a useful site–though everyone can hate your goals and disagree and critique them and boycott them and all that.  Aligning goals and policy, but on opposite ends of the spectrum are Reddit and Shakesville.

Reddit: Though within-subreddit moderation can be pretty high, across-subreddit moderation is low. And by low, I mean nearly non-existent. However, reddit mainly wants to have a Wild West Internet setup. (“Subreddits are a free market. Anyone can create a subreddit and decide how it’s run”[link]), and their policy reflects it. I have feelings about this, which is to say that I don’t like it.

Shakesville: Shakesville is the opposite of reddit. Explicitly a safe space, they have a highly structured comment policy, use content notes, and wield a fierce banhammer. They want a space without explaining at the 101 level, and they want to exist as a haven on the internet. For one reason or another, I’ve never become part of the regular commenters, but I appreciate the idea.  The commenting policy–which is followed very closely–creates the space Shakesville is looking for. Readers are devoted, and the comments fit in with their goals: violating the rules of the safe space will get you banned. Of course, I don’t think this is how the entire internet should run–101 spaces matter, and fucking up and misunderstanding and asking really awful questions and learning because someone took the time to explain why, exactly, affirmative action isn’t racist against white people? That matters too. But safe spaces can be useful, and Shakesville is one of them.

And when comment policies don’t match up with the goals?

Basically, you get every mainstream news site. Seriously, have your read the comments? Don’t read the comments. No real conversation happens, because everyone is busy yelling about how Obama is a Muslim, the earth is flat, and The Next Great Conspiracy Theory. And when the occasional debate does start, some ALL CAPS WARRIOR leaps in. It’s an exercise in futility, and most people hate it…so they don’t participate, and then even fewer people are left to patiently explain that no, it’s not true that atheists eat babies.

As for troll-hunting in real life?
I don’t like call out culture–the naming and public shaming (particularly shaming on the internet, where stupid is forever) rubs me completely the wrong way. Yes, people have really awful damaging attitudes, and sometimes I do think it can be done carefully, well, and surgically*, but mostly, allies should spend less time calling out and more time making change. And change doesn’t happen by alienation. (Caveat: this doesn’t mean you have find r/MensRights and make a go of explaining feminism. But when you think you can have conversations, do that.)
Relevant reading: I Remember Saying Stupid Shit

What do you think?

*Note: This post was written by Kate, and not Ashley.

**Goal: define “carefully, well, and surgically” by the time I’m on the panel on Saturday.

You can follow SkepTech at @skep_tech

Housekeeping

Hi! I’ve been gone for spring break, but am (obviously) back now! And wielding these:

Femin-Its. Because my partner is the best.

Femin-Its. Because my partner is the best.

I’m also taking this quarter off to work at an undisclosed location that involves babies(!), data analysis, (meh) and psychopathology(!!). While the schedule seems to work very well with blogging, I’m still settling in, and it’ll be a few days until I’m completely back.

Until then, what’re your thoughts on this?
Or these three responses?

Also, halp, I can’t decide which bowtie to get! (No, really. I can’t decide.)