This article originally appeared on the website of Psychology Today on October 4, 2017. It is republished here in revised form.
“Having seen hundreds of patients who claimed to house multiple personalities, I have concluded that the diagnosis is always (or at least almost always) a fake.” – Allen J. Frances, M.D., Professor Emeritus of Psychiatry, Duke University; Chair of the DSM-IV Task Force
“I have treated many individuals who were called multiple personalities. There is no such thing…. Usually I have had to remove them from some therapist who has been parading them around giving exhibitions, and then get down to work.” – Robert A. Berezin, M.D., psychiatrist in private practice; former professor of psychiatry, Harvard Medical School
“I believe all multiple personality disorder cases are artificial productions provoked by the attention doctors and others give them—all of them.” – Paul R. McHugh, M.D., University Distinguished Professor of Psychiatry, Johns Hopkins University
No diagnosis in the history of psychiatry has provoked more controversy—both inside and outside of the field—as dissociative identity disorder, formerly known as multiple personality disorder. Mental health professionals fall on one of two sides of the debate, either believing it to be a major disorder induced by severe childhood trauma or, alternatively, a cultural fiction, dreamed up in the minds of Hollywood, a small but influential group of psychiatrists, and their patients. The 2016 release of the movie Split reignited this debate and put dissociative identity disorder once again at the forefront of the national psychiatric discourse.
The birth of dissociative identity disorder as a psychiatric diagnosis aligns closely with the fraudulent Satanic ritual abuse panic of the 1980s, as Noll (2013) so eloquently reminds us. Facing existential crisis as the biological wing of American psychiatry quickly outpaced and supplanted psychoanalysis as the dominant theoretical paradigm, some Freudian-minded psychiatrists saw opportunity to reclaim their turf by asserting, however inaccurately, that severe trauma in one’s past can lead to the development of multiple, distinct personality states within the same individual.
Despite the illogicality of a person being comprised of more than one personality, this radical group of psychiatrists, coupled with several sensational—and deceitful—depictions in American media, led to the inclusion of a new chapter on “dissociation” in DSM (Noll, 2013).
Shortly thereafter, the diagnosis took off like wildfire, with some psychiatrists and psychotherapists seeing and treating it in virtually all of their patients, and some patients claiming to have not two or three personalities, but 20 or 30 or 100! The journal Dissociation was founded to document these fantastical stories and give credibility to a condition that from its start was met with skepticism amongst critically-minded mental health professionals and academics. Still, the condition became a cultural phenomenon, and more and more people started to identify as housing more than one self, always under the tutelage of an intellectually- and financially-invested psychotherapist.
I have seen a number of patients claiming to have dissociative identity disorder, some self-diagnosed and some diagnosed by another psychotherapist or psychiatrist. Not a single patient had a credible presentation, and all had significant motivation for producing a different persona.
I am in agreement with Allen Frances, M.D., professor emeritus of psychiatry at Duke University and chairman of the DSM-IV Task Force. In his 2014 article on Psychology Today, Frances argues that the diagnosis of dissociative identity disorder is almost always a fake, although the patients said to have it may not be consciously attempting to deceive.
What is the appeal of the diagnosis of dissociative identity disorder? Like Frances (2014), I contend that the diagnosis offers a useful and dramatic metaphor for patients to relay their internal conflicts and moral-existential dilemmas. These conflicts between moral and immoral, ego and id, good and evil become symbolically dramatized in a fashionable label of dissociation. But the diagnosis becomes too real to the patient, usually under the influence of an enthusiastic but misguided therapist or online chat group, and the patient comes to translate an abstract metaphor into a concrete psychiatric disorder. The result is a patient who claims not to be responsible for the things said and done during the dissociated mental state.
As McHugh (2008) points out, patients diagnosed as having dissociative identity disorder have an intense need for understanding and attention, and the psychiatrists and psychotherapists who treat DID are more than willing to give it to them. The vast majority of patients meet diagnostic criteria for borderline personality disorder (Horevitz & Braun, 1984). Most are engaging in a sophisticated form of game-playing and method acting, the reasons for which are discernable via an analytically-informed psychotherapy.
In order to appreciate the absurdity that is the diagnosis of dissociative identity disorder, one must recognize it in its historical context. Fads in psychiatry come and go, and dissociation—and its most well-known variant, dissociate identity disorder—is no exception. The history of the disorder is one marked by recurrent false epidemics driven largely by popular books and movies, such as, most famously, The Three Faces of Eve and Sybil. This folly is highlighted by the fact that the real “Sybil” has admitted that her multiple personalities were faked, the story a ruse and a lie (Neary, 2011).
Historians of psychiatry have attempted to identify legitimate cases of dissociative identity disorder prior to its widespread, Hollywood-driven popularity, and they have been unsuccessful (Piper & Merskey, 2014). The only logical conclusion is that the disorder is a myth.
Why, then, does the diagnosis remain? The answer lies in the fact that the proponents of the concept, the so-called experts in dissociative identity disorder as a psychiatric condition, have vested interest in the legitimacy of the disorder. Many of them have devoted the entirety of their careers to the “study” and “treatment” of this mythical condition. And the patients find good use in the disorder as a means of attaining gratification and evading personal responsibility.
Hopefully one day in the not-so-distant future the diagnosis of dissociative identity disorder will be dropped from the psychiatric lexicon and recognized for what it is—a clever but mythical attempt to fool others—and sometimes the self—into believing that people are not always in control of their conduct and responsible for everything they do.
For additional information on the myth of dissociation and dissociative identity disorder, readers are directed to Dr. Richard Noll’s 2013 article When Psychiatry Battled the Devil published on Psychiatric Times. Dr. Noll is a clinical psychologist and historian of psychiatry at DeSales University in Pennsylvania.
Frances, A. J. (2014). Multiple personality—mental disorder, myth, or metaphor? Psychology Today. Retrieved from https://www.psychologytoday.com/blog/saving-normal/201401/multiple- personality-mental-disorder-myth-or-metaphor
Horevitz, R. P., & Braun, B. G. (1984). Are multiple personalities borderline? An analysis of 33 cases. The Psychiatric Clinics of North America, 7(1), 69-87.
Neary, L. (2011). Real ‘Sybil’ admits multiple personalities were fake. National Public Radio. Retrieved from https://www.npr.org/2011/10/20/141514464/real-sybil-admits-multiple-personalities-were-fake
Noll, R. (2013). When psychiatry battled the devil. Psychiatric Times. Retrieved from http://www.garygreenbergonline.com/w/wp-content/uploads/2013/12/Psychiatric_Times_-_When_Psychiatry_Battled_the_Devil_-_2013-12-06.pdf
McHugh, P. R. (2008). Try to remember: Psychiatry’s clash over meaning, memory, and mind. New York: Dana Press.
Piper, A., & Merskey, H. (2014). The persistence of folly: A critical examination of dissociative identity disorder. Canadian Journal of Psychiatry, 49(9), 592-600.