News

Debating Dissociative Identity Disorder

Dismissive: I was distressed to read "Going to Pieces" [by Craig Malisow, April 17]. In this article, Malisow describes a real area of clinical controversy, but unfortunately does so in such a dismissive tone that he undermines the usefulness of his piece. Of the mental health professionals he mentions, Dr. Goodwin, Dr. Decker and Dr. Allen are, as he describes, highly qualified and reputable experts in trauma therapy (I am not familiar with Dr. Ross). Describing his interviews with these professionals, Malisow seems impatient, cynical and unwilling to consider the complexity of the issues he is raising. Malisow describes the phenomenon of patients who describe cult ritual abuse and resulting dramatic personality fragmentation, and he asks some reasonable questions: whether therapists ever question the reality of these accounts, and why only some survivors of abuse seem to develop multiple personality dis­order. These are questions that have been debated at length in thepsychotherapy literature for several decades.

Dissociative identity disorder is an uncommon condition, but for those of us who have worked with patients with this condition, seems as real and as clear a condition as any of the other complaints a patient might bring. On the other hand, it also is a condition that lends itself to dramatic narratives. James Chu, a psychiatrist at Harvard Medical School, has written thoughtfully about real and factitious presentations of DID. True DID would generally be understood to result from a fundamental pathology in the development of a coherent self, most likely the result of complex abuse or trauma early in life. There may also be constitutional factors that result in differences in dissociative capacity.

It is difficult to comment on the phenomenon of reports of cult ritual abuse. These reports peaked in the mid-'90s, and many probably were not based in fact. Malisow greatly simplifies the situation of a therapist who is faced with complex reports of abuse. While of course a therapist is interested in what is true and what is not true, it usually does not help the patient for the therapist to become tied up in assuming the role of an investigator. If a report is clearly delusional, such as the description of flying purple dinosaurs Malisow suggests, of course a therapist or psychiatrist would want to address the psychotic nature of the experience. It usually isn't that simple, however. In my own experience, some stories I thought at one time sounded ridiculous later turned out to be true, while others that seemed believable were proven false. A therapist can support a patient in exploring the truth and coherence of his experience.

While many cult stories sound unbelievable, the recent raid of the Texas cult, in which barely pubescent children have been systematically raped by adults under the justification of their religion, certainly suggests that not all reports of cult activity are false. It is most becoming to all of us who work and write on these subjects to do so with some compassion, humility and respect for the complexity of the truth.

Elizabeth Weinberg, MD
Clinical Assistant Professor of
­Psychiatry
Baylor College of Medicine
Houston

An online reader weighs in:

Nonsense: Is this con still making the rounds? I would have thought this dropped out of sight like all those people who claim to have had anal probes aboard flying saucers, or the Salem witchcraft trials.

This nonsense started about 30 years ago with the publication of a book titled Michelle Remembers, and it's been kept going through the publication of similar fake memoirs.

Among the common threads in these con artists: They were always girls, always betrayed by their parents (almost invariably by both parents), always recruited into cults of Satan worshippers (never Methodists or Mormons or Jews), always pregnant young, also always scarred and/or tattooed, always gang-raped every night for several years in a row by an enormous group that always included the town's leading citizens.

In daylight, these kids may have lived in modest homes, even trailer parks, and been mostly ignored by the cool kids in high school, but, by golly, when that evening sun went down, they were always partying with the elite and tons of them. And yet nobody ever knew. They supposedly had scars and tats but nobody else ever noticed, even in the shower room. They were even preggers, but nobody caught on — not even doctors who examined them years later.

In the case of Michelle Remembers, it turned out the purported shrink who was writing this account of an actual case was actually "Michelle's" second husband. Her first husband had courted and married her in high school, and not only could he not remember her having any of the scars or tats that she claims the Satanists put all over her body, he says that she was a virgin when they married. And, although her narrative suggested that she spent her pre-teenage and teenage years as the sex goddess of one coven, her family actually changed towns a couple of times. In none of those towns — either before, during or after her purported sex slave careers there — was there even any evidence, or even rumor, of orgies, Satanism or human ­sacrifices.

I am amazed that this crap is still going strong.

Bernard J. Sussman
Potomac, Maryland