Clinical Psychology Review 22 (2002) 481–497
Harald Merckelbacha,Grant J. Devillyc, Eric Rassina,
How should the different identities (i.e., alters) that are thought to be typical for (DID) be interpreted? Are they just metaphors for different emotional states or are they truly autonomous entities that are capable of willful action?
This issue is important because it has implications for the way in which courts may handle cases that involve DID patients.
Referring to studies demonstrating that alters of DID patients differ in their memory performance or physiological profile, some authors have concluded that alters are more than just metaphors.
We argue that such line of reasoning is highly problematic.
There is little consensus among authors about the degree to which various types of memory information (implicit, explicit, procedural) may leak from one to the other alter. Without such theoretical accord, any given outcome of memory studies on DID may be taken as support for the assumption that alters are in some sense ‘‘real.’’
As physiological studies on alter activity often lack proper control conditions, most of them are inconclusive as to the status of alters. To date, neither memory studies nor psychobiological studies have delivered compelling evidence that alters of DID patients exist in a factual sense. As a matter of fact, results of these studies are open to multiple interpretations and in no way refute an interpretation of alters in terms of metaphors for different emotional states.
The older literature on DID offers some strong claims as to the literal status of alters. Anecdotal reports of alters differing in their allergic reactions, in their response to medication, and in their optical functioning abound (e.g., Miller, 1989). These anecdotes
led Simpson (1997, p. 124) to pose the following question: ‘‘Why not claim that they wear different size shoes?’’ …
Still, a literal interpretation of alters can also be found in the DSM-IV and in many serious articles on DID. In their thought-provoking essay on DID, Lilienfeld et al. (1999) present several examples of treatment interventions that seem to be predicated on the belief that alters in DID are independent agents. These examples include asking to meet an alter, giving names to alters, and encouraging alters to write letters to each other. On the basis of these examples, Lilienfeld et al. (p. 513) conclude that ‘‘many or most influential authors in the DID treatment literature treat alters as independent entities or even personalities, at least during the early phase of treatment.’’
It is this literal view on alters …. Yet, theoretical and methodological shortcomings of these studies restrict any conclusions that can be drawn from them. Memory studies on DID suffer from the absence of articulated theories about memory functioning in DID.
Psychobiological studies, on the other hand, primarily suffer from the absence of proper control conditions. This is unfortunate, becauseit is now perfectly possible to specify control conditions for this type of research.
…Neither memory studies, nor psychobiological studies have elicited compelling evidence
that supports a literal view on alters in DID. …A case in point is Gleaves (1996, p. 48) who notes that ‘‘what is critical to understand is that acknowledging a patient with DID to have genuine experiences of alters as real people or entities is not the same as stating that alters are actually real people or entities.’’ Obviously, this conceptualization of alters is reminiscent of the position that alters exist largely as a result of role enactment in which patients become absorbed.
Thus, it is probably time to de-emphasize the literal interpretation of alters advocated by the DSM-IV. …
…Meanwhile, the hypothesis that alters in DID may be nothing more than the result of some patients’ tendency to attribute causality to inside agents, only becomes a coherent position when one seriously considers the possibility that expressed alters are metaphors rather than real entities.