Alters in Dissociative Identity Disorder Metaphors or Genuine Entities?

Clinical Psychology Review 22 (2002) 481–497

Harald Merckelbacha,Grant J. Devillyc, Eric Rassina,

Abstract
How should the different identities (i.e., alters) that are thought to be typical for dissociative identity disorder (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.

Conclusion
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.

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8 Comments

  1. Steve

     /  06/14/2011

    Shen,

    I hope you’re still out there. I’ve got a queston for you.

    Why is it that combat veterans with PTSD have intrusive memories that they can’t forget? Why don’t combat vets develop DID and repress memories, truly horrific memories, of watching people die violently, or of having killed people, maybe innocent people? This remains the most glaring inconsistency in this whole debate, never adequately answered by proponents of DID/MPD. Combat vets can’t forget what happened. All the credible research on memory points to this as well, that strong emotional experiences leave strong memories. Period

    The other inconsistency that never gets discussed is that early on in this debate repressed memory proponents used to argue that the mind could create false memories. Clinicians believed that patients who displayed symptoms of having been sexually abused, ( the laundry list of symptoms in the 1980’s included everything from depression to hangnails), but who reported memories of a good childhood were fabricating those memories to protect themselves from the horror of what really happened. This was common thinking in the 1980’s. Good memories could be false, bad memories were real.

    What a sorry mish mash of ever changing explanations and pseudo-intellectual gobbledygook.

    This all boils down to clinicians and patients who haven’t the humility to admit that they went temporarily off their rocker. It’s that simple. It’s an unflattering comment on the nature of humanity, in particular the character of the mental health profession.

    .

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    • @Steve. Chris Sizemore, AKA the Three Faces of Eve proports to have developed alters after witnessing violent acts like you describe regarding combat vets. That is a fact that you will also not hear the DID supporters talk about – if it’s known in the first place.

      My take on the DID excuse of repressing traumatic events is due to issues like betrayal trauma = sexual abuse by a parent or other loved family member.

      You are absolutely correct about good childhoods not being believed. Evil is what DID is all about. Remember evil, relive evil, spend time feeling betrayed and unloved. Those thoughts would make anyone dissociate, drink, drug, whatever to get away from the pain. Now………… I did NOT say it would make someone develop Personalities. Quite a hughejump that I won’t take.

      I agree that most clinicians do not care enough about their patients, or their profession, to be honorable and stand up against this horrific injustice levied against patients. That goes for clinicians who treat the amorphous DID or not.

      As many people before me have said: this is a modern-day witch hunt.

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    • shen

       /  06/15/2011

      Well, Steve, I haven’t interviewed all the combat veterans with PTSD, so I can’t tell you what they do or do not experience. Of course, I’m fairly certain it was not sexual abuse before the age of five, but I don’t really know. I also don’t know why you people feel so certain that no one can have an experience just because you haven’t had it.

      I’m okay now. I’ve been sick all day and coming in here over and over for reasons I can’t understand. I have talked to my therapist and she has given me some tools to use to identify why I give a flying fuck what you all think. I will work with her tomorrow and then I will be able to put you and your XXXXX behind me. I’m glad you have all the answers… I’m still trying to figure out some of my big questions and I’m very glad I have the help of someone who is compassionate and caring and willing to do whatever needs to be done. It works for me. I’m very sorry if it hasn’t worked for you…

      of course you do actually have to try and trust.

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      • So what you are saying is that combat PTSD is different than DID PTSD? I haven’t read that – except if you are referring to betrayal trauma et al.

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      • Steve

         /  06/15/2011

        Shen,

        Do you want me to believe that sexual abuse before the age of five is more traumatic than combat? This is the sacred cow that even websites like this rarely dare to question. Shen’s suffering is greater than that of combat vets? It’s more horrific than seeing bodies blown apart, of friends dying bloody in your arms with their insides hanging out, of killing innocent civilians, some of them maybe children? You’ve got to be kidding me.

        You need to spend some time with people who’ve really suffered, Shen. It’s probably the only thing that can cure an incorrigible narcissist such as yourself.

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        • @Steve. I understand your point – I wouldn’t go so far as to say that one person’s trauma is more severe than another’s. Along the lines of your statement, I question why combat vets are not displaying multiple personalities by the thousands? How about tsunami survivors? Or nuclear reactor fall-out survivors? and on and on.

          It would appear that most people in the world cope with trauma some way. They don’t flock to therapists. They don’t develop multiple personalities. They don’t stay in therapy and relive the trauma over and over. They do not act like little children and cuddle teddy bears. The reports regarding therapists flooding natural disaster zones has not shown to be helpful or to make a significant difference. Americans seem much less resilient than the rest of the world and to have more delicate psyche’s. Why is that?

          Alter personalities do not remotely seen as a metaphor – they are treated as real and separate entities.

          What’s a shame is that many people dx with DID do not have anything more to go on regarding their alleged trauma except for new or recovered memories or a list of “symptoms”. Many of them have no corroboration and even siblings don’t agree. Take Rosanne Barr as a high-profile case. How many years did it take her to come to her senses about DID therapy? At least she did it and her family has a chance to reunite and heal.

          The lack of resilience shown by DID proponents is an unfortunate byproduct of treatment. Maybe they, and their therapists, should all go to a 3rd world country and learn how other people cope with trauma without developing multiple personalities?

          Take Chris Sizemore’s example (the woman the Three Faces of Eve is based upon). Her trauma that led to multiple personalities (and there were around 21, not 3) was seeing a man severed in 1/2 at a mill and another time she witnessed a dead person retrieved from a ditch. Both occurred within a 3 month period, if memory serves me, when she was 2 or 3. Much of her memoir has inconsistencies in it just as all other anecdotes about the origin of a particular individuals DID onset.

          I suggest all people who support DID read it Chris Sizemore’s memoir- “My Life”. It shows clearly the toll it took on her husband and children. Her daughter became her caretaker and her son was in the shadows. The financial toll it took was enormous. How her husband hung in there is beyond me. Chris was demanding, the center of attention at all times and stressed the family to the breaking point.

          Then when she got better, she went on book and movie tours and left her husband alone – yes, she was bringing in money. But when he developed health problems, she didn’t find it necessary to stay at his side. Her reasoning was that she had not lived in the past and was hell bent on living then. Her husband was left alone.

          She mentions how her doctors Thigpen and Cleckly gained notoriety from her story as well as financial gain – she got a mere $8,000 from the sale of her story. Clearly, therapists used her for their own purposes as many other do.

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          • Steve

             /  06/15/2011

            Jeanette,

            I think being able to place ones “trauma” in perspective is essential to getting over it. That’s the essence of Viktor Frankl’s book, ” Man’s Search for Meaning”.

            Frankl was a Jewish psychiatrist who survived a Nazi concentration camp. The experience led to his theories of psychotherapeutic practice and to the book.

            It should be noted also that the saying among Holocaust survivors is ” Never Forget”.

            It’s not ” We Can’t Remember “

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          • good point, Steve.

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