Abstract
In response to the article ‘Assessing markers of working memory function in dissociative identity disorder using neural stimuli: a comparison with clinical and general samples’ Australian and New Zealand Journal of Psychiatry, volume 38, no. 1/2, pp. 47–55, I was surprised by this paper as I had always understood dissociative identity disorder (DID) to be a controversial iatrogenic diagnosis whose origins and rise to prominence was related to social forces and American diagnostic fashion [1]. Although the authors quoted DSM-III they eschewed the far more ambivalent ICD-10 [2] which notes ‘this disorder is rare, and controversy exists about the extent to which it is iatrogenic or culture specific.’ Even greater scepticism is expressed in the New Oxford Textbook of Psychiatry [3]. Such scepticism is not confined to textbooks. In two surveys, fewer than 50% of U.S. psychiatrists believe the diagnosis should be present without reservation in DSM-IV, with an even lower percentage for Canadian psychiatrists [4].
I am thus troubled by research which uncritically accepts as valid, diagnoses such as DID. Such research in a circular way reifies ideas, giving them the appearance of solid, scientifically based diagnoses when they may be anything but that. The Dissociative Experiences Scale (DES) is an example of this process. This instrument was thoroughly disassembled and shorn of its mantle of scientific validity by Hacking [1], who described how its development and uncritical use in a circular way supported the ideas of the multiple personality movement and bought into being ‘the fact of a dissociative continuum.’ Yet despite the lack of scientific credibility, the instrument continues to be widely used. Perhaps all this would be no more than an abstract scientific debate if it weren't for the real possibility that diagnosing DID may harm patients through amplifying and pathologising distress, ignoring cultural and social contexts, and providing a false narrative for ‘understanding’ their distress while perhaps denying other more valid narratives.
A far narrower forensic concern is the transmission of unestablished ideas into the courtroom where they may be ascribed a reality unjustified on the basis of their standing in psychiatry. This is in seen in the defence of psychological blow automatism (PBA) where unsubstantiated and untestable ideas about dissociative disorders and dissociation (a concept which Janet later completely resiled from [5]) may be presented in court as well-established fact, giving wings to the pig of PBA and providing an avenue for acquittal for those defendants and their counsel able to conjure such a defence.
Given all the uncertainty about dissociative identity disorder, should research not be attempting to answer a more fundamental question: is there any place for dissociative identity disorder and why does this disorder have so much currency in some circles yet have none in others?