Does Dissocative Identity Disorder (DID) really exist? What was formerly known asMultiple Personality Disorder (MPD) (and throughout this paper both terms MPD and DID willbe used interchangeably) has become somewhat of a debate. Some call it a fad, some sayPsychiatry is now being taken out of the dark ages. What ever you believe, it’s being talked about.      The DSM IV's diagnostic criteria include:

     1) The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
     2) At least two of these identities or personality states recurrently take control of the person’s behavior.
     3) Inability to recall personal information that is too extensive to be recalled by ordinary forgetfulness.
     4) The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
     The psychiatric world is in conflict on the existence of multiple personality, and statisticsspeak for themselves. In a recent survey of 1000 psychiatric professionals holding a doctoratelevel degree, (selected from a pool of 31,818 professionals within the APA), 79% of therespondents believe that MPD does in fact exist, 8% do not. 62% of the respondents believe thatDID is extremely rare and 33% believe that dissociation in general is rare. 28% of the respondentsbelieve that DID is feigned for secondary gain, 9% believe that they have had a client feigningMPD. 38% of respondents believe that multiple personality is better characterized by calling it ahysterical or a conversion disorder. 84% believe that MPD occurs due to childhood trauma, andnot through hypnosis (55%) or via media influence (51%).65% believe that it does occur crossculturally. (Cormier, Thelan, 1998).
     The issue of the validity of DID is based on repressed memories, hypnosis (including itsmisuse), and malingering. To understand where these issues arise from, lets look into where DIDcame from, based on findings in biological, psychological, and social factors.
     Very little evidence has been presented on the biological factors in the etiology ofdissociative disorders. Some say it is just temporal lobe epilepsy, or related to a disorder withinthe temporal lobe. Some say it is prosopagnosia (an impairment of recognizing faces) (Oltmanns,1998). We do know that dissociative disorders seem to be related to the high ability to behypnotized, and physiological function seems to vary across the personality states. There alsohave been studies indicating that DID is more common among first degree biological relatives(DSM4, 1994). The psychological factors are believed to be a result of childhood trauma,particularly the trauma of child abuse(Oltmanns, 1998) The model of dissociation we learn is thatthe child, so incapable of comprehending what is going on with her, (there are cases of males withMPD but, the majority of survivors in therapy are women. From this point on, the patient will bereferred to as female) will submerge herself in fantasy, imagining the abuse is happening tosomeone else. Social factors say that since the child can not go to another person (implying if theparents won’t help, I will get someone else), they will turn to themselves for comfort. Onetheorist has been so bold as to say that it is a case of iatrogenisis (Spanos, 1996), or a patienttakes on the role of what the therapist believes to be true about her.
     The validity of repressed memories is a core issue in the validity of multiple personality. Ifrepressed memories do not exist, can multiple personality? Those patients that are diagnosed withMPD are highly suggestible and highly hypnotizable. They are prone to memory implantation(Loftus, 1994) and confabulation. The statistics of those diagnosed with multiple personality andthe abuse that they endured from a sampling of 100 patients include 83.9% who claim to besurvivors of sexual abuse and 75% who claim to have a history of physical abuse (Oltmanns,1998). Are these accounts merely the work of overzealous therapists implanting the memories?When do false memories occur? Loftus tells a story of false memory about a patient, named"Sara". Sara employed screen memories of a ritual mass murder in her Sunday school class toprotect herself from believing the truth that her grandmother was less than perfect as she readgrisly stories to the child from her detective magazines. The screen memory was implemented topreserve the memory of a loving grandmother, wheeled in to cover the drab emotional abuse.Screen memories are also created to cover the more prosaic forms of abuse. Sara did indeed havea false memory, to serve as a protection from the real memory (Loftus, 1994). Another issue ofrepressed memory is this: why is it that none of these accounts of abuse can be proven? (Ofshe,1996) The fact is, many of the patients claiming multiple personality (95%) do offer the therapistdocumentation including the perpetrator’s verbal confession to the therapist and medical proof ofscarring from abuse (Kluft, 1996). While it is true that false confession does exist,(Loftus, 1994)can 95% of these accounts of proof be wrong?
     Do multiples qualify as even having repressed memories? People with MPD became suchfrom a self defense mechanism that put a protective wall around them, shielding them from theabuse (Cline, 1997). The memories are never lost, in fact the alters (term used from this point onto describe the identities in the multiple) that took the abuse feel the memories with the sameintensity that one would expect to see in a survivor that was violated just moments ago. The hostpersonality, whether or not it is the core, (Putnam believes that the host is usually NOT the birthperson, and the birth person is usually the last part to surface. Putnam, 1989) is usually completelyamnesiac to the abuse, so she can carry out day to day function. The host is usually the part thatbegins therapy, receives the MPD diagnosis, and recovers memories. These memories, however,are not lost.
     Therapists who use hypnosis are under attack for creating multiple identities. Hypnosis is afavored technique used in the diagnosis and treatment of DID, due to the fact that peoplediagnosed with DID are highly hypnotizable, and using hypnosis helps them reveal memorieslocked behind walls of defense. (Bliss, 1985) Hypnosis, being a shaky science, is viewed asunreliable and leaves the patient open to false memories. (Spanos, 1996). Iatrogenic ailments areailments that are doctor made. The therapist will suggest and reinforce horrific memories. Annwas diagnosed with MPD and, when she became pregnant with her second child, began to see aspecialist in MPD. The doctor, who had recently attended many seminars on satanic ritual abuse(SRA), put Ann under hypnosis. He suggested that her psychotic grandmother (previouslydetermined to be the cause of her original dissociation issues) was in league with Satanists. Whenshe denied that this was the case, he instructed her to go home and think about it. In the followingsessions, he hypnotized her and iatrogenicly implanted the memories of satanic abuse, includingthe sacrifice of her child, when she became a baby breeder for the cult. She accepted this as thetruth, as it was reinforced each time she returned to therapy. The therapist, at the time of thebaby's birth, ordered that she have no contact with the child, in fear that a cult-loyal alter wouldsurface and harm the child. Ann’s husband, disturbed by the turn of events in his wife’s therapyhospitalized his wife, where the staff had orders to not reinforce any memories. The SRAmemories suddenly dissipated, and she returned to normal functioning (Loftus, 1994).
     Another incident of hypnotism gone awry was when Anne Stone, a woman presentingproblems of postpartum depression sought therapy. Her therapist began to suspect multiplepersonality disorder. Although Anne did not recall having any childhood trauma, the therapist wasconvinced that this was indeed the case. Through hypnosis, in a psychiatric hospital Anne wasdiscovered to be harboring many alter personalities and "discovered" that she was a high priestessof an international satanic cult. She "remembered" being involved in many cult rituals, and asword got around the psychiatric ward, other multiples "remembered" her taking part in their ritualmemories, including infant sacrifice. She then "remembered" having her children take part in therituals, and the children were hypnotized into remembering these accounts. Several years went by,satanic influences found in everything, and she found herself unable to continue to pay for thetherapy. She was released from this hospital into another, state run facility. The hypnosis wasdiscontinued, and her bouts with switching into alternate selves lessened, then stopped. She findsherself no longer remembering these incidents, and the truth then surfaced. She was neverinvolved in anything like the hypnosis told her. (Ofshe, 1996)
     Hypnosis can create more of a problem than it is worth. There is a case in which atherapist was having difficulties with his patient so he induced another personality to aid him fromthe inside. The alter was quickly created and was easily called at will. The idea did not work asplanned, and much dispute was created on the validity of this "alter" (Bliss, 1986).
     Hypnosis, when used correctly, can be a valuable tool. People who are truly recoveringmemories via hypnosis tend to be very exact and do not accept suggestion. These patients willcorrect the therapist when leading questions are asked. (Feldman, 1993)
     Some psychiatrists refuse to use hypnosis as it reinforces the fragmented, run and hidementality. In a dissociative state, the patient is in a self-induced hypnotic trance. To reinforce thisway of coping by using hypnosis tends to prolong therapy and intermesh the therapist with thepatient (fascination with the disorder can be detrimental to the healing process)(Cameron,Stienman, 1995). Chris Costner Sizemore (Eve in the Three Faces of Eve) also attests to therefusal of using hypnosis. When the book, The Three Faces of Eve was written, her psychiatristreadily used hypnosis to encourage her alternate selves to surface. Her doctors, after the bookwas written, refused to focus on the switching of identities, and the subsequent identities werethen integrated into the whole. It took 2 and a half years to integrate 2 identities through hypnosis(one of which she attested was created in hypnosis) and another 7 years to integrate the other 20identities. (Sizemore, 1989)
     Cases in which hypnosis has proven useful include Sybil, (Schreiber, 1973) in whichstandard analysis was implemented until the patient and the therapist came to an impasse andneeded to use hypnosis to further their work. Eugene Bliss is quite often quoted as claiming thathypnosis is the best way to go, as it encourages the multiple to use her ability to aide thepsychologist in the healing process (Bliss, 1985). Hypnotic techniques are useful in bringingdown amnesic barriers between alters, summoning an alter, either by name or by a description ofan act (like who destroyed the writings), and getting to the bottom of what caused the pathologyin the first place. (Putnam, 1989)
     There is also the wonder of malingering, or faking to receive secondary gain. This must bedistinguished from factitious disorder, or a feigned condition that, unlike malingering, is motivatedprimarily to assume the sick role rather than by a desire for external gain. We see the courts filledwith people claiming the diagnosis of MPD so they will not be held accountable. For instance,there is the case of the Hill Side Strangler. Kenneth Bianchi was charged with murdering twocollege women and was implicated in several other rape-murders where victims were left nakedon the hillsides in Los Angeles. Considerable evidence supported Bianchi's guilt, but he reportedepisodes of blanking out. Psychiatric opinion was called for. The psychiatrist in questionsuggested to Ken that maybe he wasn't alone, when Steve surfaced. When Steve was asked if heknew of Ken, the answer was yes, and that he hated Ken. Steve also confessed to the crimes,saying he killed "all those girls." Not surprisingly, numerous experts on multiple personality tookan interest in this case, and disagreed on whether or not the case of multiple personality was realor feigned. One of the psychologists that interviewed Bianchi was Martin Orne, a famous therapistinternationally known for his authority on hypnosis. Orne tested Bianchi to see if he was feigningby suggesting new symptoms. Orne suggested to him that if Bianchi really had MPD there wouldbe a third identity. As if on cue, a third identity surfaced, named Billy. Various other test wereconducted and Bianchi was determined to be indeed feigning multiple personality. The insanitydefense failed, and he was convicted of murder (Oltmanns, 1998). This is an excellent example ofmalingering.
     In the case of Willam Milligan, there is much speculation on the validity of his multiplicity.Milligan was arrested for multiple counts of rape. During an interview with a prison psychologist,Milligan suddenly stated that "Billy's asleep, I'm David." He was then seen by Dr. Wilbur, thepsychologist who treated Sybil. She verified that multiplicity was indeed the issue at hand.Milligan plead insanity for his case and the plea was uncontested. He was sent to a treatmentfacility, with the verdict of not guilty. Many people argue with this as being a valid case ofmultiple personality, as Milligan was faced with the fact that he was going to be sent to jail, andthis is the most convenient disorder to be used in an insanity plea (Aldridge-Morris, 1989).
     No matter what conflict, there will always be two sides, both with poignant arguments.There will always be conflict on the issues of Dissociative Identity Disorder, and there will alwaysbe someone out there that feels that DID does not exist. For every example of a seemingly validcase there will always be one that shows that there is a case of misdiagnosis, or plain malingeringfor secondary gain. There is no test to clearly diagnose multiplicity, though the MMPI will alwaysbe used as a means to help aide the psychologist in his decision of this disorder.
     Determining DID is not an exact science and every method can fall under attack.Repressed memory recovery is a controversy in itself, and a person who is determined to haveMPD through this process will also fall under attack. Hypnosis is a common parlor trick to see ifsomeone will act like a chicken. Hypnotic subjects, especially those that are highly suggestible caneasily take on the roles that are assigned to them, and alternate identities are the ultimate role.Issues of secondary gain and multiplicity are also a strong point in the fight on the validity onDissocative Identity Disorder. There will always be people that will imitate an illness so they willnot be held accountable, from depression to schizophrenia to multiple personality. Deviantbehavior is boundless as to what will be used to get away with anything. However, to discard adisorder, just on how bizarre it may seem is wrong. For many people Dissociative IdentityDisorder is the way they see life. The frightening periods of amnesia, the horrifying accounts ofabuse that are recalled by the individuals, and the idea that this is a possibly never endingnightmare are not easily discarded, nor should they be. The cases of those who unwittinglyfeigned their illness through the suggestion of their therapists briefly show how horrifying themere idea of multiple personality truly is. Those that feign this disorder due to having a factitiousdisorder are ill, possibly worse than the multiple which they are imitating. The true thing is not ajoke, and regressing to the era that if it wasn't a mood disorder or an anxiety disorder, it had to bea psychotic one, namely schizophrenia would be illogical.
     Abuse is an issue that one would prefer to sweep under the rug. No one wants to see thatothers may live a lifetime of horror from an incident that occurred many years ago. DissociativeIdentity Disorder (from a general consensus) is a product of abuse and a constant reminder to thepublic that there are things that will shatter a life. The bizarre lifestyle that manifests itself throughthis (that often sounds like a horror film or science fiction film) is frightening. No one with a heartwants to believe this, the psychiatric community included.

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