DSM 5: Multiple Personality Disorder - Manufacturing an Epidemic

"Only seldom", wrote Mikkel Borch-Jacobsen in 1997, "can we date the emergence of a psychiatric syndrome with such precision: Multiple Personality Disorder (or MPD, as it is known to psychiatrists) was born in 1973 with the publication of Flora Rheta Schreiber's book Sybil ... Schreiber's book was ... the first one that firmly tied multiple personality to child abuse, a notion that had gained widespread recognition in the 1960s and that was to become an essential feature of present-day Multiple Personality Disorder."[1]

Multiple Personality Disorder entered the DSM nomenclature as a separate diagnosis with the publication of the DSM-III in 1980.

The DSM-III criteria were:
A. The existence within the individual of two or more distinct personalities, each of which is dominant at a particular time.       
B. The personality that is dominant at any particular time determines the individual's behavior.    
C. Each individual personality is complex and integrated with its own unique behavior patterns and social relationships (p. 259)

See: DSM-III-R Revisions in the Dissociative Disorders: An Exploration of their Derivation and Rationale.[2]

"In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate," Wrote Ethan Watters in the New York Times.[3]

Many recovered memory supporters point to the various DSM editions as evidence for the legitimacy of recovered memory therapy.  Pro DID organisations may do the same, but the DSM cannot on its own account for the MPD epidemic.

It might be argued that Mikkel Borch-Jacobsen isn't quite correct with regard to his dates - or it that the period before Schreiber's book was a period of slow gestation.  Either way, as Canadian science philosopher, Ian Hacking observes...

"... in 1972, multiple personality had seemed to be a mere curiosity. “Less than a dozen cases have been reported in the last fifty years.” You could list every multiple personality recorded in the history of Western medicine, even if experts disagreed on how many of these cases were genuine. None? Eighty-four? More than a hundred with the first clear description given by a German physician in 1791? Whatever number you favored, the word for the disorder was rare."

"[By] 1992, there were hundreds of multiples in treatment in every sizable town in North America. Even by 1986 it was thought that six thousand patients had been diagnosed. After that, one stopped counting and spoke about an exponential increase in the rate of diagnosis since 1980. Clinics, wards, units, and entire private hospitals dedicated to the illness were being established all over the continent. Maybe one person in twenty suffered from a dissociative disorder."

Ian Hacking

Ian Hacking, Rewriting the Soul: Multiple Personality and the Sciences of Memory (Pinceton: Princeton University Press, 1995).


Undoubtedly the publication of 'Sybil' was a water-shed.  The book was made in to a  film with the same title in 1976.  A made-for-television movie was broadcast in 2007 but doubts over Schreiber's therapeutic techniques and the honesty of her reporting had been raised by then. The tele-movie failed to have the impact generally attributed to the earlier publications. [5]

But the scenario will be all too familiar to anyone with a passing knowledge of the emergence of transgenderism and identity theory.  Schreiber had not been entirely honest with her account of 'Sybil's' therapy.   By the time that was discovered 'Sybil', like John/Joan, had entered the realms of psychological myth - and again like John/Joan,  it was all too often accepted as evidence for the existence of MPD: not as evidence of sloppy and misleading reportage. [6] [7]

Through the 1980's and into the 90's multiples became standard fare on American television chat shows such as Oprah and and Phil Donahue:

"Phil Donahue was apparently the first talk-show host to present a program on MPD; he was followed by Sally Jessy Raphael, Larry King, Leeza Gibbons, and Oprah Winfrey. Meanwhile, celebrities were coming forward with their tales of childhood sexual abuse: Roseanne Barr, La Toya Jackson, Oprah herself.

Phil Donahue

Some of them claimed to be multiples as well.  Roseanne, who had unearthed twenty-one personalities within herself—Piggy, Bambi, and Fucker, among others—made the rounds. Again and again on the talk shows it was stressed that MPD was not rare; it was common, and becoming more so. "This could be someone you know," said Sally Jessy Raphael.  Oprah's program was called "MPD: The Syndrome of the '90s."  Today, as people are sifting through the wreckage created by the MPD movement, many therapists are blaming the media for spreading the epidemic..." [8]

Mental health professionals must also hold themselves accountable.   Under the heading, 'The Catch 22 of professional associations' Swedish psychologist, Germund Hesslow, has noted:

"...professional associations are ... often the only authority to which society can turn for information on the scientific basis of these services ... They are also instrumental in shaping the rules of medical insurance ... One of the clearest examples is probably the Diagnostic and Statistical Manual of Mental Disorders, DSM IV, published by the American Psychiatric Association ... The DSM IV is presented as a scientifically based document, although it is now well established that lobbying from interest groups has influenced decisions to include certain diagnoses. It is in the interest of the APA’s members to have as many conditions as possible classified as psychiatric illnesses." [9]

The DSM-IV diagnosis for Dissociative Identity Disorder can be found HERE:

Hesslow's argument addressed the vexed issue of recovered memory therapy and multiple personality disorder (now DID).  He might just as well have been discussing 'transgenderism' and gender identity disorder (GID), soon to drop the 'D' and become gender incongruity - also heavily influenced by 'client' lobbying and special interest (true believer) groups.

The end of the 1990's bought a sudden and significant decline in MPD diagnosis. For a period of some twenty years it had boomed as part of psychiatric/psychological myth and in the popular culture.  During that time the diagnosis was almost exclusively confined to North America.

Shirley Ardell Mason

In the latter half of the 1990's information that the diagnosis and the 'fringe' treatments, such as hypnotic age regression, far from leading to a panacea, could actually harm its recipients, came to light. For one thing  Shirley Ardell Mason - the person depicted as 'Sybil' in  Flora Rheta Schreiber's book of the same name - did not benefit from the happy conclusion reported by Schreiber.
See Unmasking Sybil, By Mark Miller and Barbara Kantrowitz. [10]

This has been reflected in a number of other cases.  For  just two examples See, Therapeutic Influence in DID and Recovered Memories of Sexual Abuse, Ralph Underwager & Hollida Wakefield. [11]

Dissociative Identity Disorder, along with repressed memories and the other so-called dissociative disorders, were inexorably linked to outrageous claims of child sex abuse, satanic ritual abuse and alien kidnap stories, all faithfully dredged up from the 'subconsciousness' of various clients with the aid of hypnosis and, sometimes, a variety of supposedly psycho-therapeutic drugs, such as Amytal, Nembutal, or Pentothal. [12]

These drugs are commonly popularised as 'truth serums', but  science does not support the notion that any patient so administered is either incapable of telling a lie or of distorting the memories they access whilst under the drug's influence.
See: Amytal Interviews and "Recovered Memories" of Sexual Abuse [13]

Despite, or perhaps because of, that the psychological history of 1980's and 90's could be characterised by a tsunami wave of increasingly improbable legal and psychosocial claims.  Parents found themselves protesting their innocence both in the legal system and the court of public opinion.  Legal defences were raised and convoluted legal documents written on the issue of mens rea and the legal responsibility of alters.
See for example:
http://lawweb.usc.edu/why/students/orgs/ilj/assets/docs/10-2%20Saks_Article.pdf
http://www.hawaiipsychology.org/CE/2008_Behnke_ethics/Behnke_CV.pdf

The common law is adversarial.  Expert witnesses quickly found themselves in opposing camps, testifying from opposing positions.  This alone was almost guaranteed to ensure that the legitimacy of multiplicity (DID) and recovered memories would be rigorously questioned within the mental health professions.  That is not to suggest that legal argument was the only reason.  It is to argue that, in demanding 'expert' witnesses take adversarial positions,  legal contest played a significant part in forcing 'experts' to examine all the different possibilities. That has not happened in the case of transgenderism and identity theory, with the result that there has, as yet,  been no serious challenge to these tropes from within the profession.

Inevitably the DID debate also took place outside the courtroom.  It was the robust nature of that discussion - the drawing attention to the inconsistencies and ambiguities of dissociation that ultimately collapsed the shaky pedestal the dissociation epidemic rested upon.

Despite the predictions of some, the diagnosis is not yet ready to disappear.  See: Overview, Conclusions, and a Guess About Timing [14]

It will remain in the next instalment of The APA's diagnostic bible - the DSM-5. [15]

Of interest in the future will be how often it gets used and who uses it.

For more in-depth analysis go: HERE

Researched and written by Jo. Proctor.