Letters to the Editor
Re: The Persistence of Folly:
A Critical Examination of Dissociative Identity Disorder
Dear Editor: In their article published in September 2004 (1), authors Dr Piper and Dr Merskey respond to previous assertions that the “critics of DID ‘never review the literature adequately’” (p 593). In fact, the criticism is accurate. A case in point is their review of my article confirming childhood abuse in child and adolescent cases of multiple personality disorder (MPD) (2). In their article, Dr Piper and Dr Merskey allege that confirmation of abuse is lacking. I will quote directly from my article so that readers can make up their own minds:
Of the 9 patients with MPD, all reported either physical (89%) or sexual abuse (89%). Abusers included 7 fathers or stepfathers, 5 mothers, 1 brother, and 1 grandfather. Mean length of reported abuse was 8.3 years (range 3 to 14 years). All had reported their abuse to someone else and subsequently this abuse had been reported to child protective services. In 2 cases the abuse had been observed by the mothers and in a third case the abuse had been observed by the police. In 2 instances the parents both steadfastly denied any child abuse. In the remaining 5 cases no information was available about whether the abuse had been observed. In only one case was there absolutely no evidence to confirm previous child abuse. In 4 cases the children had been removed from the home by child protective services and in 3 of these parental rights had been terminated. Of the 3 cases where prosecution had been pursued, 2 ended in jail sentences for the fathers and one father was awaiting trial. Curiously, of the 2 mothers
who denied knowledge of abuse, both divorced their husbands shortly after allegations of sexual abuse surfaced (2, p 463).
The authors indicate that I did not state the frequency or the exact nature of the child abuse, which is correct, but I did state the mean duration of 8.3 years. Although it was not stated in the article, to be counted, physical abuse required at least beatings and sexual abuse required at least sexual fondling (in fact, it often involved sexual intercourse). During my chart review, I became extremely saddened and literally nauseated at the lurid reports of abuse and neglect.
Dr Piper and Dr Merskey never state how difficult it is to obtain corroboration of sexual abuse, since sexual abuse is almost never conducted in public. Nevertheless, in this small series, there were 3 observers. Interestingly, in this series, the corroboration was so strong that children were removed from the home, parental rights were terminated, and jail sentences were imposed.
I think that Dr Piper and Dr Merskey should explain their undue criticism of the diagnosis of dissociative identity disorder and, especially, their criticism of its traumatic etiology. They should also inform readers that they are both Board members of the False Memory Syndrome Foundation, an organization composed mostly of general members who have been accused of previous child abuse by their now-grown children.
References
1. Piper A, Merskey H. The persistence of folly:
A critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Can J Psychiatry 2004;49:592–600.
2. Coons PM. Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified.
J Nerv Ment Dis 1994;182:461–4.
Philip M Coons, MD
Indianapolis, Indiana
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