Letters to the Editor
Re: The Persistence of Folly:
A Critical Examination of Dissociative Identity Disorder
Dear Editor: This letter is in reply to Dr Piper’s and Dr Merskey’s 2 papers on the “folly” of the concept of dissociative identity disorder (DID) (1,2). Psychiatrists are, of course, entitled to their opinions about any disorder; however, the prominence given these 2 papers may create the impression that the authors have the imprimatur of the Canadian Psychiatric Association. I’m puzzled by why 2 authors who have obviously never treated DID (they say it doesn’t exist) are given such coverage. Were the peer reviewers qualified in the area of dissociative disorders?
Patients with DID already suffer from a dearth of therapists who are willing to work in this area of psychiatry. This article will do little to encourage young therapists to keep an open mind when presented with symptoms suggesting a dissociative disorder. Having treated many such patients to full remission over the past 25 years, I certainly do not share Dr Piper’s and Dr Mersky’s skepticism. I concede that overenthusiastic and undertrained therapists of various disciplines have made sometimes dramatic claims about DID. In psychiatry, much has been learned about improving questioning techniques from cases where leading questions sometimes led to unfortunate results. Trained and experienced therapists of the dissociative disorders applaud that their overzealous colleagues have corrected these misunderstandings and are now aware of the guidelines available for cautious management of such disorders. Nevertheless, we are dismayed that detractors continue to attack on the basis of issues that no longer exist!
The serious study of dissociated minds will allow us to map out the basic neurologic networks that will shed light on what constitutes a normal personality. Surely the time has come to put away the slings and arrows and appoint a group to scientifically study the phenomena of DID. Input should come from both trained therapists of the dissociative disorders and from those others who proclaim iatrogenesis and “folly.”
As with many other psychiatric conditions, the problem at present is that there is no diagnostic biological measure of dissociation. Until this exists, polarity of opinion will continue to exist, and more arrows will be loosed. However, I believe that, with ongoing studies using functional magnetic resonance imaging and positron emission tomography scans, we are on the brink of discovering potential markers of dissociative pathway functioning. If I am right, Dr Piper’s and Dr Merskey’s prediction of the demise of the diagnosis of DID within 10 years will be emphatically proven wrong. Further, I argue that, when we objectively prove the existence of dissociated mind states, we will be in a position to better understand the foundation of a single, integrated personality. Until this happens, I suggest that therapists keep an open mind and study the phenomena, not just the literature.
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. Piper A, Merskey H. The persistence of folly: A critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder. Can J Psychiatry 2004;49:678–83.
George A Fraser, MD, FRCPC
Ottawa, Ontario
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