Letters to the Editor
Reply: The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder
Dear Editor: We appreciate the opportunity to respond to Dr Coons, Dr Sar, and Dr Fraser.
Dr Coons’ letter confirms an important point in our article, which was that his paper neither details nor sufficiently documents the nature of the abuse he claims the patients had suffered. For example, how many children experienced fondling as opposed to more serious forms of sexual mistreatment? What, exactly, did the mothers and police observe? For what, specifically, were jail sentences imposed? A further weakness of his article is that it does not make clear how many of those who had “reported their abuse” had actual corroboration.
We believe our article adequately explains our reasons for criticizing the dissociative identity disorder (DID) diagnosis. We also believe that Dr Coons’ comment about the False Memory Syndrome Foundation represents some sort of slur suggesting that we are interested in protecting abusers. It is unworthy.
Dr Sar misquotes us. We did not ask about the paucity of childhood dissociative disorders but, rather, why the literature contains so few cases of childhood DID. Dr Sar claims that he and his colleagues found 5 Turkish children whom they diagnosed as having DID. The claim misses the point. First, their cases suffer from exactly the same deficiencies that we criticize in our paper—lax, vague, and overgenerous criteria for what constitutes a “personality”; failure to rigorously exclude other diagnoses; and inadequate attention to the possibility that symptoms were iatrogenically reinforced, to name 3. Second, even if the validity of these 5 cases were granted, the point would still remain that, if the posttraumatic theory of DID were correct, the condition should be reported in children much more frequently than it has been.
We would have to take Dr Sar’s word that his patients had no previous information about DID, and he implies that they never experienced any suggestive questioning. Given the wide dissemination of dissociative disorder concepts, one can only wonder at his confidence that either could be the case.
Finally, Dr Sar mentions standard scientific research and scholarship; we think respect for logic should be an important part of such scholarship—and to answer the question he poses, we are attempting nothing more or less than to point out the illogical nature of many of the concepts of DID diagnosis.
Dr Fraser agrees with us that overenthusiastic therapists have made excessive claims about DID. However, we are unaware that any “trained and experienced therapists of the dissociative disorders” have ever publicly specified and repudiated examples of those excesses. These excesses include Fraser’s own flirtation with wild stories of satanic ritual abuse (1). Until such repudiation occurs, the diagnostic and therapeutic excesses remain “on the books,” so to speak, ready for therapists to bring them forth to treat future patients.
As for his belief in the promise of brain imaging to discover markers of dissociation, we wonder how many hundreds or thousands of personality homunculi he will be able to get to dance around the top of the pineal gland.
References
1. Fraser GA. The dilemma of ritual abuse: cautions and guides for therapists. Washington (DC): American Psychiatric Press; 1997.
August Piper, MD
Harold Merskey, DM
Seattle, Washington
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