Letters to the Editor
Re: The Persistence of Folly:
A Critical Examination of Dissociative Identity Disorder. What Are Dr Piper and
Dr Merskey Trying to Do?
Dear Editor: In their recent review (1), Dr Piper and Dr Merskey claim that North American countries “export” their dissociative disorder concepts and refer in this context to one of my studies published 8 years ago in the American Journal of Psychiatry (2). Speaking from the perspective of 23 years in general psychiatry as clinical professor of the oldest university psychiatric department in Istanbul (a metropolis of 10 million having the full spectrum of psychiatric disorders), I attribute this ascription to a failure of both scholarship and international perspective on the part of what I understand to be the official journal of the Canadian Psychiatric Association.
Living in a country of 70 million persons representing enormous cultural and social diversity, I have had the opportunity to diagnose dissociative disorders among patients from various social strata ranging from the highly educated to the illiterate, from children to the middle-aged. Many new patients admitted to our emergency psychiatric wards over the years have presented with full-fledged dissociative conditions. These patients would have had no previous information about the disorder and no previous specific psychotherapeutic interventions. Istanbul is not unique in this respect: dissociative dis- orders have been reported from several centres throughout Turkey (3,4).
In the last decade, I have been involved with more than 100 studies on dissociative dis- orders, published in Turkish or English. The authors neglected to mention any of these studies or our publications on children and adolescents (5), thereby permitting themselves to question where children with dissociative disorders are to be found.
More pertinent questions would be What are the authors trying to do? Why the selective blindness to dissociation? Do the authors fear that their own presumptions are threatened by constructs like posttraumatic stress disorder and dissociative disorder (6,7)? We ought to prefer that this question be solved through standard scientific research and scholarship.
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. Sar V, Yargic IL, Tutkun H. Structured interview data on 35 cases of dissociative identity disorder in Turkey. Am J Psychiatry 1996;153:1329–33.
3. Tezcan E, Atmaca M, Kuloglu M, Gecici O, Büyükbayram A, Tutkun H. Dissociative disorders in Turkish inpatients with conversion disorder. Compr Psychiatry 2003;44:324–30.
4. Erdinc IB, Sengul CB, Dilbaz N, Bozkurt S. A case of incest with dissociative amnesia and post-traumatic stress disorder. Turkish J Psychiatry 2004;15:161–5.
5. Zoroglu S, Yargic IL, Tutkun H, Ozturk M, Sar V. Dissociative identity disorder in childhood: five Turkish cases. Dissociation 1996; 9:250–7.
6. Sar V, Akyuz G, Kundakci T, Kiziltan E, Dogan O. Childhood trauma, dissociation and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004;61:2271–6.
7. Sar V, Kundakci T, Kiziltan E, Yargic LI, Tutkun H, Bakim B, and others. The Axis I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. Journal of Trauma and Dissociation 2003;4:119–36.
Vedat Sar, MD
Istanbul, Turkey
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