Monday, August 20, 2012

Dissociation, DID, Culture, and Empirical Evidence

Dissociation is some kind of human phenomenon that crosses time and place in the human experience.  Most forms of dissociation occur in the context of religious ecstasy.  There are many many examples.  Umbanda in Brazil.  Indigenous Taiwanese healers.  Balinese ritual trance (people have been know to go into spontaneous trance states even working in factories in Indonesia).  Pentecostal direct experiences with the Holy Spirit.  Speaking in tongues.

Umbanda trance

The list goes on.  But, we find that dissociation manifests differently in different cultural contexts.

Dissociation itself is not what is in question, but Dissociative Identity Disorder (DID), previously known as multiple personalities, is.

In North American culture, dissociation generally manifests, if not in a tent revival, than in the context of hypnosis or with the patients of certain therapists with proclivities for the promotion of DID.

Does DID occur universally or is it a product of the North American culture of psychopathology?  We already know that mental health disorders can be a product of cultural place and time.  Hysteria in Victorian Europe and America is one well known example.  Neurasthenia in China is another example that has been written on extensively.

Is DID another disorder that is not universal but tied to the Zeitgeist of a particular place an time?  Right now the field of mental health is in an intellectual tug of war on the topic.  We have the historical record that gives us some insight.  The concept of multiple personalities appeared early on in the development of the field of psychology, but it was an extremely rare diagnosis up to a certain point.  That point was the publication of "Sybil" in 1973 and the subsequent film adaptation.  This was the story of Shirley Mason, AKA Sybil Dorsett, who claimed to have multiple personalities, (and later said she made the whole thing up to please her therapist, and then changed her mind again).  After the popularization of multiple personalities by "Sybil" it became a mainstream diagnosis and has benefited from several waves of popularity since.
Sally Field acting
Shirley in youth
"Sybil" acting?
Dr. Richard J. McNally, et al., has now provided us with an empirical window on the topic.  He crafted a controlled study to test a fundamental basis of the DID construct, the amnesic barrier.  The amnesic barrier being the concept that as a DID identified individual transitions from personality to personality, the one personality has no direct memory of the other personality or personalities.

These researchers used a concealed information task that consisted of flashed words on a screen in which subjects were instructed to push "yes" or "no" based on whether or not the word was on a list.  What DID identified subjects did not know is that some of the words flashed on the screen were taken from surveys conducted with at least two of each of their personalities.  The words were specific to the personalities, such as the name of a friend or a favorite food, for instance.

The crux of the study was on a microsecond lag in pressing the button related to words autobiographical to the personality.  This occurred as expected.  Unfortunately for the construct of DID, the same delay occurred for words related to alternate personalities (not currently present/aware personalities), showing that knowledge crosses alternate personalities, undermining if not disproving the amnesic barrier.  It also implies, if not deception, at least an attempt on the part of the subjects to conform to the cultural model of DID.

McNally concludes that "Cultures provide envelopes for people to express suffering or psychological pain and DID is one such cultural trope. . . . I don't think much would be lost if the diagnosis were eliminated from the Diagnostic and Statistical Manual."

Source:  "A story that doesn't hold up" in the Harvard Gazette

Original paper is on PloS ONE here

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