This is not a response to the statements in Colin Ross' book about multiple personality. It is a response to an article called Two-Year Follow-Up of Inpatients With Dissociative Identity Disorder where he claims that hospitalization and integration of multiple clients help them overcome things like depression, anxiety, drug addiction and impulsivity.

Ross was one of the worst offenders in the MPD craze of the 1980s, where many people were misdiagnosed with MPD by glory-seeking professionals. Now he has gone right round the bend and believes in eye beams.

The American Journal of Psychiatry
Am J Psychiatry 155:1462, October 1998
©Copyright 1998 American Psychiatric Association
Letter to the Editor
Treatment of Dissociative Identity Disorder
HAROLD MERSKEY, D.M., and AUGUST PIPER, JR., M.D.
London, Ont., Canada

To the Editor: The article by Joan Ellason, M.A., and Colin A. Ross, M.D. (1), is remarkable for a profusion of highly significant findings that are not scientifically meaningful.

In follow-up, those who have fared worst will be dead, unavailable, or uncooperative. Ellason and Ross obtained follow-up information on only 40% of their cohort. The high degree of selection in their study radically undermines their findings. We get no idea how many patients have deteriorated to suicide or died of self-neglect, have become incarcerated or hospitalized elsewhere, are homeless or cannot afford a telephone, or have suffered other causes of unavailability. Such patients would be unlikely to raise scores for improvement.

Ellason and Ross make no reference to the natural course of untreated dissociative identity disorder. Without this information, it is unjustified to imply that improvement resulted from the treatment. The Dissociative Disorders Interview Schedule lacks even face validity. It may be able to give replicable findings, but reliability does not prove validity. Patients who act a part may act it the same way twice, but a part in a charade is not a diagnostic entity. Likewise, Ellason and Ross rely on the Dissociative Experiences Scale, but Hacking (2) concludes that scientists whose aim is to discover facts would be "thunderstruck" by the practices on which the scale is based.

Dissociative identity disorder is highly controversial (even on this continent), liable to be produced and maintained by suggestion, profoundly flawed in logic (3), and promoted by social role expectations (4). A controversial diagnosis requires particularly well-drawn criteria for evaluation. However, the use of Kluft's (5) irredeemably nebulous "integration" criteria may trap the unwary. For example, Ellason and Ross accept "the absence of behaviorally evident separate identities." Yet Kluft has claimed that at the time of diagnosis, 40% of dissociative identity disorder patients may show no overt signs of the disorder (5). Perhaps Ellason and Ross excluded such cases from their cohort, but Ross himself (6) further complicates the matter. He warns that alter personalities may enter "inner hibernation," sometimes for lengthy periods in which state they do not manifest themselves to the outside observer. One wonders how the present authors determined that their subjects' improvements were not examples of this phenomenon.

REFERENCES

1. Ellason JW, Ross CA: Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry 1997; 154:832–839 [Abstract]
2. Hacking I: Rewriting the Soul: Multiple Personality and the Science of Memory. Princeton, NJ, Princeton University Press, 1995, p 112
3. Piper A Jr: Hoax and Reality: The Bizarre World of Multiple Personality Disorder. Northvale, NJ, Jason Aronson, 1997
4. Spanos NP: Multiple Identities of False Memories: A Socio-Cognitive Perspective. Washington, DC, American Psychological Association, 1996
5. Kluft RP: An introduction to multiple personality disorder. Psychiatr Annals 1984; 14:19–24
6. Ross CA: Multiple Personality Disorder: Diagnosis, Clinical Features and Treatment. New York, John Wiley & Sons, 1989

Contact the American Psychiatric Association at 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901 * 800-368-5777 * appi at psych.org.

See also Alters in dissociative identity disorder Metaphors or genuine entities? in Clinical Psychology Review - Volume 22, Issue 4, May 2002, Pages 481-497.

In his book,

Colin Ross claims that "alters", persons in multiple systems, are not people.

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