Multiple Personality Disorder (Hysterical Dissociative Disorder) and the DSM-II

Standard

DSM I (Diagnostic & Statistical Manual of Mental Disorders, Version I) was created after WWI to provide a framework for labeling post-war psychiatric causalities. DSM II was written after WWII for the same purpose. Vibration-is-lifeThe texts were written in the USA by American psychiatrists. The International Code of Diseases (ICD) at that time through its present 9th edition has adopted these terms. MPD was listed as Hysterical Dissociative Disorder. As of the publication of the DSM-IV, psychiatric terminology distinguished two disorders that were once labelled ‘hysteria’: somatoform disorder and dissociative disorder.Patients with hysteria often experienced what has been termed as the Cassandra Effect. In Greek literature, Cassandra was a woman whom Apollo fell in love with and bestowed upon her the gift of prophecy. Cassandra1_jpegWhen she rebuffed his advances, he cursed her with the predicament of not being believed. Hysteria had been a favourite term with Victorian Era psychiatrists, especially that of Sigmund Freud. Hysteria was strictly a female phenomenon that included faintness, nervousness, sexual desire, insomnia, fluid retention, heaviness in the abdomen, and many other symptoms. One physician catalogued seventy-five pages of symptoms; by the time he was done, even a sneezing fit could fit the diagnosis. Doctors thought that stresses of modern life caused women to develop faulty reproductive tracts (a wandering uterus).

Josef Breuer – Anna O.
Anna O. (Berta Pappenheim) was a patient of Breuer’s in the early 20th century. He diagnosed Anna with hysteria due to symptoms that included “severe cough, Anna_Oparalysis of the extremities on the right side of her body, and disturbances of vision, hearing, and speech, as well as hallucination and loss of consciousness.” Breuer observed that she experienced ‘absences‘, a change of personality accompanied by confusion Breuer decided that Bertha Pappenheim‘s illness was caused by her father’s death. He died on 5 April 1881. At the time she became “rigid” and did not eat for days. Breuer’s treatment included force-feeding and chloral injections. .

He described Anna’s behaviour as follows:

She had two completely separate states of consciousness which alternated quite often and suddenly, and in the course of her illness became more and more distinct. In the one state she was sad and apprehensive, but relatively normal. In the other state she had hallucinations and “misbehaved”, that is, she swore, threw pillows at people.

Breuer thought she was deranged and hoped she would die to end her suffering. However, Anna disappointed him: she recovered and led a productive life. Anna’s symptoms fitted the definition of what was known at that time as “split personality.” 

In the DSM-II hysteria dissociative disorder was a minor condition in the manual. It lacked its own code number. The DSM-III gave “Dissociative Disorders” its own section. Experts decided which disorders should be listed in DSM-IV. Skeptics disagreed that MPD existed. Instead they concluded that patients believed they had more than one personality. The goal of therapy wasn’t integration but helping patients to overcome the belief that they had other personalities.Accordingly the name was changed to DID, dissociative identity disorder in the DSM-5.

What I don’t comprehend is how a patient would believe s/he had multiple personalities in the first flockplace, thereby needing to be cured of this delusion. Who puts the idea into the patient’s head? If anything, multiples typically argue against the notion that they possess alters and initially refuse to accept the diagnosis and integration since they believe it isn’t needed. Joan Francis Casey, in her text Flock: The Autobiography of a Multiple Personality” demonstrated great resistance in therapy about the diagnosis, to the point where she angered her doctor. Doctors who refute the diagnosis of MPD haven’t addressed this issue to the best of my knowledge.