Abstract
Harold Merskey [1] in 1992, somewhat famously, published in the British Journal of Psychiatry, ‘The manufacture of personalities. The production of multiple personality disorder’. This paper exemplified the divergence of opinion between what seemed to be most of British psychiatry and a substantial grouping of North American psychiatrists and associated mental health professionals who were researching and treating patients with dissociative disorders, a spectrum of conditions that had been included in the DSM-III of 1980.
Valerie Sinason is a child and adult psychotherapist. The volume that she edits includes an introduction by herself and 16 chapters by separate authors which focus on the development of dissociative disorders, attachment theory perspectives, treatment, the practicalities of recognition and treatment within the British health system, and some miscellaneous topics such as ‘dissociation and spirit possession in non-Western countries’ and an interview with Flora Rheta Schreiber (the author of ‘Sybil’). With one exception, Jean Goodwin, all the authors are based in Britain and thus the volume represents the most substantive multi-authored volume on dissociative identity disorder (DID) yet published in that country, coming a decade after Merskey's pre-emptive obituary.
Sinason's book is one of substantive historical significance in the dissociation field, yet embedded in the contributions is clear evidence of most of the faultlines that have proved elsewhere to be major challenges. The volume is patchy, ranging from anecdotal and somewhat emotive pieces through to scholarly and objective expositions – a particularly fine example being Peter Fonagy's chapter, ‘Multiple voices verses mega-cognition: an attachment theory perspective.’
Many of the contributors have substantial links with the British psychoanalytic movement and/or attachment theorists. Not unexpectedly there is collectively a heavy emphasis on the work of Klein, Fairbairn, Winnicott, Bowlby, Ainsworth, Main and Fonagy among others.
It is historically interesting to learn that toward the end of his life, John Bowlby, as a clinical supervisor was actively proffering a suggested diagnosis of MPD. John Southgate recounts a consultation from 1988.
I showed him lots of drawings of little children being abused and telling me their stories of unbelievable horrors. My patient was a middle-aged woman who could not understand why I could not understand these children. John mused and thought, looking away and thinking as he often did and said ‘I think this woman is a multiple personality’, and I said – a what? He said there is a lot of work in the USA on dissociation and proposed that I should talk to these children and listen to the story they were trying to tell me.
An underlying emphasis for a number of contributors, including Sinason herself, is the issue of ritual satanic abuse. In describing one patient, Joan Coleman ventures: ‘It finally emerged that she had been brought up within a satanic cult which was currently operating, and that these trance-like episodes were dissociative phenomena.’ Coleman goes on to say that she had ‘worked clinically with a number of other survivors of satanistic ritual abuse, most of whom clearly showed multiple personality and that she had spoken to at least 300 therapists, all of whom have clients who have suffered ritual abuse.’ In the absence of presenting any verifiable evidence, Coleman describes many such clients as having been ‘brought up in families that had practised Satanism through several generations.’
Despite providing no references to support the claim, it is quite perplexing for Sinason herself to state in the book's introduction that ‘in America the largest amount of DID is diagnosed in connection with allegations of ritual satanist abuse.’ For those contributors who uncritically accept as historical truth claims of widespread satanic abuse and associated child murder and so on, there is a dearth of references to forensic evidence of such events.
All of the North American researchers/clinicians in the dissociative disorder field, whose work had stood the test of time, are collectively individuals who have been very disciplined in not leaping beyond the available data. Many, such as Frank Putnam [2], even in the early 1990s were urging extreme caution in accepting some patients' accounts of satanic abuse as literal historical truth.
While others accept without conjecture, the accuracy of historically unlikely events, the clinically cautious psychoanalyst Phil Mollon makes mention of accounts of trauma on the part of one patient which, ‘whilst not appearing completely beyond the bounds of possibility, did seem most unusual in a way which invited scepticism’. Mollon grapples with the ‘implicit optimism’ of many American texts on the treatment of dissociative disorders. In contrast to the rather fervent tone of other therapists in this volume, Mollon's view of therapy is perhaps the least sanguine to appear since Joseph Breuer cautioned that one should never consider treating more than one hysterical patient. ‘The endeavour, begun with such goodwill, may consume years of work and create immense stress and turmoil for both therapist and patient. Indeed, if therapeutic work with an MPD patient goes awry, it may consume an entire career.’
This volume provides some passages of brilliance, some passages that ominously suggest lessons not yet learnt, and much that speaks of a growing awareness in Britain of dissociative disorders in the decade preceding its publication.