Abstract
An adult female patient (age 37 years) with a reported history of child abuse victimization perpetrated by her grandfather, evinced symptoms consistent with the controversial dissociative identity disorder (DID). She reported severe sexual and physical abuse over an 8–year period (from ages 4 through 12 years) that included insertions of sharp objects into her vagina and being hung from pulleys. She had been in psychotherapy for over 6 years. Altered child personality states usually emerged quite abruptly with marked changes in facial expression, tone and prosody of voice, vocabulary, and gesture; there were reportedly differences in handwriting, behavioural and affective expressions; some were more playfully informal, warm or witty than the patient's primary persona. There was a distinctly postictal quality with re-emergence of the adult; she would roll or close her eyes, seem semistuporous and then gradually regain orientation and awareness. The patient had been subjected to much scepticism by mental health professionals and was eager to have her condition ‘validated’ via a SPECT scan.
SPECT images (23.0 mCi of flow tracer 99m-technetium) obtained in the axial, sagittal, and coronal planes during the emergence of an alter-child ‘personality’ were associated with symmetrical activity increases in left and right temporal lobes, whereas left temporal asymmetric increases occurred when the patient was in her ‘adult’ state.
Our data converge with five other independent investigations using SPECT, EEG and MRI regarding an association between presenting symptoms of DID and temporal lobe functioning. Such a reliable association should not be taken lightly and requires explanation. Certainly these results are not surprising considering the connections between the temporal lobe and the limbic system (e.g. the amygdale, involving the processing of emotional responses and the hippocampus, vital to memory storage and retrieval). One theoretical explanation is that of ‘paradoxical functional facilitation’. That is, a reduction of left temporal activity accompanied by a loss of semantic knowledge and increased visual revivifying of early life experiences may have occurred in the childhood enactment [1].
Nevertheless, neuroscientists and practitioners blithely attribute symptoms of DID to antecedent traumatic events, albeit this connection has never been corroborated; they also accept the patient's self-report of child abuse without any type of corroborating evidence and fail to confirm the existence of DID symptoms prior to psychotherapy, an important consideration given possible iatrogenic aetiology of DID. In short, the patient in this case study may have displayed iatrogenic symptoms or may simply have been a very good actress [2]. In addition, the current findings are consonant with a number of competing explanations that involve temporal lobe functioning: seizures, transcendental beliefs, false memory, and other forms of suggestibility.