110. Iatrogenesis: It's all the therapist's fault

The Running of the Beast

We want to get a little more “technical” here for a moment. In the last few decades more and more people have been going to therapists and identifying abuse in their childhood and there have been those who claim that therapists are generating these ideas. They say that therapists are supposed to have created and encouraged people to “remember” abuse that never really happened and all kinds of false accusations have been made. As well, some people are saying the same thing about multiple personality, that again, it’s the therapist who is creating and pushing the client to be multiple. Hmmm.

Dr Colin A Ross, in his book “Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment”, begs to differ and he has some very good arguments that very few therapists are guilty of this. He says that there have been experiments where some features of multiplexity were created. However, he points out that “none of these experiments result in the creation of MPD” [Multiple Personality Disorder]. People can easily pretend to be multiple but they do not show “numerous psychiatric symptoms, extensive involvement with the mental health system with limited benefit, and specific primary and secondary features of MPD stretching back for decades”.

Why don’t people have accusations about other illnesses he points out? Why is multiple personality singled out? Why not borderline personality disorder, or depression or anxiety disorder?

One of the reasons some people might be so suspicious is because when the person begins treatment for the multiplexity, he or she may show a lot more signs than previously seen, of dissociation, multiple personality being the most extreme form. Someone with panic disorder may go for treatment which might entail more exposure to the thing that causes the disorder. Thus the person shows more symptoms of panic disorder. Does that mean the therapist created the panic disorder? The same happens with multiplexity because now the person is remembering and talking about the abuse which now creates a greater need for dissociation as a coping mechanism. “Any increase in symptoms during the initial stages of treatment is a perfectly comprehensible consequence of the nature of the disorder, for both panic disorder and MPD.”

“There is no sound reason to classify MPD as more iatrogenic than other psychiatric disorders based on experiments with college students or an increase in dissociative symptoms in the early phases of treatment. ... much of the increase in dissociative symptoms during the early and middle phases of treatment is probably due to the uncovering of pre-existing alters, rather than to the creation of new ones in treatment.”

Ross says that these experiments are actually helpful in a way because they show us more about the true nature of multiple personality. “MPD is often thought to be an extravagant deviation from normal experience, a rare curiosity with little connection to everyday psychology or reality. Probably the main reason it has been considered to be rare is the perception of MPD as fantastic and improbable.” He says that many of these types of experiments have helped “to correct this misperception and lead to a different guess as to how common the disorder is in North America.”  These experiments showed that “normal” people can easily create alter personalities given the right environment. “The ability to create alters, as I see it, is a specialized development of the normal ability to become intensely involved in childhood play, books, or movies. Creating imaginary identities is a normal aspect of child development... MPD patients have drawn on this ability demonstrated in normal childhood play and in ... experiments, to cope with trauma. What better way to survive incestuous abuse than to imagine that it is happening to someone else?” “Because childhood sexual and physical abuse are common and the ability to create alters is common, MPD should be far from rare.”

Ross thinks that the reason multiplexity is singled out is because it is seen as the result of childhood abuse. We Webers think that many people do not want to believe that this much abuse has been going on under our very noses. Multiplexity suggests not only abuse but often quite severe and prolonged abuse. And often, this type of abuse may suggest ritual abuse as well. For many, it is easier to believe that there are dishonest therapists out there who are making their patients believe they were abused.

One final argument Dr Ross gives against iatrogenesis is study results done back in 1989. It was found that 40 Canadian psychiatrists had seen an average of only 2.2 cases of MPD while 44 American psychiatrists had seen an average of 16 cases. The Canadian psychiatrists were generalists, not specializing in any specific type of disorder while the American psychiatrists in the study were specialists in dissociation. However, if the specialists were influencing their patients to display more symptoms of multiplexity, then the results would have been very different to that of the generalists. But the results were all very similar. There were no differences between the groups meeting diagnostic criteria for multiplexity, no big differences in the number of personalities at the time of diagnosis or at the time of reporting. If there was any unreliability about the diagnoses then there would have been greater variation between the cases. If some or all of those American psychiatrists were creating multiplexity in their patients wouldn’t we have seen much higher numbers of personalities as well as other symptoms of multiple personality?

Some people have claimed that hypnosis can influence and create personalities and memories of abuse. However, of these cases in the same study, 48% had been hypnotized after diagnosis of multiple personality, 32% hypnotized before and after hypnosis and the rest had not been hypnotized at any point. The results were still the same for criteria met and number of personalities. “MPD patients who are hypnotized before and/or after diagnosis are no different from those who have never been hypnotized, at least not in the specific features of MPD”.

We think Dr Ross has some very good points on whether or not multiplexity is caused and created by therapists. His book was published in 1989 and we’re sure there has been plenty written about the subject since then. If you want to read more about this topic the internet has plenty. We came across one article, a review paper titled “The Persistence of Folly: Critical Examination of Dissociative Identity Disorder. Part II. The Defence and Decline of Multiple Personality or Dissociative Identity Disorder” by August Piper, MD and Harold Merskey, DM. Some of what is written is exactly what Ross was talking about.

Personally and understandably it makes us very angry to hear such accusations. Yes it is a tricky condition to diagnose. There are a lot of grey areas. There are probably any number of people pretending to be multiple for some kind of secondary gain. We think it’s very probable that the people who argue in favour of iatrogenesis have not worked with any multiples.

We have worked with quite a few therapists in different fields. None of them ever encouraged us to create alters. Most importantly, we have known quite a few multiples for many years. We have never disbelieved any of them. It was just too obvious how much pain they were in and how little fun they were having being multiple.