The email and attachment below were forwarded on to me by a senior US colleague
today. It concerns an invitation to join a petition and to collectively "lobby"
the DSM-V Task Force and Work Group to have Dissociative Identity Disorder
removed from DSM-V. It is claimed that "due to the assumption that trauma is a
primary etiological factor, the DID diagnosis has resulted in wrongful
accusations of sexual abuse on the basis of recovered memories, not only in
North America but throughout the developed world". Signatories to the petition
include Paul McHugh, Harrison Pope, Harold Merskey, August Piper, Elizabeth
Loftus, Richard McNally and Pamela Freyd. One of course would hope that such
matters are decided on objective analysis of all of the data rather than by the
"lobbying" efforts of small but noisy groups who bypass the conventions of
science.
On the subject of DSM-V, I have included a commentary on the process authored by
Robert Spitzer who chaired the Task Force which created DSM-III. He went on to
chair the Work Group for DSM-III-R. He also served as a special advisor on the
Task Force for DSM-IV.
Regarding the early history of trauma and dissociation a valuable resource is
the trauma and dissociation archive:-
http://libweb.uoregon.edu/index/news-app/story.1923


The article that went with this

Dr. Harold Merskey, DM, FRCP, FRCPC, FRCPsych.
Professor Emeritus of Psychiatry
71 Logan Avenue, London, Ontario N5Y 2P9 Canada
Tel: (h) 519-672-2298; (o) 519-679-1045; Fax: 519-679-6849
e-mail: harold.merskey@...




March 9th, 2009



Dr. David J. Kupfer, MD
Chair of DSM-V Committee,
Dr. Thomas Detre Professor and Chair, Department of Psychiatry
Professor of Neuroscience, Western Psychiatric Institute and Clinic
5811 O'Hara Street
Pittsburgh, PA 15215

RE: Dissociative Identity Disorder and DSM-V

Dear Dr. Kupfer:

We are writing to you to express concern with respect to the continuation of
Dissociative Identity Disorder as an approved diagnosis within the forthcoming
DSM-V. We believe that the identification of Multiple Personality Disorder, and
later its name change as Dissociative Identity Disorder, has been extremely
harmful to the good sense and reputation of psychiatry, not to mention the cause
of grave ill-effects to large numbers of patients and their families. In the
attached document we maintain that the diagnosis should be removed from DSM-V
and we provide the basis for our request.


Respectfully,

Signatories
(Please see Appendix A)







Please see attached.

TO: DSM-V Task Force &
Work Group on Anxiety, Obsessive-Compulsive Spectrum,
Posttraumatic & Dissociative Disorders

Draft Statement on:

The Need to Remove Dissociative Identity Disorder from DSM-V



The evidence supporting this diagnosis as a distinct mental disorder is modest
whereas much suggests it to be a behavioral artifact equivalent in nature to
pseudo-epilepsy generated by suggestion in vulnerable people. Its identification
as a special, separate diagnostic entity in DSM has harmed the practice of
psychiatry and undermined its scientific credibility. Although it is important
for us to provide evidence to support these statements, we wish to avoid
excessive detail, given that such evidence has been documented widely in the
published literature.

Origins
The notion of dual personalities was founded upon cases of bipolar illness (1)
and was followed by the idea of extra personalities. This expansion first
occurred with the hypnotically-induced introduction of a second personality and
the deliberate naming of those personalities as if they were separate entities
(1).

Prevalence
Taylor and Martin (2) recognized a total of 76 cases occurring between 1816 and
1944--slightly more than one every two years; they thought a similar number
might be unreported. In 1954 Thigpen and Cleckley (3) reported their case, which
was published as "The Three Faces of Eve" in 1957. After a film was made of this
case, the numbers of reported cases increased steadily; there was a further
dramatic leap after the film of "Sybil". (Reference?) By 1990 thousands of cases
were being diagnosed; some authors identified more cases in their personal
practices than had been described in the literature over an entire century.

Twentieth Century Suggestion
As is well known, Sybil, a patient of Dr. Cornelia Wilbur, was fully aware that
her therapist wanted her to create extra personalities (4). In 1973, Dr. Wilbur
gave tape recordings of Sybil's interviews to Schreiber [the journalist who
reported Sybil as a case of multiple personality disorder (5)]. Schreiber made
the recordings available to Ronald Rieber, a professor of psychology, who
amassed evidence showing that at least some of the personalities were artifacts
overtly created in treatment (6).

Etiology
Dissociative Identity Disorder is often alleged to result from repressing an
experience of childhood sexual abuse. This claim has not received adequate
scientific validation. For example, Piper and Merskey (7) reviewed all the
studies that claimed to corroborate DID patients' abuse recollections. These
authors concluded that "no evidence supports the claim that DID patients as a
group have actually experienced the traumas asserted by the disorder's
proponents" (7).

Proponents of the DID diagnosis assert that horrific, repeated childhood
physical and sexual abuse is the primary cause of DID. Victims supposedly
develop their multiple personalities as repositories for traumatic memories that
the "host" personality is unable to tolerate consciously. The DID diagnosis thus
relies on the concept of traumatic Dissociative Amnesia (DA or "repression"):
the notion that the mind protects itself by banishing terrifying memories from
awareness, rendering them inaccessible until the person feels psychologically
safe to recall them, often years later. There is no convincing evidence that
victims can become incapable of recalling genuinely traumatic experiences, as
the trauma theory of DID requires (8). Indeed, an extensive survey of the
historical literature, including both fictional and non-fictional written works
in multiple languages, found no written example of "dissociative amnesia" prior
to 1786 (9). Thus the notion of "repressing" a memory itself, like DID, appears
to represent a recent culture-bound phenomenon, rather than a naturally
occurring human psychological process.

In a comprehensive analysis of studies of people with documented trauma
histories, not a single mention of spontaneous amnesia for the traumatic event
was found—unless the forgetting was attributable to either organic amnesia or
childhood amnesia (10). Finally, an examination of Freud's original work gives
reason to think that the evidence from psychoanalysis for repression is also
very unsatisfactory (11, 12).

Harmful Effects
Due to the assumption that trauma is a primary etiological factor, the DID
diagnosis has resulted in wrongful accusations of sexual abuse on the basis of
recovered memories, not only in North America but throughout the developed world
(references). DID has caused mockery of psychiatry, and, for patients, has led
to misdiagnosis (13) and inadequate treatment of depression (14) [not only
depression, but other disorders that it's distracted attention away from; also,
this reference seems rather thin to make a strong statement on. Perhaps it would
be better not to reference this, but simply assert that treatable causes of
problems are missed when the DID diagnosis is applied].

Lack of Consensus
Canadian and American psychiatrists show little consensus regarding the
diagnostic status and scientific validity of DID; in surveys of board-certified
psychiatrists in the United States (15) and Canada (16), it was found that fewer
than one-third of Canadian psychiatrists and 35% of American psychiatrists
replied that DA & DID should be included without reservations in the DSM-IV;
fewer than 1 in 7 Canadian psychiatrists and only 21-23% of American
psychiatrists felt that there was "strong evidence of validity" for these
disorders. French- and English-speaking Canadians had similar opinions.

Conclusions
There are overwhelming reasons to question the validity of Dissociative Identity
Disorder. We respectfully urge you as members of the Work Group and the Task
Force to drop the category of dissociative disorders from the upcoming DSM-V
because it is scientifically unjustified, clinically harmful to patients and
their families, and it undermines the credibility of psychiatry.

Signatories
Please see Appendix A.




REFERENCES

1. Merskey, H. (1992a). The manufacture of personalities. The production of
multiple personality disorder. Brit. J. Psychiat., 160:327-340.

2. Taylor W.F. & Martin M.F. (1944) Multiple personality. J. Abnormal & Soc.
Psychol., 39:281-330.
3. Thigpen, C.H. & Cleckley, H.M. (1957). The Three Faces of Eve. New York:
McGraw-Hill.
4. Spiegel, H. (1993) Mistaken Identities: Toronto. Canadian Broadcasting
Corporation. The Fifth Estate, 9 November 1993.
5. Schreiber, F.R. (1973) Sybil. Chicago: Henry Regnery.
6. Rieber, R.W. (2006) The Bifurcation of the Self. The History and Theory of
Dissociation and Its Disorders. New York: Springer Science.
7. Piper, A., Merskey, H., (2004). The persistence of folly: a critical
examination of dissociative identity disorder. Part I. The excesses of an
improbable concept. Can J Psychiatry 49 (9): 592-600.
8. McNally, R. J. (2003) Remembering Trauma. Belknap Press/Harvard University
Press: Cambridge, MA.
9. Pope, H.G. Jr., Poliakoff, M.B., Parker, M.P., Boynes, M.D., & Hudson, J.I.
(2007) Is dissociative amnesia a culture-bound syndrome? Findings from a
survey of historical literature. Psychol. Med., 37(2):225-233.
10. Pope, H. G. Jr., Oliva, P., Hudson, J.I.: (2005) Repressed memories. The
scientific status of research on repressed memories, in Modern Scientific
Evidence: The Law and Science of Expert Testimony -- Social and Behavioral
Science, 2005-2006 Edition. Edited by Faigman D, Kaye D, Saks M, Sanders J.
Eagen, MN, West Group, pp 408-447.
11. Esterson, A. (1993) Seductive Mirage. Open Court: Chicago.
12. Crews, F. (1998) Unauthorized Freud: Doubters Confront a Legend. New York:
Viking.
13. Freeland, A., Manchanda, R., Chiu, S., et al. (1993) Four cases of supposed
multiple personality disorder: evidence of unjustified diagnoses. Can. J.
Psychiat., 23: 245-247.
14. Fetkewicz, J., Sharma, V. & Merskey, H. (2000) A note on suicidal
deterioration with recovered memory, treatment. J. Affect. Dis., 58:155-159.
15. Pope, H.G., Jr., Oliva, P.S., Hudson, J.I., Bodkin, J.A. & Gruber, A.J.
(1999) Attitudes toward DSM-IV Dissociative Disorders Diagnoses among
Board-Certified American Psychiatrists. Am. J. Psychiat., 2000; 157:1179-1180.
16. Lalonde, J.K., Hudson, J.I., Gigante, R.A. & Pope, H.G. Jr. (2001) Canadian
and American psychiatrists' attitudes toward Dissociative Disorders diagnoses.
Can. J. Psychiat., 46(5): 407-412.

Appendix A

List of Signatories



1. Paul R. McHugh, M.D. Distinguished Service Professor of Psychiatry at Johns
Hopkins University.
2. Harrison Pope, Jr., MD, MPH, Professor of Psychiatry, Harvard Medical School,
Boston, Massachusetts; Director, Biological Psychiatry Laboratory, McLean
Hospital, Belmont Massachusetts
3. James Hudson, MD, ScD, Professor of Psychiatry, Harvard Medical School,
Boston, Massachusetts; Director, Biological Psychiatry Laboratory, McLean
Hospital, Belmont Massachusetts
4. Elizabeth Loftus, PhD, Distinguished Professor, University of
California-Irvine.
5. Richard J. McNally, Ph.D., Professor and Director of Clinical Training,
Department of Psychology, Harvard University, Cambridge, MA.
6. Harold Merskey, DM, FRCP, FRCPC, FRCPsych., Professor Emeritus of Psychiatry.
7. Joel Paris, M.D. (M.B., B.Ch.)
8. August Piper, M.D., independent practice of psychiatry, Seattle, WA.
9. Numan Gharaibeh, MD (MB, BCh), Principal Psychiatrist, Western Connecticut
Mental Health Network, Danbury, CT.
10. Pamela Freyd, Ph.D.
11. Brian Boffi, MD, Principal Psychiatrist, Western Connecticut Mental Health
Network, Torrington, Torrington, CT.
12. Alexander Miano, M.D.
13. Joanne Iurato, PhD, Clinical Director, Western Connecticut Mental Health
Network, Danbury, CT.
14. Donna Pellerin, M.D., Medical Director of Inpatient Services, Danbury
Hospital, Danbury, CT.
15. Jennifer Ballew, DO, Principal Psychiatrist, Western Connecticut Mental
Health Network, Waterbury, CT


to sit back and see evil yet do nothing is evil itself.
for people with D.I.D. http://dissociativedisorders.blogspot.com/
for people interested in Ghosts http://ghosts-couldtheysnatchyou.blogspot.com/