| T O P I C R E V I E W |
| mk6283 |
Posted - 12/21/2007 : 20:28:38
I was in a lecture where the following concept was presented to me and I instantly thought of TMS. I think the ideas discussed in this article are absolutely fascinating and are yet another example of the irrefutable association between mind and body. Every time I feel as though I have grasped the full extent/scope of this powerful connection, I realize that I am only brushing the surface. Enjoy!
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9901E3DC133BF932A15756C0A963948260
Best,
MK
May 21, 1985
NEW FOCUS ON MULTIPLE PERSONALITY
By DANIEL GOLEMAN
PETER, in his late 30's, is a smooth talker who seduces women for their money; his motto is ''Pleasure is where it's at.'' Paul, his twin, is kind and decent, and prides himself on caring for people in need.
David, in his early 20's, is a highly talented sculptor.
Tom, a teen-ager, is so mechanically adept that he can pick a five-tumbler lock with a paper clip.
Dorothy, a frightened 10-year-old girl, is prone to run away from home.
All these people, in fact, exist only as aspects of John, an air-traffic controller who broke down on the job, babbling to pilots in baby talk, and who was diagnosed during therapy as having a multiple personality.
Cases like John's, once considered psychiatric oddities, have taken on new significance in the eyes of researchers, who say that the disorder represents a unique experiment of nature that provides opportunities for exploring the intricate web that connects mind, body and behavior.
''The multiple personality offers a special window into psychosomatics,'' said Frank Putnam, a psychiatrist at the National Institute of Mental Health and a leading researcher in the field. ''With a multiple personality you can do research that holds the body constant while you vary the personality, so you can sort out how psychological states affect the body.''
''Multiples exhibit some remarkable medical phenomena.'' Dr. Putnam said. He gives the example of one patient who reacted normally to a sedative drug in one personality, but was totally unaffected by it in another.
''Some multiples carry several different eyeglasses, because their vision changes with each personality,'' said Bennett Braun, who directs a unit devoted to treating multiple personalities at the Rush-Presbyterian-St. Luke's Medical Center in Chicago. Dr. Braun reports the case of a young woman who in one personality was colorblind for blue and green, a problem that ended with the successful treatment of her multiple-personality condition. Another woman, admitted to a hospital for diabetes, baffled her physicians by showing no symptoms of the disorder at times when one personality, who was not diabetic, was dominant. A young man was allergic to citrus fruit in some personalities, but not in others.
Research on brain patterns of multiples has produced data of unusual promise. Dr. Braun reports the case of a woman who, at one point in her treatment, manifested four personalities. Brain wave measurements showed each had a distinct pattern of brain function. After her successful treatment, when these four personalities were blended into a single, integrated one, the remaining pattern was still distinct from any one of the previous four.
''The difference between the personalities were significantly greater than normal people simulating other personalities could produce,'' said Monte Buchsbaum, a research psychiatrist at the University of California at Irvine, who collaborated on the study. ''The personalities looked like completely different people.''
Skeptics argue, however, that there is far too little systematic research as yet to establish whether multiple personalities represent something more than an extreme in the normal abilities of people to present a variety of distinct ''selves'' that are not separate personalities. And others suggest that diagnosis and treatment need refining.
''The very effort to make the diagnosis of multiple personality and treat it often may create the disorder,'' said Martin Orne, director of the Unit for Experimental Psychiatry at the University of Pennsylvania. Dr. Orne is editor of The International Journal for Clinical and Experimental Hypnosis, one of four scholarly journals that have each devoted an entire issue to the disorder in the last two years.
A Topic of Growing Interest
Psychiatric interest and research on the topic has mushroomed. The International Society for the Study of Multiple Personality, formed last year, will hold a meeting next fall in Chicago, and more than 200 scholarly papers have already been submitted. Over the past weekend, at the meeting of the American Psychiatric Association in Dallas, a workshop was offered to psychiatrists on the diagnosis and treatment.
The key sign of the disorder is a person seeming to have developed at least two distinctive personalities that alternate in control of the body. Another important symptom is partial amnesia: some but not necessarily all of the multiple personalities are unaware of the others.
Circumstances that lead to the condition are usually brutal, typically extreme neglect or abuse ''the likes of which you wouldn't believe,'' in Dr. Braun's words. Patients he has studied have undergone such traumas as being dangled out of a window, being forced to watch a murder and to dismember the body, being buried alive and being the victim of sexual sadism. Most often such events occurred when the patient was between the ages of 3 and 8 years old.
The disorder seems to represent a psychological adaptation to an otherwise unbearable situation. Most experts agree that the main predisposing factors are the ability to go into a spontaneous hypnotic trance and harsh trauma in childhood. About 20 percent of people have the capacity to go into such a trance, said Eugene Bliss, a psychiatrist at the University of Utah. ''It can happen without people knowing it,'' he said. ''They may think of it as a reverie or daydream, or deep concentration. All those with multiple personality have this ability.''
Reaction to Repeated Trauma
The hypnotic state is apparently used by a child as a kind of psychological protection. According to experts, this temporary defense becomes stabilized into multiple personality when the child faces repeated, overwhelming trauma.
''The kind of abuse that leads to multiple personality,'' said Dr. Braun, ''is frequent, unpredictable and interspersed with love. As children, the multiples have known both love and abuse, and they string together one personality that experiences the good part, another that embodies the bad. The parent will be very loving one moment, then the next switch into a monster. Many of the parents of multiple personalities themselves seem to suffer from the disorder, and a surprising amount of the abuse comes from mothers.''
On average there are from 8 to 13 personalities in a typical patient, although there can be more than 60, according to Richard Kluft, a psychiatrist at the University of Pennsylvania who has studied more than a hundred cases.
Writing in Psychiatric Annals, Dr. Kluft describes some of the most common types of personalities: a ''host'' personality, typically the one who comes into treatment; a fearful, childlike personality; a competent protector; an ''inner persecutor,'' usually modeled after the abusive person, who tries to harm the other personalities, and an ''anesthetic'' personality, impervious to pain, that apparently arose to endure abuse.
In general, the more severe and relentless the precipitating trauma, the more personalities there will be. Many of the personalities seem to function as cushions against the pain of physical abuse. ''There seems to be a limit to how much trauma a given personality can bear,'' Dr. Putnam said. ''It's as though each were a buffer that, when filled, means a new one must be created.''
Multiple personality ''may mimic the gamut of psychiatric syndromes,'' according to a report in The Journal of Clinical Psychiatry, and is therefore often misdiagnosed. Depending on the personality involved, the diagnoses can range from schizophrenia and depression to epilepsy. The report urges clinicians treating patients who have received a plethora of diagnoses over several years and who have failed to respond to standard treatments to consider the possibility of multiple personality.
Estimates of the prevalence of multiple personality vary widely. Investigations, a research bulletin of the Institute of Noetic Sciences, which has supported some of the research, estimates that there may be as many as 16,000 people with the disorder in the United States, only about 10 percent of whom have been diagnosed. Other estimates range from one in 200 people to one in 10,000. According to an estimate by Dr. Bliss in a recent issue of The American Journal of Pyschiatry, as many as 10 percent of psychiatric patients may have the disorder, though almost none of them are so diagnosed.
Some Experts Are Skeptical
Other experts, though, are skeptical of the estimates, and see the diagnosis as faddish. Dr. Orne, for example, observes, ''There have been more cases of the disorder reported in the last 10 years than in the history of the world before.'' Corbett Thigpen and Hervey Cleckley, the psychiatrists who wrote ''The Three Faces of Eve,'' probably the best known account of multiple personality, have reported that out of hundreds of cases referred to them as possible multiple personalities, only one other actually had the disorder. Like Dr. Orne, Dr. Thigpen and Dr. Cleckley believe the disorder exists, but feel that it is far rarer than some others think.
Dr. Putnam points out that the diagnosis can be extremely difficult to make, and many cases seem to go unrecognized, even by therapists who are treating them. Indeed, in a study of 100 cases of patients being treated for multiple personality it was found that 80 of the personalities who came for treatment were not initially aware of the existence of the alternate personalities. ''
Studies have found that a majority of patients diagnosed as having multiple personality had had an average of four psychiatric diagnoses before that, and many had been in treatment for seven years or longer without their therapists realizing what was going on.
The situations that bring multiple personalities into treatment can be bizarre. One relatively common one, described by Dr. Putnam, is the ''internal murder,'' where one personality will try to kill another, not realizing that to harm the other is also to harm itself. Meanwhile, a third personality will prevent what looks to the world like a suicide by calling the police and an ambulance.
Grueling Task for Therapist
Treating multiple personalities, according to Dr. Kluft, is ''grueling'' for the therapist and ''exquisitely uncomfortable'' for the patient. The therapist often uses hypnosis to contact all the subpersonalities, and then methodically integrates them into what amounts to single-person group therapy. Along the way the patient will have to re-experience, to some degree, the traumatic events of his childhood that have been sealed off in the memory of one or more of the subpersonalities.
But Dr. Orne, for one, objects to the use of hypnosis. He argues that the therapist can inadvertently encourage subpersonalities that were not there before by implicitly suggesting to a patient that another personality may exist.
''I wouldn't care if it were useful to split people into pieces and then put them back together,'' he said. ''It's dramatic, but not necessarily therapeutic, to make people separate and then fuse. But if you see the same problem simply as people not accepting certain impulses and parts of themselves, then the therapeutic task is to help the patient accept the parts of himself he doesn't like. Hypnosis has limited utility for that.''
Copyright 2007 The New York Times Company |
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