Posted by alexandra_k on March 27, 2005, at 21:24:25
(Please don't shoot the messanger...)
Although it would be fair to say that the majority of clinicians are sceptical as to the legitimacy of the disorder (Pope et al., 1999 pp. 321-323) it was not until fairly recently that an alternative to the post-traumatic account has been offered (#1).
(#1) While many used to voice their scepticism in the form of disbelief or outright denial of the phenomenon such a position is becoming increasingly hard to sustain. It also seems to have been long considered that subjects were play-acting, or making up stories but a sustained alternative account has not been forthcoming until the work of Spanos, (1994).The number of cases diagnosed each year increases at exponential rates for a disorder that was once considered exceptionally rare. Lilenfeld et al., (1999 p. 508) report that while there were less than 80 cases reported worldwide prior to 1970, the figures at the close of the twentieth century, though difficult to estimate, appeared to be in the tens of thousands. While supporters maintain that these figures are more accurately reflective of true prevalence rates such a dramatic increase has led to increasing degrees of controversy, scepticism, and demand for an alternative explanation from other quarters.
While the post-traumatic account is psychodynamic in origin, Spanos, (1994) offers an alternative conceptualisation that is more consonant with behaviourist theory and practice. He emphasises the role of reinforcement contingencies in the creation, maintenance, and ultimate dissolution of the disorder (Spanos, 1994 pp.17-20). DID is conceptualised as a modern form, or variant of what he dubs ‘multiple identity enactment’. Alters (as a phenomenon) are considered to function in a similar way to possessing sprits or demons reported in past eras. These phenomena are thought to be culture specific; they occur only where people ‘believe in them’ and thus their expressions are considered legitimate by the enacting subject and others.
Spanos, (1994 p. 20) considers that it may be reinforcing for subjects to strategically enact multiple identities, especially when they are allowed to avoid the consequences of their behaviour by interpreting it as the actions of other agents. He notes that Protestants who were treated with prayer and fasting for behaving possessed reported fewer cases of possession than Catholics who were treated with bed rest and elaborate exorcism rites (Spanos, 1994 p. 15). While he maintains that there is nothing pathological (or disease-like) about multiple identity enactments per se, he also considers that those who present with DID for psychological or psychiatric assistance in modern times do exhibit a greater pathology (Spanos, 1994 p. 28).
The Three Faces of Eve and Sibyl were bestseller biographies depicting subjects with DID. They were made into feature films which served to bring the disorder to the attention of the general public. The rise in the number of cases reported occurred shortly after the release of these films. The psychiatrists that treated ‘Eve’ (Thigpen and Cleckly, 1984 p. 64) reported being inundated with letters and phone calls from individuals who presented with different handwriting samples and different voices that claimed to be separate selves. While they concluded that they were (pathological) hoaxes they did not seem to investigate these claims in any great depth. Spanos considers, though, that this shows the impact that media attention has on subjects with certain pathologies. The disorder has been presented in such a fashion that disturbed individuals are given an elaborate and glamorous explanation for their difficulties. The reinforcement provided by the media and greater society is thus the first factor that Spanos considers relevant to the dramatic increase in the number of subjects presenting with the disorder (Spanos, 1994 p. 20).
The second factor is considered to be the reinforcement contingencies provided by the clinicians that regularly diagnose and treat the disorder. Spanos considers that clinicians (perhaps unwittingly) provide cues by asking leading questions that educate and enable subjects to convincingly enact the multiple role. Some clinicians find the disorder intriguing and fascinating, and subjects with the disorder are thus given a great deal more attention and sympathy then they would otherwise obtain. For a subject with a history of severe abuse and / or a long history of worn out clinicians enacting multiple identities may be very reinforcing indeed (Spanos, 1994 p. 21).
He thus maintains that alters are artefacts, creations or roles that are produced and sustained in response to social reinforcement and the reinforcement provided by traditional forms of treatment. He proposes an alternative course of treatment, which involves altering reinforcement contingencies so as to extinguish the behaviours that constitute the disorder (Spanos, 1994 p. 20).
poster:alexandra_k
thread:476469
URL: http://www.dr-bob.org/babble/write/20050321/msgs/476469.html