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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by alexandra_k on March 27, 2005, at 17:03:52
'cause some of you peoples don't get over to writing much.
I wrote something on DID in case anyone is interested. I wrote it a while back now, but need to convert it into a seminar. Thought I'd post it in bits in case anyone is interested. I am really really keen to get peoples thoughts, comments, suggestions, criticisms etc etc...
I am wondering whether what I have to say is determined more by my defenses than anything else :-(
I dunno...
http://www.dr-bob.org/babble/write/20050321/msgs/476320.html
Posted by Dinah on March 27, 2005, at 20:03:45
In reply to Just thought I'd pop a link over here..., posted by alexandra_k on March 27, 2005, at 17:03:52
Posted by TofuEmmy on March 27, 2005, at 20:33:10
In reply to Just thought I'd pop a link over here..., posted by alexandra_k on March 27, 2005, at 17:03:52
Will you be presenting this material yourself? If so, be sure to protect yourself adequately. I once did a class presentation on depression and suicide, and got all teared up. Um, talk about embarrasing!! It was an awful day. I just wasn't prepared for being nervous and emotional at the same time.
Take care, emmy
Posted by alexandra_k on March 27, 2005, at 21:11:07
In reply to Is there another part to that? (nm) » alexandra_k, posted by Dinah on March 27, 2005, at 20:03:45
Dare I say that there are many many parts ;-)
I'll pop 'em up one at a time..
Want to work on each section a bit before putting it up.The first paragraph is a bit of a mouthful...
I always hate writing that bit.I'll put the next one up soonish.
Posted by alexandra_k on March 27, 2005, at 21:12:46
In reply to Re: Just thought I'd pop a link over here... » alexandra_k, posted by TofuEmmy on March 27, 2005, at 20:33:10
Thanks.
I'll be ok.
Have given 2 seminars on the topic before.
This one is a paper that I am trying to convert.
It is a bit of a pain because it had fairly lengthy footnotes that I will have to try and integrate.
Also want to cut bits out.I just go into 'rational mode' and we are away ;-)
Posted by Dinah on March 27, 2005, at 21:24:05
In reply to Re: Is there another part to that? » Dinah, posted by alexandra_k on March 27, 2005, at 21:11:07
I look forward to reading the second theory. :)
Posted by alexandra_k on March 27, 2005, at 21:41:23
In reply to Re: Is there another part to that? » alexandra_k, posted by Dinah on March 27, 2005, at 21:24:05
You won't like it.
:-(
You will have to go check on writing. I like to start each section in a different thread so people can post responses to the sections they want to respond to.
Posted by Dinah on March 27, 2005, at 21:45:49
In reply to Re: Is there another part to that? » Dinah, posted by alexandra_k on March 27, 2005, at 21:41:23
Oh phooey. Well, shall we come up with alternative number three? I really think there should be alternative number three or four or five.
Given that a result is possible (and I suppose that one theory is that it isn't possible), human beings are just too complicated to have only one way to reach that result. Don't you think?
Posted by alexandra_k on March 27, 2005, at 21:56:28
In reply to Re: Is there another part to that?, posted by Dinah on March 27, 2005, at 21:45:49
> Oh phooey. Well, shall we come up with alternative number three?
Already have, Dinah. That is what my paper is about :-)
>I really think there should be alternative number three or four or five.
I am hoping we won't need a four or five... I am quite fond of three, you see :-)
> Given that a result is possible (and I suppose that one theory is that it isn't possible),
Ah. Well the 'theory' that it isn't possible, or that it is just a load of BS is pretty much the origins of the Socio-Cognitive Model. It seems to me that the Socio-Cognitive Model is pretty much just that phrased in good old behaviourist terminology.
It seems a little silly to say that the phenomena doesn't exist. Given that the number of people who met criteria near the close of the last century was estimated to be in the tens of thousands and all.
Seems that they have to say 'yes, lots of people DO meet criteria'. So then they need to account for why they meet it. Thats where the behaviourist bit comes in.
>human beings are just too complicated to have only one way to reach that result. Don't you think?
Yup. I allow for that... Better than the current two options, I believe ;-)
PS. You will have to answer me over on writing (if you haven't already) to get the next bit. Three post rule etc etc.
Need to go off on a bit of a tangent now...
It is necessary background stuff that needs to be said in order to understand my theory (which comes later) though. It might be tough going. You don't need to understand it all. But IMO it is worth a try...
Posted by Dinah on March 27, 2005, at 22:35:35
In reply to Re: Is there another part to that? » Dinah, posted by alexandra_k on March 27, 2005, at 21:56:28
I answered you there.
But to brainstorm a bit. Off the top of my head.
It would seem that PTSD at a young age would not be sufficient in itself to account for dissociative phenomenon. Since not every child who was abused dissociates.
Sooooo..... If you think of dissociation as a defense mechanism. And you consider other defense mechanisms. Hmmm... Perhaps there are genetic variables that make some people better at certain defense mechanisms than others. Say, a hard to stimulate adrenaline system, or a too quickly stimulated adrenaline system, just to give an example. Some physical characteristics that give people an edge in using certain defense mechanisms. A talent in it. A talent in dissociation in this case.
Then you consider why certain people overuse particular defense mechanisms.
That could be a natural talent for some over others - some just come easier than others.
Stress and the need for defense mechanisms - sexual or physical abuse being obvious examples, but no the only ones.
A lack of a broad range of defense mechanisms. If all you know how to use is a hammer and a screwdriver, you're bound to look for solutions that involve nails or pounding, or screws or prying.
So offhand there are three variables. There are probably more. A varying degree of natural talent for dissociation. A varying degree of stress requiring defense mechanisms to be used (and a varying degree of stress tolerance). And a varying number of defense mechanisms available for use.
I think the current thinking puts too much emphasis on the second, and not enough on the first and third. While probably there is a complex interplay between all three and a few more to boot. Leading to various degrees and presentations of dissociative disorders, and various causes for them.
I dunno. I'm waiting with interest for your theory. :)
Posted by alexandra_k on March 27, 2005, at 23:09:01
In reply to Re: Is there another part to that?, posted by Dinah on March 27, 2005, at 22:35:35
> It would seem that PTSD at a young age would not be sufficient in itself to account for dissociative phenomenon. Since not every child who was abused dissociates.
Indeed.
But is 'severe trauma' necessary???
According to the Post-Traumatic Model - yes. Thats why it is called the Post-Traumatic Model...
According to the Socio-Cognitive Model - no. It all depends on the reinforcement contingencies. Thats why they argue about aetiology.
> So offhand there are three variables. There are probably more. A varying degree of natural talent for dissociation. A varying degree of stress requiring defense mechanisms to be used (and a varying degree of stress tolerance). And a varying number of defense mechanisms available for use.I like that :-)
Very much.
> I think the current thinking puts too much emphasis on the second, and not enough on the first and third.I hadn't thought of the third one all by itself. Kind of lumped it into the first or second. But I like that as a seperate one...
>While probably there is a complex interplay between all three and a few more to boot. Leading to various degrees and presentations of dissociative disorders, and various causes for them.
Yeah. Three factors (best not allow for more unless / until we are forced to) and when they are weighted just so - then bingo. :-)
Though there isn't even a 'magic number'.
But maybe for those within this range - borderline
for those within that range - bingo
for those within the next range - severe etc etc.
And if one (or two) factors are weighted really high then the third one can still be within normal range yet a dissociative disorder would result in virtue of the other two...
:-)> I dunno. I'm waiting with interest for your theory. :)
It is a while off yet...
Mine is more a theory as to how we should conceive of alters. Are they selves? Are they fragments of selves? Are they merely role-plays? That is more what I am trying to answer.
Have put another bit up.
It is a theory of the mind.
In the next section I build that into a theory of the self.
Then in the following I try to look at how to adapt that to allow for / account for multiple selves.
Posted by alexandra_k on March 28, 2005, at 0:05:10
In reply to Re: Just thought I'd pop a link over here... » alexandra_k, posted by TofuEmmy on March 27, 2005, at 20:33:10
The first time I gave a seminar on the topic I was pretty nervous.
People made the inevitable MPD jokes afterwards. That was hard. I was okay with giving it - but that is because the way we do seminars is to fairly much read them out. So you just read it out...
But afterwards - questions can be hard.
Comments.
Jokes.
The jokes are inevitable.
I forget how bizzare psychiatric phenomena seem to the uninitiated.
And how strong the temptation is to pick fun or to mock.
Because it is taken as a given that 'we' are the healthy ones.
And they don't know about me.But I am okay with it now.
What is interesting to me is how people start out question time full of jokes.
And by the end... Sympathy.
That is my aim anyway.But it still suprises me when I am reading that I have to stop for inintentional jokes. Let people have a laugh. Even have a bit of a smile to keep them with me.
Try to knock that out of them at question time.
And hope that they go away a bit more sympathetic.
:-)
Posted by Dinah on March 28, 2005, at 0:09:29
In reply to Re: Is there another part to that? » Dinah, posted by alexandra_k on March 27, 2005, at 23:09:01
> Mine is more a theory as to how we should conceive of alters. Are they selves? Are they fragments of selves? Are they merely role-plays? That is more what I am trying to answer.
>
The million dollar question. One that I have no clue as to how to answer. The DSM IV is pretty clear on the criteria "a relatively enduring pattern of perceiving, relating to, and thinking about the environment and self". But that doesn't answer the philosophical question.Is it a spiritual question? A psychological one?
I wonder if the self can be thought of alone, or if it has to be thought of within a cultural context. If one conceives of oneself as an entity, is one an entity? If one conceives of oneself as a separate self, is one a separate self? How much is identity a question of self definition? Of other-definition? Are we who we say we are because we say so? Or do we need cultural recognition of some sort? If I say that I am a man trapped in a woman's body, there would be far more acceptance now than a hundred years ago. But it doesn't make the truth of it any different than it was a hundred years ago. If I say I am a self trapped in a body with another self, am I? Am I if I say so? Am I if others agree?
Does the self exist in isolation?
Or does the delineation of borders between the
"I" and the "not-I" depend as much on the "not-I" as the "I"?
Posted by alexandra_k on March 28, 2005, at 0:11:16
In reply to Re: Giving seminars about hard stuff » TofuEmmy, posted by alexandra_k on March 28, 2005, at 0:05:10
Actually 'knocking it out of them' sounds like I bail them up. I don't mean it like that. I just mean that I keep a straight face through all he jokes so they see I am not amused and ignore them. And speak respectfully. Always. And that in itself tends to be contagous. Especially when talking about delusions, I have discovered.
Posted by alexandra_k on March 28, 2005, at 0:28:54
In reply to Re: Is there another part to that?, posted by Dinah on March 28, 2005, at 0:09:29
> The DSM IV is pretty clear on the criteria "a relatively enduring pattern of perceiving, relating to, and thinking about the environment and self". But that doesn't answer the philosophical question.
Thats right. The DSM goes with 'identities' or 'alters' (as in 'alternative identities').
The post-traumatic model considers them to be 'fragments or parts of the greater self that is their summation'.
The socio-cognitive model considers them to be 'role plays' or elaborate fictions.
It was thought that 'identity' is ambiguous between a fragment and a role-play and they don't want to get too involved in controversay... Not 'selves' though. Nobody wants to call them selves but me, and Dennett, and Dennett & Humphries :-)
> Is it a spiritual question? A psychological one?It is a philosophical question.
A metaphysical question.
Metaphysics is 'the first physics'. It is the study of what exists. The metaphysical question is 'how many selves can there be associated with a single body'? Some people say one and only one. Both of the psychological / psychiatric models seem to want to say that.But before we can look at how many selves there can be to a body we need to look at just what a self is anyways. Thats why I need to develop that before arguing that alters are selves. That they are as real as any self could be.
But selves (I will argue) arise from certain kinds of complex minds that are able to produce certain kinds of patterns of complex behaviour.
So I start from mind, move to self, then consider the possibility of multiple selves.
The main objection to considering alters to be selves is dispensed with rather swiftly in a footnote. Most people have considered the objection to be decisive. But it doesn't logically follow so it doesn't hold. Simple as that.
But I am getting ahead of myself...
Posted by Dinah on March 28, 2005, at 0:50:07
In reply to Re: Is there another part to that? » Dinah, posted by alexandra_k on March 28, 2005, at 0:28:54
Ah, when you move from logic to metaphysics, I think my brain reaches its limits. :)
I think for my own purposes I'll stick with the dummies guide to the self. A self is the area inside the boundary where I end and not-I begins. Soooo, let's see. Some of the boundary tension is provided by not-I's, and the rest is provided by myself deciding what is I and what isn't.
But that doesn't account for the disavowal of what is actually part of me but that I don't wish to claim. That's where I always get stuck.
In my very humble opinion, because this is a difficult thing to grasp, role playing ought to be thrown out as a genuine part of the definition of a self. But disavowal is an almost insurmountable hurdle to overcome. Because how can you ever really know for sure? No matter what? So alters *could* be mutually disavowed fragments of the self. How could you ever prove they weren't?
(I'm having a bit of fun applying my idea of the self to narcissism though.)
Posted by alexandra_k on March 28, 2005, at 0:58:26
In reply to Re: Is there another part to that? » alexandra_k, posted by Dinah on March 28, 2005, at 0:50:07
> Ah, when you move from logic to metaphysics, I think my brain reaches its limits. :)
Thats ok. When you move from logic to math, my brain reaches mine :-)
> I think for my own purposes I'll stick with the dummies guide to the self.Sigh.
I am not very clear. Dennett writes much better than me.> But that doesn't account for the disavowal of what is actually part of me but that I don't wish to claim. That's where I always get stuck.
You and many philosophers before you.
> In my very humble opinion, because this is a difficult thing to grasp, role playing ought to be thrown out as a genuine part of the definition of a self. But disavowal is an almost insurmountable hurdle to overcome. Because how can you ever really know for sure? No matter what? So alters *could* be mutually disavowed fragments of the self. How could you ever prove they weren't?How could you ever prove they were??
Don't give up.
Please.I think the next bit might be a bit easier...
Posted by Dinah on March 28, 2005, at 1:13:08
In reply to Re: Is there another part to that? » Dinah, posted by alexandra_k on March 28, 2005, at 0:58:26
Whatever behaviorists believe, doesn't the heart of Spanos's therapeutic intervention go to reported behavior, not actual behavior?
Try as I might, I can't see how his intervention would have any beneficial result at all on actual behavior except in genuinely iatrogenic cases. But it would have a similar result on reported behavior in both genuine and therapist induced MPD.
How did he purport to tell the difference between reported behavior and actual behavior?
Or did his assumptions that there were no genuine cases cause him to not even try?
Posted by alexandra_k on March 28, 2005, at 2:53:17
In reply to Back to Spanos, posted by Dinah on March 28, 2005, at 1:13:08
> Whatever behaviorists believe, doesn't the heart of Spanos's therapeutic intervention go to reported behavior, not actual behavior?
Nope. Actual behaviour.
Though that is impossible in practice of course... But I didn't write the theory ;-)
Typically the idea seems to be something along the lines of hospitilised peoples being put into seclusion when 'alters' appear. After a while... they just stop appearing. The notion is that that should generalise back to IRL - well, that it would if people stopped reinforcing people for switching.
> Try as I might, I can't see how his intervention would have any beneficial result at all on actual behavior except in genuinely iatrogenic cases. But it would have a similar result on reported behavior in both genuine and therapist induced MPD.He doesn't make that distinction. ALL CASES are supposed to be created, maintained, and dissolved by the reinforcement contingencies that operate.
> How did he purport to tell the difference between reported behavior and actual behavior?Well... They don't quite say it like that. But they should... They should if they were being meticulous ;-)
> Or did his assumptions that there were no genuine cases cause him to not even try?He doesn't think there is anything more to the disorder than the reinforcement contingencies that operate to create and maintain those behaviours. Change the contingencies so that the behaviour is no longer rewarded and then peoples are cured!!
Ta da.
Posted by Dinah on March 28, 2005, at 2:56:44
In reply to Re: Back to Spanos » Dinah, posted by alexandra_k on March 28, 2005, at 2:53:17
Posted by alexandra_k on March 28, 2005, at 3:13:23
In reply to Sigh (nm) » alexandra_k, posted by Dinah on March 28, 2005, at 2:56:44
Hmm. I hope I aren't being unfair to them...
I try to be charitable.
The trouble is that CBT therapists (in general) get more from behaviourism than from psychodynamic theory. And what does that mean for the CBT therapist??? That they hope their DID client just goes away because their theory isn't equiped to deal with it.
I mean they can ignore it for a while... Not reinforce it etc. But aside from that there is really nothing to be done.
So what needs to be done is to provide an alternative theory that is phrased in terminology they understand. Thats why I probably sound quite behaviourist in the rest of the paper...
Make sense???
PS I do prefer to talk about this over on writing because then we retain copyright to our posts...
Posted by alexandra_k on March 28, 2005, at 3:43:05
In reply to Re: Sigh » Dinah, posted by alexandra_k on March 28, 2005, at 3:13:23
Not that anybody seems to understand it.
Sigh.
What am I supposed to do???
Write a treatment manuel???
AAAAAARGH.
Posted by alexandra_k on March 28, 2005, at 3:44:29
In reply to Re: Sigh, posted by alexandra_k on March 28, 2005, at 3:43:05
Posted by Dinah on March 30, 2005, at 19:51:59
In reply to Re: Back to Spanos » Dinah, posted by alexandra_k on March 28, 2005, at 2:53:17
I was reading my book about the dependent patient today and they were discussing behavioral therapy (as opposed to CBT). In particular they were talking about extinction techniques. It made me feel like I should wag my tail and bark. It made me sooooo mad that I wanted to go out and start some behaviors that they'd want extinguish, never mind stopping ones because of their pathetic systems of reinforcement and lack of reinforcement. They did have the grace to say that it was primarily designed for classroom use, or inpatient use, where the environment could be closely controlled. And also that if was of limited value in changing long term behavior. But geeeeez, what a horrible view they have of people.
It's enough to put me in charity with cognitive-behavior therapy.
Posted by alexandra_k on March 31, 2005, at 3:30:30
In reply to Arrrgh » alexandra_k, posted by Dinah on March 30, 2005, at 19:51:59
> But geeeeez, what a horrible view they have of people.
Skinner wrote a book "Beyond Freedom and Dignity". That says a lot. "1984" was written as a reaction to Skinner's ideal society. I think he wrote about his ideal society (run on behaviourist principles) in "Walden Two". Apparantly there is a little cult or society or whatever you want to call it somewhere in the US where they try to live by that.
To be fair...
I think behaviourism is right or true so far as it goes.
But it leaves out so very very much.You can tag cognitive theories onto it which is an improvement:
> It's enough to put me in charity with cognitive-behavior therapy.Yup.
But there is still something missing...IMO
It is still a fairly bleak view of humanity.I don't know...
Behaviourism works best for beings that are non-verbal or pre-verbal. Once you have developed language you tend to follow 'rules in the head' as well as tracking reinforcement contingencies. So you can train people (with language) according to a schedule but they don't perform the way they should on the basis of the reinforcement contingencies if they are following a rule.
That is just one example of where things go wrong.
Another way in which this shows that things are going wrong for the behaviourist is that they are not allowed to talk about 'rules in the head'. That is an INTERNAL hence UNOBSERVABLE hence OCCULT kind of process that needs to be BANISHED from psychology if we want a real science of behaviour JUST LIKE PHYSICS (according to Skinner).The trouble is that it also seems to be a perfectly adequate description of what is going on in that case. And the behaviourist doesn't seem to be able to offer us a better one.
But it works good with
possums
chickens
ponies
rats.Would you believe that the behaviourists at my uni have actually taught cows to milk themselves???
True.
This is the end of the thread.
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