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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
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).
Posted by Dinah on March 27, 2005, at 22:20:44
In reply to (ii) The Socio-Cognitive Model, posted by alexandra_k on March 27, 2005, at 21:24:25
Ah yes, Spanos. What I've never understood is this.
He believes that the response of pro-DID/MPD clinicians may encourage people to behave in a way that conforms with this model. I have no problem with this concept, in a way. I certainly think there can and have been "cases" that were iatrogenic in nature. That would be hard to deny.
On the other hand, he never considers that his proposed treatment may promote iatrogenic "wellness". That if a clinician ignores or disapproves of a legitimate report of symptoms or experiences, the patient may well quit reporting them, not because they ceased to exist, but to please the clinician.
I don't get that.
Posted by alexandra_k on March 27, 2005, at 22:42:52
In reply to Re: (ii) The Socio-Cognitive Model » alexandra_k, posted by Dinah on March 27, 2005, at 22:20:44
> He believes that the response of pro-DID/MPD clinicians may encourage people to behave in a way that conforms with this model.
Ah. It is more that he believes that the response of pro-DID/MPD clinicians (among other things) may encourage people to behave in a way that has them meet DSM criteria for the disorder.
He thinks ALL of the reported cases are like that.
> On the other hand, he never considers that his proposed treatment may promote iatrogenic "wellness". That if a clinician ignores or disapproves of a legitimate report of symptoms or experiences, the patient may well quit reporting them, not because they ceased to exist, but to please the clinician.
Yeah. Gleaves (and others) use that same objection too. I guess all that can be said is that for Spanos the world does not work that way.
I guess it is the behaviourist influence. They have a case of the 'nothing buts'. All of the DSM disorders are 'nothing but' a list of behavioural symptoms. If you can alter the behaviour so that it no meets the criteria then you have cured the subject of their ailment. All there is to their ailment is their meeting the criteria. Spanos may well say that he had cured someone only to have them revert in the face of altered reinforcement contingencies when a new clinician starts reinforcing them for the behaviour that he was punishing away.What I don't understand is how he got ethical approval to attempt to induce DID in first year college students by the use of hypnosis. For course credit, no doubt...
It worked.
Temporarily.
Lucky for him, I would say.
Or they would surely have sued his *ss.
At least I hope it was temporary...
And what does that show us: nothing.
Try interpreting the significance of that finding...
Posted by Dinah on March 27, 2005, at 22:54:32
In reply to Re: (ii) The Socio-Cognitive Model » Dinah, posted by alexandra_k on March 27, 2005, at 22:42:52
Except that you aren't altering the behavior. You're altering the reported behavior. Good enough for Spanos, perhaps. Not good enough for those who not only still have the criteria, but now also have to hide the fact.
I suppose I could be cured of depression and anxiety if I tell Spanos that I'm happy happy happy and going all over the city, even if I'm really lying in bed crying and refusing to wash or leave the house except for his appointments?
Not shooting the messenger, Alexandra.
Just thinking that four or five semester of algebra and other mathematics should be required for theorists of any persuasion.
Posted by alexandra_k on March 27, 2005, at 23:57:21
In reply to Re: (ii) The Socio-Cognitive Model » alexandra_k, posted by Dinah on March 27, 2005, at 22:54:32
> Not shooting the messenger, Alexandra.
I know. The theory makes me bristle too...
> Except that you aren't altering the behavior. You're altering the reported behavior.
Oh. But to 'cure' someone you need to alter their behaviour and their reported behaviour. He thinks you can reinforce them away for good.
> I suppose I could be cured of depression and anxiety if I tell Spanos that I'm happy happy happy and going all over the city, even if I'm really lying in bed crying and refusing to wash or leave the house except for his appointments?Oh no. See lying in bed crying etc is behaviour too. He doesn't mean just altering behaviour he can observe. He thinks that it will generalise back to that behaviour taken as a whole will be better.
> Just thinking that four or five semester of algebra and other mathematics should be required for theorists of any persuasion.
:-(
Why???
Posted by Dinah on March 28, 2005, at 0:19:21
In reply to Re: (ii) The Socio-Cognitive Model » Dinah, posted by alexandra_k on March 27, 2005, at 23:57:21
Because most of psychology (outpatient at least) is self report. And not all behavior is visible.
And to miss the rather obvious conclusion that people can lie and misrepresent in both directions seems relatively lacking in logic.
And mathematics (especially algebra, though I suppose geometry too) is the best teacher of logic I know.
I have a favorite cartoon. (Foxtrot - Bill Amend - copyright 1993). It's of a brainy little boy talking to his sister. She's complaining about word problems in math and he says "Are you kidding? Word problems are great! Without word problems math would be just some abstract bunch of formulas that live only within the confines of a classroom or a textbook. But in reality, math is everywhere you look! It permeates everything! You can't escape it! And that's what word problems let us in on. And the more math you learn, the more math you see..."
Posted by alexandra_k on March 28, 2005, at 0:37:05
In reply to Re: (ii) The Socio-Cognitive Model, posted by Dinah on March 28, 2005, at 0:19:21
> Because most of psychology (outpatient at least) is self report. And not all behavior is visible.
Ah.
> And to miss the rather obvious conclusion that people can lie and misrepresent in both directions seems relatively lacking in logic.Ah. A distinction may be useful:
(a) metaphysics - the study of what is.
(b) epistemology - the study of knowledge.The point is that what is the case (metaphysics) is one thing... and what (if anything) we can know about it (epistemology) is another. The behaviourists are just making the metaphysical claim that mental illnesses are 'nothing but' their behaviours meeting the DSM criteria (whether anyone observes them to meet it or not). So a misdiagnosis could be made on the basis of limited observations of their behaviour.
> And mathematics (especially algebra, though I suppose geometry too) is the best teacher of logic I know.Hmm.
Logic is the best teacher of Logic.
(I have done logic - see {joke})
I can't do math :-(
I thought you might have been poking me.
Posted by alexandra_k on March 28, 2005, at 0:41:07
In reply to Re: (ii) The Socio-Cognitive Model » alexandra_k, posted by Dinah on March 27, 2005, at 22:20:44
> Ah yes, Spanos. What I've never understood is this. He believes...
He believed..
He died (tragically).
Lillenfeld (et al.) have continued in his honour...sigh
Posted by Dinah on March 28, 2005, at 0:54:29
In reply to Re: (ii) The Socio-Cognitive Model » Dinah, posted by alexandra_k on March 28, 2005, at 0:37:05
I tease on occasion, but only with a smile, and only with those I feel affection for.
I state.
But I don't poke.
:)
Posted by alexandra_k on April 1, 2005, at 18:37:58
In reply to I don't poke. » alexandra_k, posted by Dinah on March 28, 2005, at 0:54:29
Ok.
Sometimes (on very rare occasions) I feel poked. But most often I go away for a while and when I come back and reread it I realise that you aren't poking at me.Just my insecurities...
This is the end of the thread.
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