Oct 26

Schizophrenia and Dissociative Identity Disorder: Not the Same

QUESTION:

What’s wrong with the following popular jokes? (Besides their general offensiveness, I mean.)

1. What’s the worst thing about schizophrenia?      

Paying more than once for everything.

2. Roses are red/Violets are blue/I’m schizophrenic/And I am too.

3. A psychiatrist asked her multiple personality patient, “So do you feel like you’re cured?”      

He replied, “Absolutely. We’ve never felt better.”

 ANSWER:

The first two jokes confuse the definitions of the distinctly different conditions of schizophrenia and dissociative identity disorder (formerly known as multiple personality disorder). A diagnosis of schizophrenia does not include having more than one personality but may include having delusions or hallucinations, neither of which are likely to cause a sense of internal division.

The third one implies that integration of personalities has to be the only or ultimate goal of therapy for those with dissociative identity disorder (DID), a common myth that might have something to do with the popularization of “Sybil” and her supposed treatment, a topic that was addressed in yesterday’s post.

In fact, some individuals with DID do wish to achieve the merging of their different alters, but many do not. My own approach with clients with DID has been to find out what they want. (Note: This should not be a novel thought among therapists.) The upshot is that my experience has been to work with clients’ alters or “parts” to help them learn to co-exist, not to integrate.

Identifying as a dissociative with a system of different parts—and not identifying as a one-name/one-personality-only type of person—does often lead, when feeling safe enough, to using “we” versus “I” in self-reference. Thus, if a client with DID were to say to me, as in the above joke, “We’ve never felt better,” I’d be very happy for them.

Oct 25

“Sybil Exposed”: Not An Argument Against Multiplicity Itself

A newly released book by journalist Debbie Nathan, Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case, is currently getting a lot of attention in the press, as well it should if it is accurate in its depiction of highly fraudulent practices on the part of three individuals—the therapist, the author of the original book about Sybil (1973), and the patient herself—who allegedly conspired to make this woman’s condition and treatment into something that it wasn’t, turning her into “Sybil Inc.,” an immensely popular and lucrative enterprise.

On the positive side of this mess, the products generated by Sybil Inc. have served to popularize multiple personality disorder, now known as dissociative identity disorder (DID), and have given many people hope that their complex conditions could become better understood and treated.

On the negative side, the doubters—including some mental health professionals who don’t believe the condition actually exists in anyone—may now seize the chance to use Sybil Exposed to add fuel to that particular fire. See? Dissociative identity disorder is a crock, some are likely (illogically) to maintain.

I have neither read Nathan’s book nor can I weigh in on whether our Sybil of yore does represent one big fat lie, but I have witnessed and do strongly believe that there are those who do live with DID and that they represent one major truth: it is possible, it is indeed highly creative, when faced with severe childhood trauma, for one’s personality to become divided in order to withstand the torturous pain.

Do an online search for DID and you’ll find many up-to-date books that can serve to offset any indications, however shocking and upsetting, that this one particular patient/therapist/writer team may have fabricated multiplicity. (Clarification/ update, 6/10/12: In other words, there are still many experts who cite other case examples and histories; there are still many who believe that DID exists.) Two highly recommended books are The Dissociative Identity Disorder Sourcebook by Deborah Haddock and Multiple Personality Disorder From the Inside Out, edited by Cohen, Giller, and Lynn W.

With so many written and oral testimonies by those who’ve experienced DID firsthand, I confess that it’s beyond my ability to comprehend how anyone in my field could be a disbeliever. I contend that the therapists who disbelieve are either uninformed or unexposed or that they are so closed off to the possibility that they are unable or unwilling to see or accept it in their clients.

Moreover, clients may be unable or unwilling to reveal themselves fully in therapy if they sense any of the above characteristics in their shrinks.

For anyone who counters with, If they can hide it, it must not be so, consider your own personality. Do you routinely, for various reasons, keep parts of yourself in check? Please don’t say no. Because if you don’t, the rest of society may ask you to get some help learning how.

Oct 24

“How I Met Your Mother” Therapist: Friends Don’t Diagnose Friends

On How I Met Your Mother (HIMYM), it’s been made clear that Kevin, the former therapist of Robin, is now dating her. Those troublesome boundary problems were addressed in last Monday’s post, and I’m not going to rehash them here. Suffice it to say, I don’t like this development.

But the most recent episode (October 17th), handled another interesting theme, that of the therapist trying to fit into the social group of his new girlfriend without ruffling any feathers by diagnosing their issues.

True enough, some therapists who are new to a particular social group may not always fare so well, at least at first.

Scenario Example: You are a therapist. You go to a party. You meet someone new. Conversation leads to: So, hey man, what do you do? You say, I’m a therapist.

Said maybe not so receptively, Oh. Are you going to psychoanalyze me/diagnose me?

Or, said maybe too enthusiastically, Wow, that’s great! So, help me figure out…”

In HIMYM, Kevin just wants to be liked. Therefore, he suppresses his opinions when repeatedly asked to weigh in on their dysfunctional dynamics. Eventually, though, in a fit of frustration, he lets loose on such problems as their “separation anxiety,” “inappropriate social behavior,” and the one I found most clever, “survivor guilt,” a twist on its real meaning in that Lily felt lonely one night and watched an episode of TV’s reality show Survivor without her usual watching partner, her spouse Marshall.

When Kevin adds that the only unhealthy thing he hasn’t seen is violence, we see a montage of actual, as in previously aired, moments that featured a good deal of hitting. Kevin, being new to the group, of course has missed all of that.

The upshot is that although Kevin is now angrily viewed by Robin as maligning her and her friends as “mentally ill,” everyone quickly gets over it.

Therapists, please don’t try this at home. It only works in sitcoms.

Oct 21

Therapist Boundaries (Violence): “Good Will Hunting,” “What About Bob?”

Do a Google search about therapist boundaries, specifically therapists and violence, and you’ll find plenty about clients attending therapy for being violent. Look no further, in fact, than this past Monday’s post about sitcom How I Met Your Mother (HIMYM), in which a main character winds up in court-ordered therapy for assault.

But can you find any reliable info about therapists being violent? Against their clients? No? Do we have to (misguidedly) look to the movies for such things?

Like Robin in HIMYM, Will (Matt Damon) in the movie Good Will Hunting (1997) has to attend therapy after an episode of violence. Finding the right shrink for Will, who trusts no one who tries to help him, turns out to be no easy feat. Well, maybe the less traditional, more directive kind of therapist we eventually find in Sean Maguire (Robin Williams) will fill the bill.

But before Will gets anywhere close to the meaningful catharsis the film wants him to have, he has to put Maguire through the usual hoops, in one instance meanly and provocatively maligning Maguire’s dead wife. What follows is this disturbing scene involving terrible therapist boundaries:

Lesson #1 (You Wouldn’t Pick Up From The Movies): It’s never okay to choke a client. (Or harm a client in any way.) Even if the client then backs off and actually moves on to have one particular wowie-zowie life-changing therapy session.

Next up, there’s actually worse things a shrink can do. In the film What About Bob? (1991), the psychiatrist played by Richard Dreyfuss goes nuts himself dealing with Bob (Bill Murray), his dependent client who follows him, uninvited of course, on vacation.

Lesson #2 (You Might Not Pick Up From the Movies): Even unsuccessful attempts at killing one’s clients are not allowed.

Oct 20

“Monk”: Episode in Which He Resists His Therapist’s Vacation

Thankfully, I’ve never encountered anything like what happens in the video below, which is taken from an episode of Monk, a TV show that ended first-run episodes in 2009. It should be noted that the main character, a detective (played by actor Tony Shalhoub), deals with extreme OCD and phobias.

Alas, how unfortunate that Dr. Kroger caves at the end. He had done so well with trying to end the session on time despite Monk being in the middle of his statement.

But managing the ordinary hour-to-hour time constraints is indeed different than managing vacation plans. And if Kroger, when faced with an unyielding client, can’t stick to his personal choice to have one significant and special day off, yes, his wife will probably be upset, but the one in the couple needing help might be Dr. Kroger—not his wife, as Monk suggests.