Guest entry: Multiple personality disorders, a theory

posted by Antigone Kostas, MD (psychiatry resident)

Key Thoughts After Reading Richard Gottlieb's "Does the Mind Fall Apart in Multiple Personality Disorder? Some Proposals Based on a Psychoanalytic Case"

In one of our case conferences, a resident presented a patient with a diagnosis of multiple personality disorder (MPD) to open discussion. However, what we residents very quickly learned from our supervising attendings is that no credible psychiatrist really BELIEVES in multiple personality disorder. Instead MPD is a figment of very suggestible, most often sexually or physically abused people. Therefore when a friend who is not in psychiatry asked to learn more about MPD, I groaned. Nonetheless, I gathered some articles on the subject and was actually surprised to find one that offered an interesting perspective in understanding MPD. Gottlieb takes a psychoanalytic approach to MPD rather than one looking to hypnotize the patient and fuse the multiple selves. Below is his explanation of how MPD evolves.

Gottlieb argues that MPD is not a problem of a disintegrating mind or multiple selves. Rather it is multiple behavioral states (not selves) stemming from fantasies of being multiple people. First he says the person must believe that multiple personalities are possible. This is not a far leap when one considers what happens during trauma and when one dissociates. The dissociating person thinks, "This terrible thing is not happening to me, but rather I am over here as an observer of a different me who is the unfortunate participant, victim...." (Gottlieb 1997) etc. Hence the multiple view points. Also, these people are often victims of sexual/physical trauma who have had their "bodies forcibly intruded upon, entered, filled, and emptied." Implicitly, Gottlieb argues that if someone has had control over someone else's body, someone else could likewise have control over his/her mind. Thus, the emergence of MPD.

Gottlieb, Richard M. "Does the Mind Fall Apart in Multiple Personality Disorder? Some Proposals Based on a Psychoanalytic Case." Journal of American Psychoanalytic Association, 45: 907-932.