‘Public fascination with dissociation and its disorders has endured for many years — examples include the books “Sybil” and “The Three Faces of Eve,” both adapted into wildly popular feature films, each about a woman with “multiple personalities.” …Now people are capturing their experiences with dissociation and posting them on social media. …as conversations about mental health continue to migrate into public forums. But research suggests that much of this content isn’t providing reliable information. We asked several mental health providers to explain more about dissociation….’ (The New York Times)
One of my colleagues and mentors, Dr Judith Herman, psychiatric pioneer in trauma studies, is quoted as opining that dissociation is “way under diagnosed.” There is a sense in which she and others with similar views are right. I am constantly diagnosing dissociative disorders that have not been recognized by mental health professionals not familiar enough with their recognition, often resulting in years or decades of unsuccessful treatment and needless distress for patients whose difficulties have been misdiagnosed.
But the opposite problem is also emerging. Fueled by the easy online dissemination of psychiatric information both accurate and inaccurate, dissociation and dissociative identity disorder have joined a series of faddish diagnoses with which people self-label themselves. These have included chronic fatigue, fibromyalgia, ADD and ADHD, bipolar disorder, and OCD. Encouraging patients to seek responsible diagnosis by trained and experienced professionals rather than doing the research themselves often leads to dismissive claims that we want to maintain a monopoly on esoteric knowledge that should be democratized and freely available. Self-diagnosis has come to be seen as a virtue, but it is anything but. It should not be seen in terms of the issue of access to the information. The old adage in the field, “A physician who treats themself has a fool for a patient” is truer still for a non-physician, and especially so in mental health care.
Sometimes a patient presenting with an insistence on having a particular diagnosis represents wishful thinking. The aphorism “You see what you want to see and you hear what you want to hear” is pervasive, but someone discerning pointed out that the “second ‘you’ in each clause is not actually ‘you’.” The important thing to figure out in their treatment is what part of them is longing to construe things that way and why. Sometimes you might simply assume that the insistence, for example, on having a dissociative disorder is because explaining things that way represents a hopeful move in the direction of applying the effective treatment. But many of us feel that there are no treatment approaches found to be of established specificity and effectiveness for dissociative experiences. This is different from the situation in, say, insisting that your life struggles are explained by having ADHD, when a request for treatment with a stimulant like Adderail is often not far behind. Or, sometimes, a patient’s investment in having a given disorder may represent a wish to be let ‘off the hook,’ in this age of rampant medicalization of behaviors and behavioral disorders and deflection of personal responsibility.
I think it is no surprise that the therapeutic advances in psychiatry creating the most excitement these days — ketamine, TMS, and psychedelic treatment — all to some degree share one appeal, that of being relatively ‘quick fixes’ in contrast to the preexisting modalities of treatment we have offered. Do they represent true exciting advances or simply what needs to be offered to appeal in times of changing political, economic, social and cultural conditions?
Related: New Study Evaluates Quality of Information on YouTube, TikTok About Dissociative Identity Disorder (American Psychiatric Association)
