>> i'll give youa quick introduction, i'll tell you quicklywhat i'm gonna go over, and it's dividedinto three sections, so i've got threesets of slides, and we'll takea break between each of thosesections. and we'refinishing at... 9:00 or 9:15? 9:15-- it's alittle loose?
>> we could go later if you-->> 11:15, 12:00? (audience laughing) uh, so, i'm a psychiatrist,born in canada, grew up in canada,went to medical school in canada from'77 to '81. did my psychiatrytraining in canada from '81 to '85. then, i was anacademic psychiatrist in canada,'85 to '91.
and then, in '91,i moved to dallas where i've been since, runninga hospital-based trauma program. in '98, we openeda trauma program here at forest view,and then, in 2000, i kind of inherited apre-existing trauma program at a hospitalin la. and in dallas, i've-- i'mnow at my third hospital. so the first hospitali was at is closed-- the corporation wentout of business.
second hospital i wasat closed temporarily, so we moved to asister hospital in the dallas area. so basically, i... help with oversight,overview, educating the staff,consulting to the staff. i do lots of writing,lots of talking, and i do, in dallas,three groups a week in person. here in michigan,i do two groups a week
by video conference. i come up once a monthfor two days. and in la, i dotwo groups a week by video conference, and gokind of intermittently to la. so i'm actuallyhands-on involved in clinical work,not just a theory guy, sits at his deskand smokes cigars and plays golfsort of thing. i decided to be apsychiatrist way back,
and then kind ofdid a life detour around and about, got tomedical school in '77, 100% intending tobe a psychiatrist. but i learned fairlyquickly in medical school that it's best to keepthat a little bit quiet, because the surgeonsand the internists generally didn't havea whole lot of respect for psychiatry, andwere all disappointed if they heard you'regoing to psychiatry.
didn't really have anyparticular thoughtsabout trauma, dissociation, multiplepersonality disorder, anything kind ofin that ballpark at the beginningof medical school. then in... early in... hey. for some reason,when you phoned me, i answered, i said, "hello,"but you weren't there.
>> i was standing outside toolong-- my phone fell asleep. (laughing)>> oh, not to mention you. this is jessica, who'sthe program director at the forest viewhospital. >> hello. >> feel free to sit somewhere.>> okay. >> and so, early in thethird year medical school, you start doingrotations, and... you do surgery,internal medicine,
pediatrics, obstetrics,gynecology, and psychiatry. and your basic job asa medical student is to get harassedby the nurses, try and stayout of the way, and do some kind of menialtask that nobody else wants to do. and that involves takinga history, for one thing. so somebody comes in, and youhave to go take a history
and write it upin great detail, because the psychiatristsdon't want to spend all that time askingall those questions or writingthat stuff out. and as you're doingthat, of course, then you learn,by asking questions, talking to people, findingout what's going on. and so... kind of like a third ofthe way into the rotation,
which was eight weeks, i was assigned to do anintake history on a woman who had been referredin by her family doctor. and she was late-ish 20s,and her story was-- so this is in edmonton,in canada-- her story was, a week previous tomy talking to her, she had all of a suddencome to at the airport, and she had a blankspell of a week, and didn't knowwhere she'd been.
not even what cityshe was in, for a week. then, from that pointin time, going back, she had normal memoryfor a month, and at that point in time, shehad come to at the airport, but that time she wasmissing a whole month. so that was kindof the puzzle of what's goingon with this woman, and i'd read a littlebit about hypnosis, so i was kind of practicingmy hypnosis techniques
with people who are... not really trauma people,just general adults, psychiatric in-patients for help for sleep,help for relaxation, maybe a littleanxiety reduction. basically just practicingthe rigmarole of hypnotizingsomebody. so since she had amnesia,i thought, "well, maybe i'lltry hypnotizing her,
"see if shecan remember." she's very easy tohypnotize, and immediately she remembered that she hadbeen in eastern canada-- she was separatedfrom her husband, she was in eastern canadavisiting her kids, on both occasions, and she had bought thema whole lot of presents. well, where did sheget the money from, was the question.
well, where shegot the money from was her pretty wealthy,high-spending construction guyboyfriend. and he wisely haddecided to set up a joint accountwith her, and she had taken a whole bunchof money out of his account and put it in fourdifferent accounts, and then, during the periodof time she didn't remember, she'd emptied outthose accounts,
used that to buythe plane ticket and buy a whole bunch ofpresents for her kids. so is that true or didthat really happen? so what we did iscalled the banks and went througha procedure, and a detective actuallycame in and interviewed her, because she had bounceda couple of checks. so all these bank accountsdid in fact exist, the money in factwas spent.
she was married-- orseparated-- she did have kids. and so, that wasinteresting, as a third-yearmedical student. and my supervisingpsychiatrist was off on vacationfor a couple of weeks, so his replacementsupervisor basically said, "oh, yeah, whateveryou wanna do." that was mysupervision. and...
after a couple ofthese hypnosis sessions, she said,"you know, sometimes, "i joke aroundwith my boyfriend, "and i tell him, 'thatwasn't me you kissed, "'that was suzy,'"a different name. i said, "yeah,okay, whatever." and then, i can'treally remember why, but i decided afteri had hypnotized her and she's all relaxedand everything,
to say, "well, how areyou feeling today, suzy?" all of a sudden, 11-year-oldsuzy's talking to me. she's the one whodid all the money and the bank accountsand bought the ticket and went back andsaw the kids, and the grown-up regularperson didn't remember. so there i was with a caseof multiple personality. third-year medical student,know nothing about nothing. so my supervisor, bythis point, had come back
from his period ofvacation, so i said, "well, i've got thismultiple personality case." he's like,"oh, yeah, okay." "well, what shouldi read about that?" this is in 1979. he says,"i don't know. "why don't you goto the library?" good suggestion. so i go tothe library.
started lookingaround in textbooks, and i find a coupleof review papers, one from the '70sand one from the '60s, and i learn that thisis the 200th case of multiplepersonality disorder ever diagnosed in thehistory of western medicine. huh. so that's alittle bit weird. and what arethe odds of that?
and so, i end upwriting that case up and publishing it in the"international journal "of clinical and experimentalhypnosis" in 1984. that was my first case--that's how i got into it. and i thought, "well, thatwas really interesting, "but obviously i'mnever gonna see "another case again. "it's just astatistical fluke." then, finishedmedical school,
i'm in myresidency program, and we have a long-termpsychotherapy program where each residentfollows two people for as longas required. and every year,on each of those cases, you change supervisor. so you get a bunchof different cases and a bunch ofdifferent supervisors. so i'm workingwith this woman
who's a pretty seriouslybattered spouse, depressed, agoraphobic,anxious, and lo and behold, shehas a couple parts inside. so now i'vegot two cases. then i finish myresidency in 1985, and, um, at the endof the academic year, which is theend of june, and in september, a woman comesto the emergency department, is assigned to me as a generalin-patient psychiatrist,
and lo and behold, ifigure out that she has multiple personalitydisorder. so now, i'veseen three cases. so at this point, i'mthe leading expert in western canada withthe most publications of any psychiatristin western canada. equals two. three cases,two publications. so this is how istumbled into this area.
i had no idea, no attitudes,no thoughts, and so, now, the puzzlegets even bigger. well, wait a minute, ifthere's only been 200 cases, how come now i've gotthree all by myself? and the possible answersto this question are... "there's something veryweird about colin ross-- "he makes people act like theyhave multiple personality, "and they just do thatfor whatever reason." or, it must bemuch more common
than just a couplehundred cases. and so, i'm gonna talkabout the epidemiology, how common it is,how it can be diagnosed, and, in '94, when"dsm iv" came out, the name was changed from"multiple personality disorder," mpd, to "dissociativeidentity disorder," did, but it's thesame basic thing. so multiple personality anddissociative identity disorder
are the same thing. so jumping intosome slides here, i'm gonna showyou some data now and a little bit of thescience of how all this works. if i can. mmm. oh, okay,this one. okay. so first of all, it'salways good to define terms.
so if you read the generalpsychology literature, psychiatry literature, you'll quickly find thatthere's people out there who don't believein all this stuff. psychologists,psychiatrists. and one of thethings they say is that dissociation'san extremely vague thing, nobody knows what it is,nobody can define it, nobody can measure it.
well, that's truein their minds. but not in my mind. it's actually veryclearly defined. but the confusing pointis that there's actually four different meaningsof the word "dissociation" that are used inthe literature, and people aren't always clearwhich meaning they're using, and people whoare reading aren't always clear whichmeaning they're intending,
so there isconfusion. but it can be sortedout quite easily. so dissociation--meaning number one is it's a generalsystems meaning of the word"dissociation." general systems theoryis just a theory of how systems in theuniverse operate, in general. could be a solar system,could be a cell, could be an atom, couldbe an organization.
so it's howsystems operate. and in the generalsystems meaning, "dissociation" is theopposite of "association." so if two thingsare associated, they're connected,they're interacting, they've got somethingto do with each other. if they're dissociated,they're disconnected, not interacting, out ofrelation, split apart. so dissociationbasically means the same
as "disconnected." and i'll come backto all these meanings as we gothrough it. second meaning is it'sa technical term in cognitivepsychology. so this is guys who doexperiments with rats and mice and all kinds ofdifferent animals. and there's thousandsand thousands of papers published in psychologyabout all kinds
of learning experimentsand so on. so a typical experiment is,if you're looking at memory, there's conscious memory,unconscious memory... which is declarative memory,or procedural memory... or explicit memory,implicit memory. they all kind of meanconscious, unconscious. and so, there's a famousguy who had brain damage, who... if you met him 50 timesin the last month,
every single time,he has no idea that he's met you before,it's a brand new thing, because he can't record anymemories and store them. they just disappearautomatically because of the damageto his brain. and this guy's verywell-studied and so on. and so, there's a wholebunch of different tasks that he was run through,and lo and behold, the more hedid a task--
like there's a task wherethere's three pegs like this, and you stack blocks on them,and you have to re-stack them in a certain pattern, and like anything in life,the more you do it, the better youget at it. well, his performanceimproved with practice at the same rate asnormal college students, although he had nomemory whatsoever of ever being exposedto the task.
which shows that his--part of his memory's intact and learningand recording, he just has noconscious record of it, which is part ofpiles of evidence that procedural memory,declarative memory are separate systems. you can knock one out,and the other can still beoperating. and then, inhuman experiments,
there's basically-- you takeall these college students who are guinea pigswho get course credit and the professors crankout lots of papers, so it's goodfor everybody. and you run them throughall these different tasks. well, one task is youmemorize a list of word pairs, which are homophonicword pairs, meaning they sound the same,like r-e-e-d and r-e-a-d, but they havedifferent meanings.
so you have maybe 30 ofthese pairs of words, and you memorize them,and then a week later, you're asked to writedown as many of them as you can remember. so pretty goodchunk of people are not going to rememberreed/read, consciously-- they don'twrite it down. so it's gone fromtheir memory. and then, what you dois you give them a cue.
so with spontaneous recall,the information isn't there. you give them a cue. "what's the name of atall tubular plant "that growsin marshes?" and they're supposed towrite down the answer. so the first group, likeyou guys on this side-- your word listincluded reed/read. your word listdid not. so you guys, when you'reasked that question,
you misspell r-e-e-das r-e-a-d much more frequentlythan you guys, who are neverexposed to reed/read. because the word read--r-e-a-d-- is grumbling around inyour brain somewhere. you can't consciouslyaccess it, you don't rememberit was on the list, but it's affectingyour output, your conscious verbalor written output,
showing that you can haveinformation in your brain that you can'taccess consciously, but it's affectingyour behavior. and there's zillions ofexperiments like this. so this means that thememory is dissociated. it's not inconscious memory. so the conscious--i can remember my name and my address andmy parents, etcetera-- that system, theinformation isn't there,
it's dissociated andheld in the other system. so that's a technicalmeaning of dissociation, and that kind of dissociationis experimentally proven over and over andover and over. it's a very rigorouslyproven thing. that's just howthe mind operates. which is just commonhuman experience. so there's allthis controversy about whether thiskind of dissociation
and this kind ofamnesia actually occurs... but if you think aboutit for a second, this is the way your mindoperates all day every day. "so, what wasthat movie, okay? "oh, yeah, yeah-- but whatwas the actor's name? "well, yeah, he was in thatother movie with kevin bacon, "and kevin baconknew this guy "who knew that guy--oh yeah, that's his name." so we're constantlydoing these little...
various mind trickswith ourselves, or we're just repeatingthe recall effort, and then theinformation's there. it wasn't there,and now it is there. so it's just an everydayuniversal human experience, that information canbe in your brain, you can't find it, but with somesort of procedure or effort, it pops back. and there's lots of evidenceshowing that hypnosis
and other research, that the memory that youcan't access initially, and then it gets cuedand you do remember it, has the same rateof memory error as just memory--regular memory you've rememberedall along. so it's not more accurate,it's not less accurate. then, there's aphenomenological meaning of dissociation.
so when i wentto medical school, i was taught if you usea bunch of big words, you soundreally smart. so phenomenologicalmeaning. that just means thesymptoms that people report that are in all thesedifferent questionnaires and symptom measures thatwe'll get into in a bit. so that's the actual symptomsthat people experience are dissociative symptoms.
then, there's anxiety symptoms,there's depression symptoms, etcetera. there's nothingmysterious about it, it's just symptomsthat people report that kind of clusterinto this group, just like depression symptomscluster into a group. and then, there's apostulated intrapsychic defense mechanism. so this is a theory about adissociative defense mechanism
that's operatingin your brain. so the funny thing is thatthis meaning of dissociation-- some sort of theory aboutwhat's going on in your brain, how your defensemechanisms work, is actually onlyone possible cause of the phenomenologicalsymptom form of dissociation. so there may or may notbe this defense mechanism called "dissociation"...but it's only one of many possible causesof the phenomenon
you can see where we can getreally confused really fast. one person's talking aboutthis defense mechanism, another person's talkingabout a symptom. but if you sortthese meanings out and you keep them clear,here they are. there's also a lotof confusion about the difference betweenrepression and dissociation that i'll come back toin the third segment. and "repression" beinga freudian term.
and the best way to,uh, explain that is a guy named hilgardwho created something called"neodissociation theory." he talks abouthorizontal splitting and vertical splitting. so this is just a diagramfor the difference between repressionand dissociation. because people talkabout repressed memories. it's sort of the samebut not really the same
as dissociative amnesia. so if there's a horizontalbarrier in your mind, the theory of repression,as stated by freud, is you have information inyour conscious mind, your ego, and it's upsetting,you have conflict about it, you don't like it,so you push it down into your unconscious mind,or your id. and there's ahorizontal barrier. your consciousmind's up here,
your unconsciousmind's down there. and when stuff is pushedinto the unconscious mind, then it gets all involvedwith dreams and fantasy and unconsciousmental processes and get it allelaborated and distorted, and things can happento that memory that don't happen ifthe information's just stored in yourconscious mind. and there's actually twosubtypes of repression.
one subtype of repression iscalled "repression proper," where it's in yourconscious mind, like something traumaticor conflictual happens... you can't deal with itand you push it down. primal repressionis nothing to do with experienceor memory-- that's where youhave some impulse coming from yourunconscious mind or your id, and it's trying to come upinto your conscious mind--
say, somesexual impulse-- your conscious mind isall hung up about it and uneasy about it so itjust keeps it squashed down. it never actually makesit up into consciousness. so there's these twosubtypes of repression. that's freudianrepression theory. dissociation is different--it's vertical splitting. in dissociation,nothing is pushed down into the unconscious,into this mysterious place
that you can neverexactly pinpoint or find. it's in a different compartmentof the conscious mind. so the barrier,the split, is this way. there's conscious mind here,which doesn't remember, and conscious mind therethat does remember. so it's kind of a differentmodel and different theory. a lot of people who don'tbelieve in dissociation, who attackdissociation, and say you can't haverepressed memories
of massive trauma--it's not possible, the mind doesn'twork that way, also say that thedissociative disorders are based on all thisbogus freudian theory about repression. which is just ascholarly error. dissociation theory is acompletely different thing from repression theory. it's a differentset of mechanisms,
even at thetheory level. and in early freud, likehis studies on hysteria published in-- just beforethe end of the 19th century, he, with his co-author breuer,describes classical, classical multiple personalitykind of cases. whole series of women, tonsof childhood sexual trauma, they come into therapy30 years later, they've got all kindsof different symptoms, including amnesia
and sometimes full orpartial multiple personality. and when he waswriting like that, he assumed that the memorieswere real and accurate and the incestreally did happen. so whenrepression theory-- when early freudiantheory applies, then it's really moredissociation he's describing, and the assumption is theincest really happened, the memoriesare accurate.
not perfectly accurate,but basically accurate. then, in 1897-- so that'scalled the "seduction theory"-- they were seducedby adult pedophiles, and that's why they'vegot all these symptoms 20 or 30 years later--that's seduction theory. in 1897, he repudiatedthe seduction theory. he decided that thememories were false. in order to explainto himself why the memories are false,he developed repression theory.
so repression theory isall based on the idea that these arefalse memories. not maybe 100.0%, butsubstantially, mostly. so the people who attackthe dissociative disorders make a couple ofconceptual errors. they say that dissociation andrepression are the same thing, which is not true. and then, they say thatthese are false memories, because the therapistsare basing their therapy
on repression theory,which is completely bogus, and that's why they're cookingup all these false memories. which is completelywrong and backwards. if you follow repressiontheory as stated by freud, you assume thememories are false. you don'tbelieve them. so the people who don't believein dissociative disorders are accusing the therapistsof believing false memories because they'remaking their therapy
based onrepression theory. it's all justa big huge mix-up. so this is whatgoes on in my field. so now, we're gonna talkabout the phenomenological meaning of dissociation,and symptoms. so there's the-- so i'm gonnaguess this is the pointer. there we are. so there's the dissociativedisorders interview schedule that i developed, that'sa structured interview--
a bunch ofstandardized questions. and you'll see thedissociative experiences scale, which is a 28-item measureyou fill out yourself, you score it, andthe total score can go fromzero to 100. and then, there'sthe scid-d, which is anotherstructured interview for dissociativedisorders developed by a womannamed marlene steinberg.
so in this project, in generaladult psychiatric patients in a hospital in dallas,we excluded anybody who already had adissociative diagnosis, which is only likeone or two people. so these are all peoplewho don't think they have adissociative disorder, never been treated fora dissociative disorder, never been told they havea dissociative disorder. and what we dois we give them
the dissociativeexperiences scale, and an interviewer gives themthe one structured interview. and then, a second interviewerwho doesn't know the results of the dissociativeexperiences scale, or the ddis, interviews them with thesecond structured interview. and then, we look at, "well,what's the agreement rate here?" so this is just general adultpsychiatric inpatients. and lo and behold, in basicallya one-hour research interview, or even 45 minutes,
according to the onestructured interview, 40%, according to thescid-d, 44%, and then, the third armof the study was... after all these people haddone two structured interviews, i was randomlyassigned 52 people by the researchassistant, who are a combinationof people who are negative for a dissociative disorder and positive for adissociative disorder,
and i had to decide how manyhad dissociative disorders, and i actually wasthe most conservative. but if welook at did... it's not arare thing. so there's about-- there's10 to 12 studies now in eight or ninedifferent countries more or lessset up like this. you get generaladult inpatients, exclude anybody who hasa dissociative diagnosis,
give them the dissociativeexperiences scale, one or other of thesestructured interviews, sometimes aclinical interview, and the overall average ofall these studies is 4.4% of general adult inpatientsin psychiatric hospitals have previouslyundiagnosed did-- dissociativeidentity disorder. they don't think they have it,they don't claim they have it, they've never beentold they have it,
they've never hadtreatment for it, and it canbe detected in a fairly simpleresearch interview. so that's kind of theepidemiology of it. and then, in themental health field, there's a thing called"inter-rater reliability." so it's-- if two psychiatrists,or 100 psychiatrists, absolutely cannot agree who'sdepressed and who isn't, like it's game over,right?
doesn't matter whattreatment you believe in or what genetic researchyou wanna do. if you can't degree who isand who is not depressed, it's just chaos. so the statistic forthe rate of agreement is called"cohen's kappa." which varies fromplus 1 to minus 1. so if cohen's kappais 1.0, then two different ratersagree 100% of the time
who's depressed,who is not. if it's minus 1, theydisagree 100% of the time. so it's perfect agreement,perfect disagreement. and then, random is rightin the middle at zero. so here's thecohen's kappas for did. if we compare one structuredinterview to the other, my structured interviewto the clinician, for some reason thisnumber's a little low, using thedissociation scale,
and there's a sort of sub-scalewithin it that you can analyze. so these are kappasranging from 0.71 to 0.81. in the "dsm v"field trials-- so "dsm v" cameout in 2013-- in the "dsm v" field trials,which is a lot of money spent, we're getting alarge number of people to interview lots andlots and lots of patients, and they look atthe cohen's kappa for the differentdiagnoses,
cohen's kappa fordepression was 0.28. cohen's kappa forschizophrenia was 0.40. so psychiatristsare really lousy at deciding and agreeing onwho is clinically depressed and who isn't, and the top of the scalein the dsm field trials was actually ptsd,which was in the-- i forget the exact number,it was around 0.72. so did and ptsd actuallyhave higher cohen's kappas
than most... of the major, well-known,regularly talked about psychiatric diagnoses. so that'sgood to know. and in my structuredinterview, there's all thesedifferent sub-sections. so... there's psychosomatic symptoms,schneiderian psychotic symptoms, secondaryfeatures of did,
which is dissociative borderlinepersonality disorder, esp paranormalexperiences, and thentotal score. so, like on this scale,there's 16 items here. there's 11 here. there's 33 here. there's nine here. so all i did was justtake the average score here and divide it by 9,multiply it by 100.
take this one, divide by 16,multiply by 100. so i converted them all toscales that go from 0 to 100. and then, i putthem on this graph. and what we havehere is did. i don't know if we can--oh, here we are. so this is did. this is dissociative disordernot otherwise specified, which is basicallypartial did. and this is schizophrenia,and then we have...
psychiatric adolescence,chemical dependency, gi clinic-- gastrointestinalclinic-- population, and the generalpopulation. i'll come back-- i'm gonnatalk about this thing here. if i can get thepointer to show up. well, i'm gonnatalk about this in the next section. why do people with did havemore psychotic symptoms, more symptoms ofschizophrenia,
than people withschizophrenia? but leaving that aside, clearly,this structured interview, this kind of walking throughall these symptoms, clearly differentiatespeople with did from almost did, andthen from other groups. which is part ofshowing the validity and the reliabilityof any disorder. you wanna beable to do that. okay, so one ofthe conundrums is...
what's the relationship betweendissociative identity disorder and borderlinepersonality disorder? there's all kinds ofcontroversy about it, all kind of attitudes, allkinds of academic fighting. basically, the academicworld is a bunch of-- it's like the bloods andthe crips, basically. it's gang warfare atthe intellectual level. so there's guys stabbingeach other in the back, attacking each other,discrediting each other,
blocking promotions,intriguing. except, again, nothere at grcc, right? so bpd and did-- borderlinepersonality disorder-- are really embroiled ina lot of controversy. and one of the skeptical thingsis, "oh, those people with did-- "they're just a bunchof borderlines." well, so i did someresearch comparing a large sample ofpeople with did to a large sampleof people with bpd,
and what dowe find? "comorbidity" means all theother mental health problems that go along withyour main problem, and what gets to bethe main problem's kind of arbitrary. so comorbidity's basicallya whole mess of depression, anxiety, substance abuse,all kinds of different things. and lo and behold,the comorbidity profile of these two thingsare pretty similar.
basically everybodywith did and bpd, if you're in apsychiatric hospital, either is or hasbeen depressed, has some kind ofmood disorder. lots of anxiety,lots of panic, lots of ptsd. so it's very similar,but the did people are just a littlebit more. that's thegeneral pattern. in terms of theirdissociative disorders,
well, amazingly, 100% ofthe people with did have did on the structured interview.(audience chuckling) but that's good to know thatthe structured interview is picking all these peopleup, not missing them. so the interestingthing, though, is the people with bpd,11% also have did. so the borderlinepersonality disorder people have said in "dsm iv"and "dsm v," that dissociative symptomsin bpd are kind of minor.
but actually, in fact, they'recomplex, chronic, and major. and there'slots of 'em. lots of eatingdisorders. a little bit morein the did group. and this is what we seeclinically all the time. when you're treating did,you're always treating a whole bunch of otherstuff at the same time. and then, in terms of thepersonality disorders, again, astoundingly,100% of the borderlines
are borderline. but so are over halfof the people with did. and they have lots ofthese other personalitydisorders as well. so personality disordersare very overlapping things. they're not clear, simple,discrete categories. and if you have borderlinepersonality disorder, you're likely tomeet criteria for two or threeothers, at least. but, yet again, the patterns,they're very similar,
but overall, the didpeople tend to be more. so they're more similarthan they are different. well, i wasn'tsatisfied with that, so i didanother study. with inpatients again,and now we've-- using the structuredinterview, we've divided them into people who haveboth did and bpd, only did,only bpd, and neither.
and the data-- like if idecided i was gonna fake some data so itwould look good, i'd just make itlook like this. it doesn't getany better. it's perfect-- it fits withexactly what i predicted. which the people who haveboth are the most severe. the people who have neitherare the least severe. and these two groupsare in between. so there's atotal trauma score,
and then duration ofsexual abuse in years, number of different abusers,number of types of sexual abuse, duration ofphysical abuse in years, number ofphysical abusers. it just goesdown, down-- i mean, it's not perfect, itbumps up and down a little bit. but basically, it'sjust a line like this. so when you have both,you're worse off than if you have only oneof those two diagnoses,
and if you have eitherone, you're worse off than somebodywho has neither. in terms of differentdiagnoses... same thing. you're more depressed,you're more substance abuse, more psychosomaticsymptoms, more amnesia, fugue-- that's anotherdissociative diagnosis-- depersonalizationdissociative disorder, now, though i specified. so not surprisingly,these guys have the most,
these guys havenot so much, and these guysare in between. but the peoplewith just did-- this is supposedto be under here-- have more dissociation thanthe people who have just bpd, which makes sense, which fits,which is logical. so basically,the message here is-- we've got lots ofresearch on this. we're not just walkingaround with opinions.
and then, uh... all these differentsymptoms clusters that were onthat graph-- so the people withdid have the most, these guys are intermediate,these guys are the least. and all these differentsymptoms clusters are seriousmental health trouble. okay, well, that'ssort of interesting. so we actually have a wholebody of literature showing--
using the same rules thatyou use for depression, dissociation, psychosis,substance abuse, anxiety, so same rules,same sort of methodology, we've shown that ourdiagnoses perform as well, are as reliable, are as valid,hang together as well, as any other setof diagnoses. which is cool,but who cares? because the only thing thatreally counts is treatment. so i'm gonna show you a coupleof treatment outcome studies
now, where we give a bunchof questionnaires on admission tothe program-- this is in dallas. then, we repeat thequestionnaires at discharge. and then, one studyat three months, another study, that'sjust an analysis now, at up to 10 months,another study two years. so what happens when allthese dissociative people come into the hospitaland we treat them?
this is a typical sample,so most-- it's 90% women, average age isusually in the 30s. you can't be an adolescentin our program. the federal governmentwon't let adolescents be mixed inwith adults. average lengthof stay, which is a combinationof inpatient and stepping downto the day program-- average length of stay in theprogram overall is 18 days.
what happens totheir symptoms? well, before itell you that. so they have lots andlots of sexual abuse. lots of depression, lots ofborderline personality disorder, lots of psychosomaticsymptoms, half are did, half havesubstance abuse problems. very typical ofour population. so it's atypical sample. and lo and behold,in this 18 days,
the beck depressioninventory's the most used depression inventory. drops by closeto 50%. the "how suicidal they are"drops to close to 50%. how hopeless they are,pushing 50%. and the dissociation scoredoesn't significantly change. so this is the targetsthat we address in the inpatient setting. "you're here basicallybecause you're suicidal."
it's more or lessa suicide program. we could call itall kinds of things. the best namewould actually be the "dealing with yourfeelings" program, but that doesn't quite havethe marketing ring to it. and i don't think themanage care companies would be thrilledby that name. but the depression, thehopelessness, and the suicide-- those are the targetsof the treatment.
and that's a verynice drop in scores, and the dissociation takesmuch longer to treat. so we take thedissociation into account, and we work with it, butwe're not really targeting it-- that's not our maintreatment target. uh, another study. same concept. 50 people this time,admission and discharge. the scl-90 is a whole hodgepodgeof different symptoms,
all across the board. the beck score goes down,suicide, hopelessness. dissociationdoesn't change. so we got severalreplications of this. and, um,what you see-- this is just a list ofthe references here, which, if any of you wantcopies of the slides, you can provide, right?>> say that again? >> you can provide these slidesto anybody who wants them?
>> i could, if that'sall right with you. >> yeah, yeah, absolutely.>> i'll post them on-- >> they're only 50 bucks a set,so it's a pretty good deal. so this is just showing that,you know, i've published a bunch ofoutcome studies. and what happensat three months is it's not that-- okay, it'snice to be in the hospital, we give you some tlc,you improve, and then,two weeks later,
you're right backto where you were. those gains are sustainedat three months, 10 months, two years,and, in fact, the symptom levels keepgoing down, down, down. so here's a study i did,published in the '90s, where we intervieweda bunch of people in the programin '93. they're therefor a few weeks. then, we re-interview themtwo years later in '95.
and here, we're askingabout, this point in time, going backfor a year. here, we're askingtwo years later using standardizeddiagnostic interviews here. and the number ofactive diagnoses-- depression, substance abuse,eating disorders, schizophrenia,etcetera, did-- is dropped by 50%, and the number ofpersonality disorders
active in the preceding yearhas dropped by 50%. and all these peoplemeet criteria for borderlinepersonality disorder. but they'rea sub-group. everybody in thisstudy met criteria for multiplepersonality disorder. i just pulled out the25 who met criteria for borderline,as well. and what we have is reallynice treatment outcome,
two years later. their psychosomaticsymptoms are dropping, their psychotic symptoms,dissociative symptoms, their borderline has droppedby a third, basically. paranormal experiences,which we can talk about more if anybody'sinterested. how suicidal they are,how many suicide attempts. their dissociation scorenow, in two years, has droppedsubstantially.
their depression score-- and this is just anotherdepression measure. so lots of differentkinds of problems dropping downsubstantially. and this is aninteresting thing, in terms of theirabuse histories. so there's-- the people whohate dissociative disorders and think they're all bogusare always accusing us of cooking up all these falsememories out of nowhere.
so this is the duration ofphysical abuse in years-- child physical abuse,up to age 18. number of perpetrators, durationof sexual abuse in years, number of perpetrators, and number of typesof sexual abuse. so that's a whole list ofdifferent sexual things one person cando to a kid. and lo and behold,when we asked them exactly the samequestions two years later,
there's no statisticallysignificant increase. there's a littlebit of an increase in a couple of 'em,not really here, not really here,not really there. so two years later, after moreof this "false memory therapy," they're not reportingmore trauma memories than two yearspreviously. which is pretty goodevidence that we're not just pulling fake memoriesout of nowhere.
so that's... the first talk. thank goodnessfor water. and so, the summarypoint here is-- and so, this whole thingcould be extended to a half day. and i could go intoso much detail you'd all probably besuicidal yourselves. (scattered chuckling)
but basically,the point is, there's a wholebunch of research, it's a substantialbody of literature, it's replicated in manydifferent countries. there's good psychometricsto it, so... there's all these differentstatistics that are used to see how solid andstrong a measure is. we've usedall of those. one of the studies i didwas actually a series of six
or seven papers-- one's called "trauma anddissociation in china," in the "americanjournal of psychiatry," which was theofficial journal of the americanpsychiatric association. so i worked withpeople in shanghai, at shanghai mentalhealth center. basically, i talked to themand they did all the work. and so, multiple personalityis never diagnosed,
it's not in theirdiagnostic manual, it's not taught, it's notin their popular culture, it's not in moviesor on tv or... they don't havesoap operas with people with multiplepersonality. and it was quitereadily detected in our researchprotocol. and that's important,because that's a culture where the multiplepersonality can't be explained
by contamination, or "ipicked it up from the radio," or "i picked itup from tv," or "i picked it upfrom my therapist." so just a lotof research, and the quantity ofresearch is smaller than for depressionor schizophrenia, but the qualityis about equal. i rest my case. here is the stereotypethat dominates the field--
"schizophrenia is abiological brain disease. "it's genetic." of course, the environment cansort of color the symptoms a little bit, so ifyou have schizophrenia and you're somewhere inthe jungles of new guinea, you're not gonna think that thecia or the fbi are after you, because you'venever heard of them. but the basic formof the disease, how common it is, it's auniversal genetic brain disease.
hear that from the americanpsychiatric association, national alliance forthe mentally ill. if you just searchschizophrenia on the web, you'll get told overand over and over it's a geneticbrain disease. not all the time, buta fair bit of the time, they'll explain--(clearing throat) excuse me-- that schizophrenia isnot split personality. not multiplepersonality.
there's people out therewho are confused. and they thinkthat schizophrenia and split personalityare the same thing. but we professionalswho are physicians, who treat biologicalbrain diseases, know that that'snot the case. it's very clear. it's a totallyseparate category. and it's kind of thisfluffy, neurotic light thing
that's highly suspicious,maybe not even genuine at all. schizophrenia...it's just like cancer. and schizophrenia is notcaused by bad parenting. just like arthritis orcancer are not caused by bad parenting. and dissociativeidentity disorder is a reaction tothe environment. so everybody'sagreed on this. people who don'tbelieve in it
think it's a reactionto bad therapy. people who dobelieve in it think it's a reactionto childhood trauma. but everybody's agreed-- it's not an internalbiological disease that you'regenetically born with. it's a reaction tothe environment. and you don't treatit with medication. although people with didare frequently on medication
because they're also depressedand also anxious and so on. but the did,the dissociation itself-- there's no medicationfor that. and everybody'sagreed on that point. so you treat it with anenvironmental intervention, not with medication. and if you believe in it, youtreat it with psychotherapy. if you don't believe in it, youtreat it with "benign neglect," which, if youdon't feed into it,
you don't reinforce it,you don't talk about it, it just kindof fizzles out. and this you get statedin professional journals and booksand so on. so totally separatecompartments. genetic brain disease,reaction to the environment. never the twainshall meet. they have nothing todo with each other. so if i was a regularbiological psychiatrist,
i would've justcleared that up for you, end of discussion. i actually just gotback from this year's american college ofpsychiatrists meeting, which also, funnily,was also in puerto rico. sad to say i was stuck onthe beach for two afternoons. >> (faux concern) ohh!(audience laughing) >> so each year, there'sa dean award lecture, where some top researcherin schizophrenia
gets an award forhis lifetime work-- or her lifetime workon schizophrenia. and they basicallygive a talk describing their lifetimework on schizophrenia. so this guy kenneth kendlergot that award, and he's pretty well "top dog"guy in schizophrenia and genetics. and it's kind ofa catchy talk with a catchy title.
"the genetics ofschizophrenia-- "toward theidentification "of individualsusceptibility loci." that sounds kindof scientific. kind of like somebig shot talking. and he isa big shot. and, oh... whoop... oh, there itgoes, okay.
a little tricky. he doesn't look likedr. evil, right? he's a kindly academiclooking kind of guy. and this is a quotefrom the talk based on his lifetimeof research on genetics. "most, if not allof the reason "why schizophreniaruns in families "is due to shared genes andnot shared environment." most, if not all,
of the reason whyschizophrenia runs in families is genetics. it may not be all...but it could be all. but if it's not all,it's most, if not all. so in other words,it's predominantly, "major big league"a genetic disorder. that's his conclusion fromhis lifetime of research. so...what are the facts? what's the research thatsupports this conclusion?
well, there's amethodology called "twin concordantstudies." which are a little bitold-fashioned now. the reason they'reold-fashioned now is because of what the data are,which we'll get to in a second. so basically,there's identical twins, non-identical twins. identical is mz--monozygotic-- one egg. fraternal, non-identicaltwins are dz--
dizygotic--two eggs. and what you wannalook at is concordance. so if the firstidentical twin is female, how often is the second--this is a quiz question. if the first identicaltwin is female, how often is the secondidentical twin female? 100% of thetime, right? if the first identicaltwin has red hair, always red hair.
etcetera. so some traits clearly arepurely genetically controlled. and if you take one ofthese identical twins-- let's say you have a set ofchinese identical twins, you take one out ofthe family at birth and put 'im in anenglish-speaking family, they're gonna grow upspeaking english. whereas the one thatstayed in the chinese chinese-speaking familyis gonna speak chinese.
so from that, we know thatwhat language you speak isn't comingfrom your genes, it's coming fromyour environment. but incredibly, whenyou're-- a chinese kid is adopted intoa caucasian family, they don't becomecaucasian. so now we knowthat being caucasian, or being female,or having dark hair, is genetic, and it's notmodified by the environment.
so the first thing you wanna dois look at the concordance rate. if the concordance rateis very, very low, then you know that it'snot really genetic. if it's purely genetic,then the concordance rate's going to be 100%. but what's the concordancerate for speaking chinese versus speaking englishin identical twins? it's almost 100%,right? so you, the concordance ratedoesn't prove it's genetic,
it just means itvery well could be. then, you've gottago look at adoption and do someother strategy. so the concordance rateis kind of the first pass. so you wanna look atthe concordance rate for cystic fibrosisin identical twins. it's 100%. if the first twinhas cystic fibrosis, other twinalways has it.
first twin doesn't have it,other twin never has it. it's a purelygenetic disease, totally proven medically,nobody doubts it. so what's the storywith schizophrenia? which is mostly,if not all, genetic? well... to find out, we should go tothe expert, kenneth kendler. so in this same talk,he's presenting his data, which supportedthe conclusion
that schizophrenia's mostly,if not all, genetic. and he looked at this16,000 pair of twins, and he looked at the concordancerate for schizophrenia. so what do we think-- like ifi was gonna take a poll here, to support the conclusionit's mostly genetic, what kind of concordance doyou think we would want? it's not likelyto be 100%, because the mental healthfield's kind of like fuzzy. but we'd want some kindof high number, right?
so if the concordancerate was 90%, then i'd go, "yeah,it very well could be "mostly, if not all,genetic." 80%? eh, that's still mostly,if not all. 70%-- well, that's gettingaway from "if not all," but still mostly. 60%-- well, that'sjust barely mostly. so what was the actualconcordance rate
that he observed andpublished in his research that got him the awardfor demonstrating that schizophreniais mostly genetic? anybody wannatake a guess? >> 32.>> (laughing). that's agood guess. in his own sample-- and this is actually higher thanthe real actual average number, if you add togetherall the best studies.
in his own data set, when thefirst twin has schizophrenia, the other identical twin doesnot have it 70% of the time. that simple fact,by itself, proves conclusively,scientifically, medically, biologically,beyond a shadow of a doubt, no other possibility, that schizophrenia could be atmost only a little bit genetic. and this result-- whichthe numbers bounce around from study to study, butwhen you add together
the best-designed studies,and the most recent studies, it actually comes out morein the low 20s, like 22%. so what's upwith my field? how, how does this mythget perpetuated? so you go to theseacademic meetings, and the top expertin the world, comes and giveshis award speech and says it's mostlygenetics, 31%, and everybody goes...(scattered laughing)
"good talk." there's somethingreally wrong. i mean, it's justabsolutely not possible. so i have a letter in press,letter to the editor, at a journal called"psychosis," which is edited by a friendof mine who's very skeptical about all these "geneticbiological schizophrenia" guys. so he likedmy letter. so the letter is...
something like january 29th,or something like that. there's, in the journal"nature," which is-- "nature" and "science" arethe two top science journals in the world. so if you're-- if you figureout the structure of dna for the first timein human history... and your name iswatson or crick, where do you publishyour paper? "nature."
i mean, it is top,top journal. so in thisjournal "nature," there's a paperpublished in january, and there'sa write-up-- i just talked about the write-upin the "new york times." there's numerous other write-upsin many other media outlets. this is the biggest,most important, fundamental advancein the study of the biology ofschizophrenia ever.
we've really, forthe first time, started to tap into theunderlying genetic causation of schizophrenia. we're really startingto figure it out. we've really got our hands onsomething for the first time. that's what the author said,all these different commentators. what was theresearch? so there's like 39--some huge number-- 39,000 people withschizophrenia,
28,000 controls. and this is a schizophreniagenetics consortium, which has pulled togetherall of these studies where they dogenome-wide analysis, which is they-- theycan just basically throw your bloodin a machine, and it'll scanyour entire genome. because now, thanks tothe human genome project-- and this is gettingcheap enough now
that they can dothese gigantic numbers. so that's millions of dollarsof research money. and what theyzoned in on was a singlenucleotide polymorphism, which means little variationsin one atgc base pair. and they looked ata specific gene called the "c4complement gene." and they looked at four--out of all these genes that they scanned, theyfinally found one somewhere
that had some sort ofstatistical significance to it, and it turned out to bethe c4 complement gene. and there'sfour variations of this single nucleotidepolymorphism. for the first threethey looked at, there was no increased riskof schizophrenia at all. but the fourth one, this is where they foundthis fundamentally new insight into the underlying geneticbiology of schizophrenia.
which is now gonna open upthis revolution in psychiatry. so if you havethis gene variant... how much does your riskof schizophrenia go up? this fundamentalbreakthrough finding. the most significant,profound finding in the history ofschizophrenia and genetics. what would youthink it might be? the answer is your odds ofdeveloping schizophrenia sometime in your lifego up from 1% to 1.27%.
that's it! it's just-- it's like being at the madhatter's tea party or something. i mean, it'sjust ridiculous. it doesn'tmake any sense. it's massive over-hypingof this result, which then generates moregrants, more motions, more interests,more excitement, and divertsmoney away
from studying maybesomething in environment that's causing peopleto go crazy. like child abuse,for instance. so this is dominatingthe field all the time, this kind of thinking. okay, so, just jumpingover to did now, just to refreshyou a little bit. what is did? what's a typicaldescription of it?
well, here's--this is the-- so we're in the categorynow of neurotic reaction to the environment, totally different box fromgenetic brain disease, which isn't even, in fact,a genetic brain disease, which we've knownscientifically for decades, but we keepsaying that it is. little side detour-- backto the american college of psychiatrists meetingin puerto rico last week,
the mood disorders awardwas a lecture given by a woman who's actuallyin university in galveston, not too faraway from me. top handful of childhooddepression experts in the world, presenting allher research. and she's talkingabout how effective anti-depressantsare for children. and she's verypro-anti-depressants. because genetic braindisease, medication,
are all partof a package. that package ispromoted as a package. okay, so we can diagnosedepression in children. so this isan hour talk. it turns out that thefda has only approved two anti-depressantsfor kids under 18. fluoxetine, which is prozac,and escitalopram. for prozac,there's two studies. for escitalopram,there's one.
showing positive results. she didn't mention howmany studies there are where there's no differencebetween drug and placebo. in the fda, you could have10 different studies of prozac. they only require thattwo show a difference between the drugand a placebo. if there's eightother studies that show nodifference at all, they don't care,doesn't matter, gets approved,
goes to market. that's how thewhole thing operates. then, there's a whole bunchof other anti-depressants on the list whereall of the studies failed to show any other--any difference at all between the drug orthe anti-depressant and the placebofor depressed kids. but we got two drugs, atotal of three studies. so then, she averagestogether all the literature
on anti-depressantsin kids. thousands andthousands and thousands and thousandsof kids. and she says, "how many kidsrespond to anti-depressants "compared to placebo?" where "response" is definedas your depression score drops by 50%or greater. so being a responderdoesn't mean you're better, it just means you'reat least half better.
so not a very toughdefinition of "responder." overall, when you add thewhole world's literature on anti-depressantsin children, you add it together,60% respond to the anti-depressantsand 50% respond to placebo. that's it. it's not tooimpressive. and so, there's this wholeroom full of 500 psychiatrists, and they're all,"uh-huh, yeah, good,
"great talk,here's your award." there's somethingfundamentally wrong here. but at least we know thatdissociative identity disorder and schizophreniaare separate things. so here's a classical-- it'sa little bit older text. you'll see the languageis a little bit archaic, but, you know,typical case description of dissociativeidentity disorder. "the delusion of beingpossessed is very commonly seen
"as a specific type of'double personality.' "single emotionallycharged ideas or drives "attain a certaindegree of autonomy, "so that the personalityfalls to pieces. "these fragments canexist side by side, "and alternatelydominate the main part "of the personality, theconscious part of the patient. "however, the patientmay also become "a definitely different personfrom a certain moment onwards."
it's completely consistentwith the entire did literature. "naturally, such patientsmust speak of themselves "in one of theirtwo versions, "or they may speak in thethird person of the other two, "usually he designates himselfby one of his several names. "the splitting of thepsyche into several souls "always leads to thegreatest inconsistencies. "in a few cases, the'other' personality "is marked by use ofdifferent speech and voice.
"thus, we have here twodifferent personalities "operatingside by side." extremely cleardefinition of did. "when specific 'persons'speak through the patients "in various cases ofautomatic speech, "each person hashis own special voice "and distinctmanner of speech. "thus, the patientappears to be split "into as many differentpersons or personalities
"as they havecomplexes." complexes is not talkedabout that much now. it's a late 19th,early 20th century term. "the blocking of therecall of memories "is a common occurrenceduring the examination "of these patients." so they havelots of amnesia. so this would be fromsome classical textbook on dissociativeidentity disorder, right?
this is clearlynot schizophrenics. this is people withsplit personalities. different voices,names, ages, amnesia. what book isthis from? there we go. this is a bookby eugen bleuler, published in 1911. he's the guy who coinedthe term "schizophrenia." it used to be called"dementia praecox" before that,
which means "earlyonset dementia." this is the guy who inventedthe term "schizophrenia," writing one of the classical20th century's textbooks on schizophrenia, describing a substantialchunk of his caseload. it's exactly the samething as "dsm iv," "dsm v" in greatminute detail. and he says that splittingis the fundamental thing going on inschizophrenia.
and he says that splittingis exactly the same thing as dissociation, whichis pierre janet's term for the same thingas he calls splitting, and pierre janet iskind of the father of dissociation theory. so the guy who originally coinedthe term "schizophrenia"-- every psychiatristknows that-- most psychiatrists,of course, don't read the book-- is completely confusedabout the difference
between did andschizophrenia. and many people that he'scalling "schizophrenic" clearly have did. so there's actually,in fact, mass confusion in the profession... i'm sad to say. i might turn around andchortle for a second but... i'm very sadto say that. okay, so let's lookat this relationship
between dissociation,psychosis, and some research. genetic brain disease. oh, by the way, thewoman who was giving the talk aboutanti-depressants in children for an hour didn'tmention child abuse, childhood trauma, ptsd, oranything like that, once. in an hour. that's how relevantall that stuff is to childhooddepression.
which we're treatingwith anti-depressants that don't work anybetter than placebo because it's abiological disease. okay, so this is generalpopulation in canada. team knocked on people'sdoors and interviewed them with the standardizeddissociative disorders interview schedule,dissociative experiences scale. so this is people inthe general population. not in treatment.
and i divided theminto 397 people who had no psychoticsymptoms at all and 35 who reportedthree or more. simple. i mean, this is notrocket science, right? and look at the differencein their abuse histories. physical or sexualabuse, or both, 8.1% if you have nopsychotic symptoms. 45% if you havethree or more.
from this, you mightconsider the possibility that physical and sexual abusehave got something to do with psychosis. you would think. your rate of having psychosisgoes up from 8% to 45%, not 1% to 1.27%. i mean, that's amassive finding compared to thestrongest finding in all of schizophreniagenetics ever
after they've spentliterally a billion dollars or whateverthey've spent. same people. much higher dissociativeexperiences scale scores, more somatic symptoms,secondary features of did, more borderline criteria,more esp paranormal. this is starting to looklike the same pattern as when i compared did toborderline personality disorder. it's all the samekind of comorbidity.
okay, different study. this is 83 peoplein canada. long, stable, clinicaldiagnoses of schizophrenia. most of them havebeen diagnosed as having schizophreniafor 10 years or more. same dissociativeexperiences scale score, same dissociative disordersinterview schedule, i divide them into people saythey were abused physically or sexually or bothin childhood,
and people who say theywere neither physically nor sexually abused. lo and behold, if you have alongstanding stable diagnosis of schizophrenia,and you answer "yes" to a very simplequestion-- "yes, i was either physicallyor sexually abused or both," you have much moredissociation, more somatic symptoms--this is another set of dissociativesymptoms.
you're more borderline. you have more ofall this stuff. you have moreschizophrenia. you're twice as manypsychotic symptoms as the person with schizophreniawithout an abuse history. and those schneideriansymptoms-- named after kurt schneider,a german psychiatrist-- are the hardcore symptomsthat are everywhere in the schizophrenia literatureand in the dsm criteria.
whole different measureof standardized thing that's used in tonsof research. whole list of differenttypes of psychotic symptoms. lo and behold, theabused schizophrenics has way more of those thanthe non-abused schizophrenic. ideas of reference is... uh, "that message onthe side of the bus "is deliberatelymeant for me. "they put it on thebus to let me know."
that's an ideaof reference. voices,paranoid ideation, thought insertion is thoughtsbeing stuck in your mind that aren'tyour own. hallucinations, readingsomeone else's mind. so in schizophrenia,the symptoms are divided into positivesymptoms and negative symptoms. the positive symptoms--and they're measured by this thing called thepanss, "positive andnegative syndrome scale,"
and by lots ofother scales. they're everywhere in theentire schizophrenia literature. negative symptoms are thethings you should have that you're missing. so that's kind ofburned out, empty, no social connectedness,no life, no spontaneity, no desirefor anything. the positive symptomsare things that are there that you shouldn't have,like being agitated,
mixed up, jumbled up thoughts,hallucinations, delusions. and lo and behold, theabused schizophrenics got more positive symptomsand fewer negative symptoms. and the composite score is justwhen you add the two together. so now, we're starting tosee that "wait a minute..." we can see-- takea whole bunch of-- say everybody in thisroom has schizophrenia, i go, "all you guys who havephysical and sexual abuse "in childhood siton this side,
"all you guys who don'tsit on this side." you guys over hereare gonna have way more negative symptoms,fewer positive. you guys are gonna have morepositive, fewer negative. and these symptomshave a lot to do with how well yourespond to medication, what your treatment needs are,what your housing needs are, what your relationshipqualities are like, and what yourprognosis is like.
we can make this majordifferentiation into a much more treatabletreatment response group, much more difficult, simply byasking a couple of questions. but that is nowhere in the standardschizophrenia literature, until the lastfew years. starting tocreep in now. okay, so now we'vegot 160 people with multiplepersonality,
83 people withschizophrenia. let's compare them. so they're not matcheddemographically so it's notperfect research. ideally, it should bethe same average age, same percentage offemale, and so on. but this isa first look. oh, wow...what do you know? people with multiplepersonality have twice as much
childhood abuse as peoplewith schizophrenia. but people withschizophrenia have way more than the base rate inthe general population. people with mpd have-- by all thesedifferent indicators, much moresevere abuse. they don't just havemore "yes" answers, they have muchmore severe abuse. they have moredissociative disorders.
not surprising. but wait aminute here, these are peoplewith schizophrenia, 25% of them are coming upmeeting criteria for mpd, did, on a standardizedinterview. so it's not likethese are really clear, distinctseparate groups. they're all overlapping,confusedly mish-mashed together. substance abuseabout the same.
more depression, moreborderline personality. so by and large, thisis the same pattern, whether you compareabused schizophrenics to non-abusedschizophrenics, people with did topeople without did. and the common themeis the trauma. some more dissociativesymptoms. higher dissociation score,more somatic symptoms, dissociative symptoms,borderline.
here we are again. well, that's interesting,but take a look at this line. yet again, the peoplewith multiple personality have more symptoms ofschizophrenia, on average, than people withschizophrenia. so these symptomsof schizophrenia cannot possibly bespecific to schizophrenia. they may not evenhave anything to do with brain diseaseat all.
they might be traumadissociation symptoms that the person wouldn't haveif they weren't abused as a kid. well, we've got all theseclinicians out there who can tell the differencebetween schizophrenia and dissociativeidentity disorder-- they never diagnoseddissociative identity disorder, they just knowit's rare and iffy. so if that wasactually true, what would we think we wouldsee in large series of people
who have a diagnosis ofmultiple personality or are inpsychotherapy for it? we wouldn't seeprevious clinicians saying they hadschizophrenia. but in these two series,40%, a quarter, had previous diagnosesof schizophrenia from other clinicians, half had been treatedwith antipsychotics, and a bunch had hadelectroconvulsive therapy,
shock therapy. which tells us thatthe previous clinicians thought these people wereseriously, seriously, seriously mentally ill, needed the mostheavy-duty treatments for major serious mentalillness that we had, and a half of the time,or a quarter of the time, got an actual diagnosisof schizophrenia, proving that most clinicianscannot tell the difference.
and these are people whoare participating in, you know, high-level,hardworking, cognitively functioningpsychotherapy. this is the panss, that positiveand negative syndrome scale. this is the norms forschizophrenia in the manual. and this is thedid series. yet again, did people aremore positive, less negative. this is justmy research. these findings have beenreplicated in multiple samples
with multipledifferent measures. okay, so we all knowthat hearing voices is... a sign of psychosis and verytypical of schizophrenia. this is the schneideriansymptoms of schizophrenia, which include several differentforms of hearing voices. what's the percentage ofpeople with schizophrenia who have at least oneschneiderian symptom? this guy kurt schneider said,"these are the hardcore symptoms "of schizophrenia."
this is published seriesin the literature. only a third of the peoplein this published series of schizophrenia cases hadany of the core symptoms that's a little weird. so if you total these12 or so series, there's 2,500 people,only just over half had any of theseschneiderian symptoms, which are the core,defining symptoms of schizophrenia,in theory.
on the other hand, if youhave multiple personality, 87% have one ormore symptoms. so again, there'slike multiple ways of looking at it,multiple sources of data, same pattern overand over and over. what gets called"psychosis" is actually more typical ofpeople who are dissociative than of people whoare psychotic. so i took this same series--1993, '95--
now, i pulled out the peoplewho had psychotic diagnoses on the structuredinterview. schizophrenia orschizoaffective, which are the two major,heavy duty psychotic diagnoses. so these people all, in fact,had multiple personality, all were getting treatedwith psychotherapy. but... 36 of them metstandardized dsm structured interview criteriafor psychotic diagnosis
in '93. in '95, they're on fewermedications and lower doses, and their primary treatment'sbeen psychotherapy, and now instead of100% met criteria in the previous year,only a quarter did. their axis i diagnosesare dropping. same pattern as wesaw when we pulled out the borderline people. and the same thingover and over.
their thoughtdisorder scores, this other measure, the--(mic cuts out). thought disorder, psychosis,depression's dropping down, all different thingsare dropping down. another measure ofpsychotic symptoms, in my structured interview--dropping, dropping, dropping, dropping,dropping. so all kindsof symptoms, including the psychotic symptoms,are going down,
which is agood thing. the positive symptomsare going down. also the negative symptomsare going down. the dissociation scoredropped dramatically. depression,hamilton depression, the scl-90s-- theall across the board different symptoms. then, there's apsychosis sub-scale. so we've got four differentmeasures of dissociation--
of psychosis, rather, allfollowing the same pattern. so we're successfullytreating-- "oh, wait a minute, whatare we treating again? "oh, yeah, borderlinepersonality disorder. "no, no, no,schizophrenia. "no, i mean, actuallywe're treating depression. "no, no, we're treatinganxiety disorder. "wait a minute,we're treating..." we're treating this wholepot of different diagnoses.
and the typical clinicianwho sees these people, says they have schizophrenia,schizoaffective, bipolar, someheavy duty diagnosis, gives them meds, maybe ect,and no psychotherapy. this is just the waythe field operates. which i thinkis a sad story. there's probably, iactually just read a paper this morning--or this afternoon, while i was sittingat the airport,
waiting for three hours...(scattered chuckling) which was handy, because i gotlots of emails done and stuff. um, it's asummary article, and they were talking about15 different studies published. none of theseexisted 10 years ago. mostly in thelast five years. they're studies withlike 5,000 people, 7,000 people, 3,000 peoplein the general population. or large collections ofschizophrenia patients,
psychotic patients, like,hundreds and hundreds, and there's multiplestudies like this. just asking aboutchildhood physical abuse, sexual abuse, neglect,bullying, family violence, a whole bunch ofdifferent forms of trauma, and lo and behold,it's way up there in peoplewith psychosis. so having a history of severe,chronic childhood trauma increases your riskfor psychosis
in many, many, many studies,in many different samples, by like,20-fold, 40-fold. there's a study calledthe "adverse childhoodexperiences" study, which is done in akaiser permanente population in san diego. so they had17,000 people who were all in thekaiser permanente system, and they gave 'em this adversechildhood experiences scale, and then they reviewedall of their medicalpsychiatric records,
because theyowned them all. and the adverse childhoodexperiences scale has 10 different questions, andyou either say "yes" or "no," and the total scoreranges from zero to 10. so, "yes, i wassexually abused, "yes, i was physicallyabused, family violence, "parent with substanceabuse, parent went to jail," different formsof childhood trauma. and one of the guys who'sthe core guy in the study,
is an epidemiologistfrom the cdc, so he's spent his whole lifelooking at the statistics of disease at the centerfor disease control. and this guy says in talks,and says in papers, "most epidemiologists neverget a finding like this "in theirentire careers." what was thespecific finding? the specific findingis, if your ace score-- "adverse childhoodexperience" score--
is 4 or higher,compared to zero, your risk of iv drug usegoes up 1,400 times. that's kind ofa big finding. that's a little biggerthan 1% to 1.27%. and so, ace scoresgo up dramatically... in conjunction with all kindsof different physical and mental healthproblems. the higheryour ace score, the more psychoticsymptoms you have.
more suicideattempts. more depression. hearing voices. being admitted topsych hospitals. okay, that's all kindof understandable. but other things that go updramatically with ace score include cardiovasculardisease, funnily enough,having cesarean sections, cancer,
lung disease. there's a whole bunchof health outcomes that go up dramaticallywith childhood trauma. childhood traumais driving a lot of billions of dollarsof healthcare costs in the united statesper year. what is one of the things--so when you see the graph, it's like, "ace score,1 through 10," what's your likelihood ofhaving a body mass index
above 30, which is thelow end of being obese? people who are obesein our program, they have bmislike 45 and 50. a score of1, 2, 5. it goes just like this--(whooshing noise). so what's thehealthcare costs of cardiovascular disease,high blood pressure, high glucose, onand on and on and on, heart attacks,in our culture?
billions of dollarsper year. that's just the financial cost,let alone the human cost. and a significant, majordriving contributing factor is childhood trauma. so we did astudy which... we're just doingthe analysis on now, but we got kind of, like,the preliminary analysis-- 67 people admitted tothe hospital in dallas for, basically,for being suicidal.
so they're admittedto a psych hospital. but they've all hadbariatric surgery, weight loss surgery. and most of them are kindof like a couple years out... and so we looked at--number one, they're allinpatients, they all have seriousmental health problems, they're obviously notdoing well psychiatrically. most of them havelost a ton of weight.
what are theirdepression scores, their dissociation scores? and we did several differenteating disorder measures. nothing reallystood out that much except theirace scores. these people hadamazing ace scores, these 67 people. there's many, many peoplewith 6, 7, 8, 9. whereas the generalpopulation is like zero, 1.
and so, that'sone sample. but what we'relooking at is people who've hadbariatric surgery, they've lost a ton ofweight, but they're still doing horriblypsychiatrically. and what is the one thingthat stands out about them? their massive amountof childhood trauma. clinically, we have peoplein the program all the time. so, it's not likein psychoanalysis
where you've gotta spend like30,000 hours digging down into the unconsciousand interpreting stuff. people justtell you. and i don't know howmany dozens and dozens and dozens anddozens of-- like, 250- to 350-pound womeni've talked to who consciously,deliberately, are keeping themselvesoverweight so that perpetrators won'tbe interested in them.
and then, when they haveeither big weight loss or they havebariatric surgery, and their weight goes down, theyget overwhelmingly terrified, because guys starthitting on them, and perpetrators aregoing to come after them. it's-- you don't have todig around, you just ask. "what's going on? "why do you keep yourweight up there?" in combination with, it'sbasically comfort food.
they're self-soothing--that's their drug of choice. they eat, they eat,they feel full. they're distracted,they're focused on that. all the badfeelings are gone. so this is... obviously not thetotal cause of obesity, but it's a significant,major contributing factor, with costs ofbillions of dollars. and it's thesame thing--
you read the obesity literatureor general medical literature, child abuse justdoesn't get mentioned. like it doesn't exist. so the analogy icame up with is... this is like being anexpert on lung cancer and giving a one-hour talkon lung cancer and never mentioningcigarette smoking once. it's just--"wait a minute." cigarette smoking's kindof an important topic
in the causationof lung cancer. it doesn't causeevery case, but if we could stopthe cigarette smoking, we would drop off somany cases of lung cancer. that's the one thing weknow can make a difference. same thing withchildhood trauma in the mentalhealth field. so try actuallyaccomplishing it. but if you couldwave a magic wand
and there was nomore physical abuse, sexual abuse,family violence, the amount of mentalhealth would drop down-- (whooshing noise). so i was kind of hemmingand hawing about whether i should go into this inexhaustive detail or not, or... do a short version of thisand just wander through other mental health issues, soi'm still kind of undecided.
so i'll probablycompress it down some. so basically... this is like the drive-byshooting bullets that get sent my way inthe gang war in academia. this is the stuff thatskeptical people say about did, and the main point is--it's just a really, really, really low-level oflogic and scholarship. i mean, just basic errors oflogic, discourse, analysis. in a philosophydepartment,
you'd just get laughedout of the department if you did thiskind of stuff. so... very commonly,arguments are applied to did that could just as wellbe used against all otherpsychiatric disorders. so did is notreal because... and fill inthe blank. but the same thingapplies to all the otherpsychiatric disorders, but that's neversaid about them.
so it's this kindof double standard, goes on allthe time. which i'll give yousome examples of. skeptics also over-generalizefrom biased samples. so in cognitive therapy,which is a very well-studied, tons of outcomestudies, method of therapy,originally for depression, and then expanded toa lot of other stuff. in cognitive therapy, youlook for cognitive errors.
so people who havebeen abused as kids, kids always blamethemselves, so they think, "i'm bad, i'm unworthy, i'mcausing it, i deserve it, "it's my fault," andthen that gets reinforced and ingrained,reinforced and ingrained. 30 years later, theycome to our program. "i'm bad, i deserved it,i caused it, it's my fault. "i deserved to beabused by my husband. "i deserved to beabused by myself.
"i'm not even a memberof the human race. "i'm a disgrace,"etcetera. all the time, all the time,all the time, all the time. so one of the methods oftherapy we applied to this is cognitive therapy,so we look at this as a cognitive error,an incorrect belief, because no child deserves tobe abused or causes abuse. so it's an errorin thinking. and then, we have awhole bunch of strategies
and techniques we do to tryand get them to see that, "no, that's not true. "it's never trueof any human being. "you deserve tobe treated well. "the only reason youweren't was just bad luck. "it's all about yourparents, not about you." in the cognitivetherapy literature-- i'll take your questionjust in a second-- there's some basic sort ofcategories of cognitive error.
there's "all or nothing,""black and white" thinking. that dominatespresidential debates. you see this "all or nothing,""black and white" thinking. "this guy's gonnadestroy america!" "this guy's the onlyhope for america!" so it's extreme, polarized"black and white," without looking at allthe subtleties in between. and it dominates discussionin the culture of all kinds of differentissues all the time.
but "all or nothing,""black and white" thinking is supposed to be typical ofborderline personality disorder. so it's a form ofmental illness that we treat withpsychotherapy. another cognitive erroris catastrophization. so the example i use wheni'm teaching it to a patient or client is...woman's upstairs, she's in her bedroom,she's about to go to sleep. all of a sudden, shehears a sound downstairs.
she thinks to herself, "if thatdog knocks over his water bowl "one more time, i'm reallygonna be mad at him." then, she goesto sleep. down the street,there's another woman who's upstairsin her house. she hears exactlythe same sound. she goes, "i thinka serial killer "just brokeinto the house." okay, so, the thinking thatyou have is going to generate
some very differentemotional reactions, right? the woman-- the woman'swho's kind of, "eh, hmm,"go to sleep. the other woman'sin full panic. so your thinking kicks upall this "fight/flight," catastrophe,adrenaline, and then the counter tothat is to de-escalate, talk yourself down. so this iscatastrophization.
another cognitive errorthat mental patients do all the time isover-generalization. so, "my uncleabused me, "therefore all menare pedophiles." well, unfortunately, ourcolleagues do that all the time. they over-generalizefrom biased samples. so they mightsee one case of did diagnosedby somebody else where there waslousy treatment
and the persongot worse, and then they conclude that allthe treatment is 100% harmful. this happensall the time. "did is not validbecause its treatment "has not beenproven effective." okay, well, so, we just gotrid of cancer of the pancreas. there's no effective treatmentfor cancer of the pancreas, so therefore, it's nota valid disorder, right? you can't say thisin general medicine.
everybody'd just lookat you like, "what?" but you can sayit about did. so if it was true thatthe treatment of did has never--has no evidence basis, never been provento be helpful, that would tell uszero about whether it's a legitimatedisorder or not. go back 200 years, we didn't--there's no effective treatments for hardly anythingin all of medicine.
that doesn't mean all thediseases were not real. so the absence of aneffective treatment tells you nothing about thevalidity of the disorder. but on top of it,there in fact is a bunch of treatmentoutcome evidence. so that's an example of youcan say that about did, but you couldn'tpossibly say it about cancer ofthe pancreas, because everybodywould just think
you should haveyour license removed. sorry, you weregonna ask something? >> yeah, um,i was... when we were talkingabout childhood abuse, now, things like--i don't know, like, uh, parents divorced, orother experiences that, you know, you could qualifyas psychological trauma, but it wasnot intended. is that something youguys keep in account
when you guys doyour research, like, "oh, we asked this question--have you ever-- "were you abusedas a child?" the person might notthink about it as, "i was not abused,"but, you know, there was certainexperience that would, uh, be consideredas trauma. you know, think like, "oh,my parents got divorced," but, you know,it's not--
>> so this was anexcellent question. and, of course, it'sreally complicated. nobody's got allthe answers. because... there aren't reallyany measures that ask about every single kindof upsetting or traumatic thing that can happen. and so, the focus isoften on physical abuse, sexual abuse-- you know,big, obvious clear stuff.
but actually in the patientswho come to the program, half the trauma comesfrom good things that should havehappened that didn't. namely, bonding,connecting, loving, unconditional love,nurturing, protection. and so, they felt very scared,small, sad, lost, lonely. but nothing happened. nobody fired a gun. nobody hit you.
so a lot of traumais actually things that nevereven happened. and then, there's kindof like mild trauma, and then medium trauma,and obvious, huge trauma, and then there's... some people canrun faster, some people arebetter at math, some people are a littletougher at surviving trauma. maybe two people have thesame amount of trauma,
but one's got afairly okay parent and one's got twonot-okay parents. so the one with theone okay parent got the same amountof sexual abuse, or they had a good aunt,or they had something to counterbalance theeffect of the trauma. so there's all thesedifferent things that kind ofcome into play. and measuring it all islike pretty complicated
and hard to do. but there's-- like a recentliterature started to grow showing very clearlythat childhood bullying has lots of seriousmental health consequences. 10 years ago, there wasnothing about bullying in the mental healthliterature. and then, divorce,it all depends, because sometimes, theamount of family pathology and the amount of trauma goesdown because of divorce,
because you got rid ofthe not-so-good parent. other times,it goes up. so there's notjust one pattern. i don't know if thatanswers your question. >> no, yeah--yeah, definitely. makes sense-- so you wouldthink that in your field, that's probably one goodarea where more research could build up on,like, trying to measure some of these variables, like-->> yeah, absolutely.
we always needmore research. so of course, my opinion is, weshould take a billion dollars from all this genetic researchthat's going nowhere and put it into thiskind of research. because there isn't aninfinite pot of money. and so, being able tostudy all this stuff, we're getting robbedby all the money being diverted overin that direction. you look like you stillhave another thought there.
>> no, no, no, i'm fine.>> okay. (chuckling) so, uh, "did isnot a disease "because it isinfluenced by culture." so this gets publishedin psychiatry journals. okay, so... hold on a second here,so you're telling me that there's actuallypsychiatric disorders that are not influencedby culture? it's an absurdproposition.
every anthropologist inevery anthropology department in the whole planet wouldlaugh his head off at you, or her head. it's ridiculous. there's no culture-freepsychiatric disorder at all. so the fact that somethingis influenced by culture... tells you nothingabout nothing, in terms of the validityof the disorder. but sort of lurkingin behind there
is this idea that, "oh, it'snot influenced by culture, "because it's abiological brain disease." "the absence of casesoutside north america "proves did is anorth american artifact." so we've accumulatedlots of cases from outsidenorth america, so that one's kind ofstarting to drop off now. but let's just say it--well, it was a fact, if we go back 30 years,25 years.
there's a lot morecases being diagnosed in north america thanoutside north america. so what doesthat prove? well, there's two competinghypotheses to explain it. so i'm talkingabout did here, but i'm actually illustratingkind of the logic of how the mental healthsystem works, and what arguments are,and how you prove things and disprovethings, and...
which could beapplied to all kinds of differentdisorders. so the two competinghypotheses are-- well, it's just being diagnosedmore often in north america because the clinicianshave become aware of it in north america, and everybodyelse hasn't got up to speed yet. that's one hypothesis-- and it'sa real, legitimate disorder, and if we do researchin other countries, we'll find lots of didall over the place.
the secondhypothesis is... it's just a hystericalfad kicked up by these crazytherapists... one of whom is me. and that's why it doesn'toccur outside of north america, because they aren'tas hysterical in the restof the world. so the fact that in the '80s,did was being diagnosed a lot more inside northamerica, was a fact.
but it's equally consistentwith both hypotheses. but the skepticalpeople use the fact to provetheir theory. but that's nothow science works. what you do is you havean observation, a fact, then you construct atheory to explain the fact, and then you have totest your theory to see if it'sright or not. you don't just go,"well, here's the fact,
"here's my theory, thefact proves my theory." no scientistoperates like that. so what you have to dois do some research and do some studiesand find out, "okay, "are there no casesoutside north america? "yes or no?" so it's this completelyunscientific kind of intellectualfunction. "increase of diagnosesof did in the '90s
"is evidence of its artifactualnature"-- same idea. also, going back in time,did was rarely diagnosed-- (mic cuts out) and that proves it's justa fad in the 20th century, which is unfortunatelypersisting into the21st century. but it's the sametwo theories. it's always been around, goingback for thousands of years, we just haven't gottenup to speed on it until... into the20th century,
versus, "no, we've createda fad in the 20th century." so the fact thatthere's more cases diagnosed 1980 to '90 than allof the 18th and 19th centuries doesn't prove whichtheory is correct. but the skeptics use the factto prove their own theory. "skeptics make appealsto authority." so appeal toauthority is... "oh, by the way, i know this istrue, because freud said so." so you just-- "freud, youcan't argue with freud."
that's an appealto authority. or if you're a philosopher,"wittgenstein said so." or if you're an englishliterature person, you might saysomething about dickens. so the skeptics provethat they're correct by referencing their friendsand their co-authors. over and over andover and over and over. so there's a littlegroup of guys who belong to the club, andeverybody in the club agrees,
therefore theclub is correct. it's justnot science. validity can beinferred from anecdotal short-term treatmentoutcome, which i measured-- talked about before. so if you finda couple of cases that did poorly... you can then conclude thatall treatment of all cases of did is badand wrong.
you just, you couldn't saythis about schizophrenia. you know, a couple ofpeople with schizophrenia came to the hospital and theygot some sort of crazy treatment and they did badly, thereforeschizophrenia is not real? you just cannotsay that anywhere bad therapeutic practicescall the validity of did intoquestion. okay, so you go to mexicoto get laetrile for cancer and you die at exactly thesame date as you would've
if you didn't go to mexico,proving that cancer's not real. it just doesn'tmake any sense. "diagnostic criteriafor did are vague, "therefore didis not valid." that could be true. if it was true, that thediagnostic criteria are vague. but how are we gonna findout if the diagnostic criteria are vague? well, we've got to dointer-rater reliability studies
and look at thecohen's kappa. so we actuallyhave evidence that the criteria fordid are less vague-- like they're--the did-- depending on if you wannago up or down on the scale, either the criteriafor depression are twice as vague asthe criteria for did, or the criteria for didare half as vague as the depression criteria,based on the cohen's kappas.
so why are we sayingthat did is vague when it's actuallydemonstrably much less vague than depression? and what is the-- how do you diagnosesubstance abuse, according tothe "dsm v"? well, obviously you'vegot to take a bunch of some kindof substances. but you have-- all thewording is things like
"clinically significant." so what's "clinicallysignificant"? there's no numberfor that. it's kind ofa vague term. to be depressed, you have tobe depressed, down, sad, blue, most of the time forat least two weeks. yeah, but how muchmost of the time? it's completelyundefined. it's literally just"most of the time."
so this is one ofthe reasons why the agreement levelis so low. so we're applying thisargument of vagueness to did, which applies moreto other diagnoses. "lack of provenphysiological differences "between altersinvalidates did." there's no provenphysiological difference between any mental disorderand any other mental disorder. so this applies toall mental disorders.
we don't have-- and thisis according to "dsm v"-- we don't have a blood test,we don't have a brain scan, for diagnosingany "dsm" disorder. "if repression is notproven, did is not real." did that earlier. "diagnosis of did encouragesirresponsible behavior." it could. it doesn't in mytreatment programs. i hold people withdid responsible
for all their behavior, and theyget the natural consequences of their behavior justlike anybody without did. so just because--you can use did to go, "oh, i can't help it--little joey inside did it," but you don'thave to. so if we had a rule in themental health system that if you'redepressed, you get half as longa prison sentence as somebody who'snot depressed,
how many people would bedepressed all the time? everybody. if we had a rule thatsaid depressed people get double the sentence,everybody would be, "i'm not depressed." so you can totally manipulateit by the rules of the system. it's not inherent in thedisorder or the diagnosis. uh... "they're really justborderlines"-- went over that.
"it's an artifactof suggestibility "and highly hypnotizableindividuals." so this is one ofthe common things. you just hypnotize thesepeople and suggest to them that they have a canaryliving in their left ear. all of a sudden,they have a canary living in theirleft ear. it's a verychauvinistic, demeaning, belittling view of women,because most of the people
in treatment are women, thatthey're "so impressionable," you just tell them, "oh,you have somebody inside." "oh, yes, i havesomebody inside!" i mean, it's like women don'teven know their own minds. it's a verybelittling model. and we actually haveall kinds of research. people with did who'venever been hypnotized don't really differ intheir symptom profiles from people whohave been hypnotized.
"it's impossible to havemore than one personality "in the same body, thereforeit's not a real disorder." well, of course it'simpossible to have more than one personalityin the same body. nobody's saying there'sliterally different people living in there. and i explain this topatients all the time. i call it the"central paradox of did." so it took a whileto figure this out.
because if you saythis the wrong way, the person goes, "oh, you'retelling me it's not real? "i'm just making it up,it's all in my head? "i might as well gokill myself right now." so you've gotta be carefulhow you deliver it. so it took me awhile to figure out how to state thecentral paradox of did, which is it's both real andnot real at the same time. and i've given thisexplanation to hundreds
and hundreds ofpeople with did. what do imean by that? well, on the one hand, it'snot literally concretely real. so if we took anx-ray of your head, we wouldn't see all theselittle skeletons in there. and if there reallywere little skeletons running aroundinside your brain, your brain would be just allmashed up and you'd be dead. and nobody goes, "oh, yeah,there's skeletons in there."
everybody goes, "oh, that'scute-- little skeletons." so nobody debatesthe point. so it's not literally,concretely true (indistinct) people, personalitiesin there. but on the other hand,it's completely psychologically true. and very subjectivelycompelling. and people really doopen up their closets, and there's likethree outfits--
so this was a... very conservative 39-year-oldmarried housewife, and there's like 16-year-oldparty girl stuff. she doesn'tremember buying it. there's the receipt,her credit card, sort of likeher signature, and she can't remember from2 pm to 4 pm yesterday, because her teenagealter went shopping. these experiencesactually happen.
they're verypsychologically real. they're just notliterally real. so this whole thingabout it's not possible to have more thanone personality is, like, completelyirrelevant. "a few clinicians aremaking all the diagnoses." uh, that was true... in 1980. it's not true today.
but so what? at one point in time, asmall number of clinicians were making allthe aids diagnoses. what doesthat prove? there's people whosee-- have clinics every week wherenumerous people with cystic fibrosiscome to see them, and there's otherpediatricians who don't see anycases at all.
well, that's because these guysspecialize in cystic fibrosis. it's completelyordinary. it's unsurprising. nobody says, "oh, a fewclinicians are seeing "most of the casesof this disorder, "thereforeit's not real." they just go, "oh, thoseguys specialize in that." "incorrect references areindicative of careless research "in the skepticalliterature."
so the skeptical guysdo a really lousy job on their references. they even get likethe wrong references. or they quotea reference supporting a point that doesn'teven support that point. so just lousyscholarship. "did has been createdexperimentally, "which provesit's not valid." hmm... okay.
so there's nothingworse in medicine than having an animalmodel of a disorder. right? so biological cancerresearchers never want to studymice that have cancer. well, of coursethey do. these are called"animal models." all of medicine is basedon things in test tubes and things in animalsthat are a model
of the disease in humans, sowe can study how it works, whether it's the immune systemor arthritis or cancer. so animal models, or experimental modelsof something, don't disprove it. they help us tostudy how it works. so nowhere elsein medicine is an experimentalversion of the disorder used to invalidatethe disorder.
what are the experimentswhere people created did that provesit's not valid? it's sopreposterous. you wouldn't believethat this stuff could get inthe literature if it wasn't in almost all ofthe major psychology textbooks as evidence thatdid is not valid. so the experiment is,you get a whole bunch of undergraduates,such as you guys.
i bring you in. i give you a... little bit of trainingfor an hour or two about what did is,what it looks like. i teach you about childalter personalities. and then, i ask you tocome back next week and act as if you havemultiple personality, and a little girl comes outand talks and she's so cute, and she doesn't remember whathappened a long time ago.
so you do that. the reason you do that is,you get course credit for it. and this is the proofthat multiple personality can be createdexperimentally-- literally. they get collegestudents to act as if they havemultiple personality, after they give thema little training on how to dothe acting. do any of these peoplehave multiple personality
for another year? or go to thecounseling center and say, "i can't remember whathappened yesterday?" none. so what if we gotyou guys together and we said, "okay, i'm gonnateach you about back pain. "you're all gonna act likeyou've got lumbar disc pain, "and you're gonnabe going, 'oh, oh,' "and you're gonna ask thedoctor for some painkillers,
"and maybe you need totake a week off of school. "and you can't hand inyour paper this week." and so, you all startgoing, "oh, oh, oh." this proves that disc painisn't a real thing? so teaching people tofake something temporarily in order to get coursecredit tells us nothing about whether thething they're faking actually happens inthe world or not. but it's-- i'm notkidding, like the majority
of undergraduatepsychology textbooks cite these experiments ascompelling, conclusive evidence that did is afake disorder. which, again, if you didthat with depression, everybody'd just go, "well,they're just faking depression. "they don'tactually have it. "it stops as soon asthe experiment's over." >> what about "bluebird"? (indistinct).
>> this guy's read toomany of my books here for his own good. so another line of argument,which i was not gonna get into, but it's a whole'nother half-day talk, is one of my books originallywas called "bluebird," but i reissued itas "the cia doctors." it's about 15,000 pagesof documents that were declassified in the'70s, plus a ton of papers from medical journalsfrom the '50s and '60s
about cia mind controlexperimentation, all totally documented,done at major institutions, ivy league schools. closest place where mkultra topsecret experimentation was done to here would be ioniastate hospital in michigan. the experiment therewas five or six military psychiatrists who had severedin the vietnam war who were now back working atthe state mental hospital
in michigan, cleared attop secret by the cia, knowing it was cia funding,were interviewing incarceratedsex offenders, and giving them barbiturates,marijuana, and hallucinogens, to see if they could get themto confess to crimes they'd never beencharged with. that seems alittle dicey. that doesn't, no, i don'tthink that would exactly pass the proper ethicalreview board.
you've got incarceratedsex offenders, you're giving themstreet drugs to see if you can getthem to confess to things, and then you're not goingto bother reporting that to the policeat all. and it's clearedat top secret. so these are the documentedtypes of experiments that were done, includingcreating manchurian candidates, which is artificialmultiple personality,
which is the movie "themanchurian candidate." this is fact,not fiction, described extensivelyin documents, that if youtake somebody, you don't justgo, "hey"-- it's the same as creatinga suicide bomber. you don't just walk upto somebody on the street and go, "hey, would you liketo blow yourself up next week?" you've gotta recruit them,you've gotta work on them,
you've gotten softenthem up a little, you've gotta givethem some rewards. 72 virgins in heaven--pretty good reward. not sure if it'sa real reward. so to get somebodyto kill themselves, i mean,it's a project. you've got to havea susceptible person, and you can't choose like thehead of the government's son, and they've gottabe kind of desperate,
and they've gotta bekind of adrift in life, and then you'vegotta work on them, work on them,work on them. if you take somebodysuch as a marine and you work on themfor a period of months with all kinds ofinterrogation techniques and brainwashingtechniques, you can create artificialmultiple personality, and use the personin the background
to go on missions, andthe person out front doesn't remember,and this is described in great detailin documents going back to thesecond world war. so what i do withthat is, i say, "that proves thereality of civilian "clinical multiplepersonality." if you control somebody,traumatize them, threaten them,manipulate them enough,
this is how thehuman mind reacts. not in all people. but a sub-groupof people. so if you reactto brainwashing by creating a newalter personality, why wouldn't you reactto childhood abuse by creating a newalter personality? oh, "did must be completelyunconscious to be genuine." i don't know where theseguys even came up with this.
they say thatpeople like me believe that did istotally unconscious. nobody in the did fieldhas ever said that. they just kind of inventthat out of nowhere, and then theyargue that, "well, "since it's not completelyunconscious, it's not genuine." which doesn't makeany sense-- i mean, who ever comes in andsays, "i'm here, doctor, "because i'm completelyunconscious
"of being depressed."(audience chuckling) uh, "satanic ritual abuseand alien abductions "are not real, soneither is did." wait a minute, what's thatgot to do with anything? only two or threepeople with did who describe alienabduction experiences... out of thousands. so a few peoplewith schizophrenia think they wereabducted by aliens,
therefore schizophrenia'snot real? it's just not-- again,absolutely makes nosense whatsoever. satanic ritual abuse--well, let's assume that all the satanicritual abuse memories, which is a sub-groupof people with did, are not real. well, okay, so, hello, thesepeople are psychiatric patients in a mental hospital--they're a little mixed up. who's surprisedby that?
nobody says, "oh, theseschizophrenics have delusions, "therefore theirschizophrenia isn't real." it just... over and over and over,this logic just doesn'tmake any sense. and then, the "extremecase escalation tactic" is just a termi invented. so they'll take the mostextreme, out-there case, and use that to be typical ofthe entire population of did.
and so they--they'll always do that-- escalate up to theextreme situation. so if you go to... i don't know theexact percentage, but over three-quarters ofundergrad-- (mic cuts out)-- or even graduate abnormalpsychology textbooks, you get theanti-did approach, and you'll hearthem talking about the hillside stranglercase in los angeles
in the 1970s. which is a serial killerwho was convicted, not 100% for sure, butprobably was faking did. and that is overwhelming,powerful evidence that did is not alegitimate disorder. one case of one guywho's a serial killer-- we're gonnarely on them? who tried to get out ofresponsibility by faking did proves what abouteverybody else?
it's just so far in outer space,it's hard to believe, but it's in the majority ofabnormal psychology textbooks as powerful evidencethat did is not real. textbooks written by,like, the top professors. this is whati deal with. okay, so this is now my favoritepart of the whole thing. and so, this book was notpublished that long ago. well, let me skipthat one-- sorry. i'll just-- because we'rea little short on time.
here we are atmy favorite one. so this book was notpublished all that long ago. "sibyl exposed." by this woman debbie nathan,who sees herself as a feminist, she's a journalist. and shirley mason was--is the real person who was in the noveland the movie, "sibyl." so the two bigbooks and novels before "dsm iii"came out in 1980
where multiple personalitygot an official slot, the two big books and movieswere "the three faces of eve" and "sibyl." chris seizmore,who's the real eve from "the threefaces of eve," i know personally--amazing woman-- has been integratedsince 1975, highly gifted artist,wonderful person. has been wellfor decades.
shirley mason, who's sibyl,i never met, and she died. but in this book, thisdebbie nathan uses the sibyl case toestablish conclusively that sibyl reallydidn't have did-- it was just a crazy therapist,cornelia wilbur, which then makes us knowpretty well for sure that all the cases areridiculous and not real. but let's look ather analysis here. this is allfrom her book.
she's born in 1923,died in 1998. she had five sessionswith dr. cornelia wilbur-- who i knew, whois now deceased-- in 1945. so five sessions. she functioned wellwith no signs of did from 1945 until she startedseeing her again in 1954. so these are the factsaccording to debbie nathan. the symptoms of did beganafter the therapy re-started,
and were caused by the badtherapy by cornelia wilbur. okay, but in the book,debbie nathan describes symptoms prior tofirst contact with dr. wilbur, described to her by many peoplein shirley mason's hometown, who she intervieweddirectly. many differentpeople. family members andnon-family members. the symptoms frombefore first contact included fugue states,which means going somewhere
and not remembering who youare for a period of time. blank spells-- so clearlydefined chunks of missing time. spending hours playing withimaginary companions with names far beyond the agethat this occurs in non-traumatizedchildren. pretending tobe vickie, one of her imaginarycompanions at times. her mother callingher by the names of alter personalities lateridentified in adult therapy.
talking in a high,childish voice when she was nolonger a child. numerous symptoms consistentwith somatoform dissociation, which meanspsychosomatic symptoms. going to bars todrink with men, and not rememberingafterwards, although she hadn'tconsumed that much alcohol. suddenly goingcomatose in public. suddenly acting dramaticallyout of character.
all of thesebehaviors, described by manyobservers in her hometown, going back into herchildhood for years before first contactwith cornelia wilbur. yet, the analysis isall the did symptoms were caused bythe therapy. this is a huge...amount of symptomatology consistent withpre-existing did. but then, she goes on tosay that all these symptoms
that existed before contactwith cornelia wilbur, were caused bypernicious anemia, a form of anemia. well, a littleminor problem... pernicious-- she never had apernicious anemia diagnosis. no doctor ever diagnosedher with that. it's just made upout of nowhere. if the symptoms were causedby pernicious anemia-- which shedidn't have--
why did those symptoms go intoremission from 1945 to 1954? so debbie nathan says shehad all these symptoms here before seeingcornelia wilbur, caused bypernicious anemia, which doesn't causethose symptoms anyway and which shedidn't have. and then, all those symptomsstop for nine years, although she wasn'tdiagnosed or treated, and pernicious anemianever goes away,
and then they suddenlystarted up again and were causedby cornelia wilbur. like, who's gonnabelieve this? this book getspublished, gets reviewed favorablyall over the places, it's cited by allthe skeptics. it'll be in thepsychology textbooks soon. "debbie nathan wrote thiscompelling analysis." and the...
final nail in thecoffin of did is that debbie nathanpoints out that shirley mason deniedhaving mpd herself. once, inone letter. okay, so you treat somebody withchronic, severe alcoholism, for a long period of time, andonce they write you a letter saying that they don'thave a drinking problem, that's it, they clearly don'thave a drinking problem? it's just-- again, it'sjust this outer space,
mad hatter'stea party... doesn't makeany sense. it's impossible. it's so far belowany kind of... high school debating clubscould do way better than this in their levelof scholarship, argument, weighingthe evidence. so then, that raisesthe question, "well, why?" why is this all goingon in the field?
what's the deal here? why do all these, like,high-ranking professors have all thisbad attitude and all these crazy argumentsthat make no sense? and my answer isi don't know for sure. but i think there'smultiple sort of factors contributing to this. one is, uh, "my professorsnever taught me about that. "i was taughtthat it's rare.
"my professorscan't be wrong. "i can't be wrong. "it'd be too shameful to admitthat we've all been wrong "for all thesedecades." so there's this sort of egotism,professional reputation. another thing is ifit's actually true, then in the ballparkof 1 out of 25 inpatients in all the psych hospitals inthe country has undiagnosed did, and we're missingall those cases?
that doesn't make us look likevery sharp diagnosticians. so therefore, we haveto say it's not real. another thing is, if there'sall these people with did-- full did-- plus a whole bunch ofpeople with kind of half, three-quarters,a quarter did, maybe a lot of us area little more did-ish than we wouldlike to admit to. so maybe, "i don'twanna look at them "because i don't wannahave to look at myself.
"maybe my behavior's sometimesa little inconsistent "and doesn't exactly meshtogether in a healthy fashion." which doesn't meanthat i have did. i'm talking"i" the skeptic. "maybe i,the skeptic, "have an unresolvedchildhood trauma history "and i don't want anybodytalking about that stuff." so therefore... when colin ross goesto the american college
of psychiatrists meeting,hears a whole hour talk by a top expert onchildhood depression-- not a mention of childhoodabuse of any kind once. then, listens to anothertalk about another expert, not a mention ofchildhood trauma once. another talk byanother expert, still no mentionof childhood trauma. maybe they just don'twanna talk about it. maybe they'reuncomfortable.
maybe it's something to dowith personal histories. next hypothesis. remember when sexualabuse was just kind of coming out ofthe closet? in 1980, the 3rd editionof the comprehensive textbook of psychiatrywas published, that i used in myresidency from '81 to '85. there's three volumes, it's3,300-and-something pages, two columns each page.
everything you need to knowin psychiatry was in there. way at the back, afterthe important stuff, like depressionand schizophrenia, and drugs, genetics, was a section called"topics of special interest." which really meansirrelevant stuff that we just stuckin at the end because, you know, gotta becomprehensive. in there was a shortchapter called "incest."
in the chapter on incestwas one paragraph talking about howcommon incest is, with a referenceto a 1955 study saying it's one familyout of a million in the united states. those are the scientific,academic, medical facts during my training. that's the levelof denial. institutional denial.
it's been in place inpsychiatry for a century. it's actually more thanone family out of 100, not one outof a million. in this same era,the mid-'80s, there's severalsurveys where, surprisingly, femalepsychiatrists got interested inchildhood sexual abuse, which is mostly, butnot exclusively, girls. it's about two to three timesas much with girls as with boys.
and they did mail-out surveys todifferent types of physicians, psychiatrists, psychologists,and i think in one survey, social workers--can't remember for sure. but all differenttypes of physicians. have you ever hadsex with somebody who's currently intreatment with you? and a bunch ofother questions. they got back-- theydescribed in their article, published in aleading journal--
angry, scrawling, you know,f bombs and the whole works, from physicians,swearing at them, accusing of being this,that, and the other, and not filling outthe questionnaire. and 10% of respondentssaid yes-- anonymous respondents,said, "yes, "i have had sex with somebodywho's currently in treatment "with me inmy practice." so 10% admitted.
so what do we thinkthe real rate is? so do we thinkthere's pedophiles in the catholic church? do we think there'sany in the boy scouts? do we think there's anyin the medical profession? do we think there'sany in psychiatry? there has to be. there's pedophileseverywhere. so part of the wholedeal is pedophiles
don't want anybodytalking about that stuff. then, the otherpart of it is... biological braindisease model. if the genetics and thebiology of the brain are the big driversof mental illness, we can't allow it to betrue that childhood trauma that's themajor driver. it's justnot allowed. so you have todiscredit it.
and any diagnosesthat are linked to it, discredit. so to me, that's what'sgoing on in the profession. you look like youhad a question. >> yeah. approximately,what's the ratio of skeptics to, you know,clinicians who believe in did? >> there's actuallysurveys by skeptics, funnily enough, who thenconclude that did is not valid,
should be takenout of the "dsm," and in those surveys,about, uh... it's a little tricky howthey word the question. so sometimes thequestion is, "should the criteriabe modified?" and the answer is "yes,"and then they say, "well, see, it'sa bogus diagnosis." well, hello, the criteriafor schizophrenia just got modified between"dsm iv" and "dsm v."
so of course we haveto fine-tune stuff, and thatproves nothing. but it comesout about... bouncing around fromsurvey to survey, hardcore skeptics aresomewhere between 5% and 15%. half to two-thirds thinkit's a legitimate disorder, needs more research,maybe needs some fine-tuning, sometimes questionable. that's kind ofthe ballpark.
so, but the very small groupof really vociferous-- i mean, they're likethe jihadists, right? they're theanti-did jihadists. they're very vocal, veryenergized, very active. and have control of undergradpsychology textbooks, by and large. >> what about the actual lit--(clearing throat) sorry, the actualliterature? is there like a lot ofliterature-- you know,
you presented us alittle of the literature you've done onthis topic, but is there, like,a lot of literature that says the oppositeof what you're saying? >> well, the literaturethat says the opposite just says it, but doesn'thave any evidence. so these guys, like the guyswho do the experiments to create multiple personalityin college students, they never once describeinterviewing a single person
with a clinicaldiagnosis of did. so they dono treatment, and they don't even talkto people to say, "hey, "tell me about yourexperience here." so it's totallyarmchair quarterbacks, and they don't have any soliddesigned research studies proving any oftheir points. >> so there's not,i mean, like, actual, empiricalresearch from their side?
it's mostly just reviews of-->> reviews and opinions. and falsereasoning. >> and sometimes, stereotypedby inaccurate descriptions of what they'reeven rejecting. >> yeah, right. we were talkingabout this before, so the stereotype ofwhat somebody with did is supposedto look like. "so they're like flamboyantly,extremely obvious.
"they're right inyour face with it. "they're claiming noresponsibility for anything. "they're trying to get allkinds of special treatment "and privileges. "and there's no evidence forany did before from anywhere." that's the stereotype. which simply isjust not reality. of course, we know thateverybody from grand rapids is actually a martianwearing a human costume.
well, we don't reallyhave evidence for that, but we knowit's true. it's kind oflike that. anyone else with athought, comment, question? about anything in themental health field? or anything to dowith college hockey, that i know alot about? (all chuckling) okay, well, thanksfor listening.
thanks for spendingsome time. (applause)
