Dissociative Identity Disorder: Diagnosis, Clinical Features and Treatment of Multiple Personality (Wiley Series in General and Clinical Psychiatry) [Hardcover]

I've read several books on this affliction, and this is the most comprehensive book available for therapists. Ross has many years of experience and knows the traps and detours in treating dissociative-traumatized patients. He understands the critical, child-like gap in the patient's thinking, believing that he/she was in control and thus to blame for what happened. Letting go of guilt means facing the frightening truth: the victim wasn't in control.

Dissociation arises from the conflict between the victims' attachment to their abusers and their need for survival. Above all, it embodies the need to keep secrets, even from oneself. This fact and the victim's ambivalent feelings are what make dissociative disorders different from post-traumatic stress due to public traumas such as assault, combat, and the like.

Ross is also very good at dispelling the myths you hear:

- Dissociation and dissociative identity disorder (DID) are not real or merely created by therapists.

- There's no objective evidence for DID. In fact, the evidence for DID is better than for many psychiatric conditions. And the brain physiology of traumatic stress is well-established.

- DID (or "multiple personalities") is rare. It's actually not that uncommon, perhaps a percent or so of the population. DID has been misdiagnosed and misunderstood for decades. Then add those suffering from related post-traumatic stress and borderline personality disorders.

- Alters are "separate personalities." Alters are actually distinct states, separated by amnesia barriers, of a single mind, frozen at different ages and distinct contexts by chronic, overwhelmingly stressful and traumatic experiences. They are triggered and revived by similar experiences later in life.

The name of the disorder was changed from "multiple personality" to "dissociative identity" to remove the implication that the victim is more than one person in one body. The victim's identity (memories, thoughts, and feelings continuously integrated in time into a single "I") is fragmented, not multiple.

The dissociated have, not more than one personality, but *less* than one.

- It has to be "Sybil" to be real. Actually, DID cases as extreme as Sybil's are rare. Most DID cases are more subtle and, by their nature, involve sophisticated strageties of hiding and self-protection.

- Recovered abuse memories are false. Actually, they're generally true. Therapists must carefully avoid leading questions and suggestion, however, and probing and validating memory takes time.

Such memories are not "repressed" - a false idea inspired by Freud. One part always knew and never forgot. The other part never knew and so had nothing to forget. Forgetting is not involved. The key to the memory problem is the existence of alters, not "repression" or forgetting.

- DID is demon possession. Actually, demon possession is DID.

Demon possession evolved into DID by the late 19th century and became a central concern of psychiatry, under the name of "hysteria." The distressing fact is that that psychiatry has regressed in some ways since then. All the cool psychologists circa 1900 were studying it (Breuer, Freud, Janet, James, Myers, Prince, etc.). Nietzsche alludes to "subjective multiplicity" and the fallacy of the "soul atom" in Beyond Good and Evil (1886). And let's not forget Lady MacBeth or Jekyll and Hyde.

- DID is an autohypnotic disorder. A half-truth. Dissociation/autohypnosis is a defense against abuse.

- DID is really schizophrenia. Still a common mistake, because of the popular confusion over "schizo." Doctors misunderstand because some DID symptoms superficially sound like schizophrenia. But DID is not a psychotic disorder. It does involve mood disturbances, usually depression and anxiety, sometimes mania.

- Dissociative patients are crazy. Actually, the traumatic situations they were in were crazy. DID is how their minds cope with distressing, uncontrollable situations. The patients are basically sane and fine. That's the paradox.

- Trauma is all caused by sexual abuse, or sexual abuse of girls. Or it's a product of evil patriarchy, or some such kindergarden Marxism.

Actually, boys are probably subject to as much abuse as girls, perhaps more physical and emotional than sexual. The perpetrators are themselves often mentally ill and/or drug-addicted. Mothers often play a major and surprising role. And female DID victims are more likely to seek treatment.

- We don't hear about DID, so it can't be real. Actually, we hear about abuse all the time, less about the lives that it ruins. Few people want to know about it and try to quickly forget about it. (Therapists exhibit the same pattern as well.) The victims would like to forget too - but become dissociative instead.

Besides Ross, there are other shorter and excellent books on dissociation, DID, and multiple personality disorder.

- James Chu, Rebuilding Shattered Lives (for therapists)

- Marlene Steinberg, The Stranger in the Mirror. Explains why DID sufferers are treated endlessly for their secondary disorders, while missing the essential problem. Provides standardized criteria for dissociation: amnesia, depersonalization, derealization, identity confusion, and identity alteration.

Also, very interesting discussion of false memories, screen memories, and memories of satanic ritual abuse and alien abuction - why they arise and seem so real, even when they're false.

- Lenore Terr, Too Scared to Cry and Unchained Memories. Definitive, readable studies of trauma, partly based on her experience with the Chowchilla child kidnapping victims. Explains why it's taken so long to replace cliches about childhood trauma with real understanding and why there's still professional resistance.

- The books by David Pelzer (the child called "It")

This book provides excellent, in-depth information. It is written for professionals, but provided in a format which does not alienate the intelligent layperson. It is a great resource for those who already have an understanding of dissociative identity disorder and are searching for more detail. Dr. Ross explores all areas of the disorder. The areas I found most intriguing included the descriptions of common roles of identities, responses to professionals who argue that dissociative identity disorder does not exist, and a wide variety of statistics based on solid experimental research. ...I have found it very helpful in my determination to be an active participant in my treatment. This book is well worth its price!!!

Dr. Ross covers the latest in trends in therapy and treatment modalities for Dissociative Identity Disorder (formerly Multiple Personality Disorder). Dr. Ross also mounts a solid apologetic for the defense of what has continued to be a controversial diagnosis in clinical circles. Included in the book are solid therapeutic approaches and, while he does not claim to provide complete training for the novice, he does provide a very solid foundation both in his theory and practice techniques from which to have a solid basis for understanding and working with this difficult disorder. David B. Rosenthal, M.Ed., LP

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