The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR.While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false.Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.
Among DID individuals, the sharing of conscious awareness between alters exists in varying degrees. I have seen cases where there has appeared to be no amnestic barriers between individual alters, where the host and alters appeared to be fully cognizant of each other. On the other hand, I have seen cases where the host was absolutely unaware of any alters despite clear evidence of their presence. In those cases, while the host was not aware of the alters, there were alters with an awareness of the host as well as having some limited awareness of at least a few other alters. So, according to my experience, there is a spectrum of shared consciousness in DID patients. From a therapeutic point of view, while treatment of patients without amnestic barriers differs in some ways from treatment of those with such barriers, the fundamental goal of therapy is the same: to support the healing of the early childhood trauma that gave rise to the dissociation and its attendant alters.Good DID therapy involves promoting co­-consciousness. With co-­consciousness, it is possible to begin teaching the patient’s system the value of cooperation among the alters. Enjoin them to emulate the spirit of a champion football team, with each member utilizing their full potential and working together to achieve a common goal.Returning to the patients that seemed to lack amnestic barriers, it is important to understand that such co-consciousness did not mean that the host and alters were well-­coordinated or living in harmony. If they were all in harmony, there would be no “dis­ease.” There would be little likelihood of a need or even desire for psychiatric intervention. It is when there is conflict between the host and/or among alters that treatment is needed.
It was Freud's ambition to discover the cause of hysteria, the archetypal female neurosis of his time. In his early investigations, he gained the trust and confidence of many women, who revealed their troubles to him.Time after time, Freud's patients, women from prosperous, conventional families, unburdened painful memories of childhood sexual encounters with men they had trusted: family friends, relatives, and fathers. Freud initially believed his patients and recognized the significance of their confessions. In 1896, with the publication of two works, The Aetiology of Hysteria and Studies on Hysteria, he announced that he had solved the mystery of the female neurosis. At the origin of every case of hysteria, Freud asserted, was a childhood sexual trauma.But Freud was never comfortable with this discovery, because of what it implied about the behavior of respectable family men. If his patients' reports were true, incest was not a rare abuse, confined to the poor and the mentally defective, but was endemic to the patriarchal family. Recognizing the implicit challenge to patriarchal values, Freud refused to identify fathers publicly as sexual aggressors. Though in his private correspondence he cited "seduction by the father" as the "essential point" in hysteria, he was never able to bring himself to make this statement in public. Scrupulously honest and courageous in other respects, Freud falsified his incest cases. In The Aetiology of Hysteria, Freud implausibly identified governessss, nurses, maids, and children of both sexes as the offenders. In Studies in Hysteria, he managed to name an uncle as the seducer in two cases. Many years later, Freud acknowledged that the "uncles" who had molested Rosaslia and Katharina were in fact their fathers. Though he had shown little reluctance to shock prudish sensibilities in other matters, Freud claimed that "discretion" had led him to suppress this essential information. Even though Freud had gone to such lengths to avoid publicly inculpating fathers, he remained so distressed by his seduction theory that within a year he repudiated it entirely. He concluded that his patients' numerous reports of sexual abuse were untrue. This conclusion was based not on any new evidence from patients, but rather on Freud's own growing unwillingness to believe that licentious behavior on the part of fathers could be so widespread. His correspondence of the period revealed that he was particularly troubled by awareness of his own incestuous wishes toward his daughter, and by suspicions of his father, who had died recently.p9-10