The Science of Monsters

Meg: “As you mentioned, dissociative identity disorder (formerly multiple personality disorder) is a controversial diagnosis. Psychology Today calls DID “unstable, open to debate and hard to pin down.” Was it covered in your education? If so, how has it been treated in the psychiatric community?”

Dr. Leasure: “DID is indeed a controversial diagnosis. Most modern mental health providers, including psychiatrists, strongly question the validity of the diagnosis, or outright believe it is a bogus diagnosis that is better accounted for by other problems, which may include substance use, neurologic disorders, PTSD, personality disorders, or malingering. In my training we received essentially no training related to DID diagnosis, other than skepticism of its existence and acknowledgment that diagnostic criteria for the diagnosis exist in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is now in its 5th version. There is a common acceptance that a large number of individuals who are purported to have DID have a history of often severe physical or sexual trauma in childhood.”

Kelly:“Based on your knowledge and experience, where do you stand on the controversy of DID?”

Dr. Leasure: “I am highly skeptical of the diagnosis and close to the line of thinking it is completely bogus. I am hesitant to state outright that it doesn’t exist, but if it does, it is exceedingly rare to the point that most clinicians have no practical knowledge or experience with it.”

Meg:“Wow, fascinating! I knew it was rare, but that puts it into perspective. So, imagine Norman Bates is in your office seeking help. He describes an extreme fixation on his mother, as well as moments of amnesia, and let’s not forget how this dangerous fixation is now spreading to all the women in Norman’s midst (as it did with the character’s real-life inspiration, Ed Gein). What sort of modern medicine/therapy could you provide Norman?”

Dr. Leasure: “My first priority would be assessing safety. I would be interested in hearing if at any time he had thoughts of harming his mother or anyone else, or if they were otherwise at risk. I would be interested in the nature of his fixation with them to help in this determination. Assessing for any abnormalities in his thinking, such as delusional beliefs, would also be important. With the periods of amnesia, I would be interested in determining if he’d had any seizures, head injuries, or other medical problems or medication side effects that might have caused amnesia. I would also be interested in assessing his use of substances to determine if they might have contributed to the amnesia or changes in his thinking. Potential treatment is difficult to speculate about without knowing more about potential symptoms or diagnoses. Certainly, if there were safety concerns due to a mental disorder then psychiatric hospitalization might be warranted. As for medication, if he had psychosis, then I would consider an antipsychotic medication. However, without knowing more information, it’s not clear to me how a medication might be effective. Psychotherapy could be a consideration.”

Kelly:“Too bad Norman didn’t get help! How does modern medicine/therapy differ from what would have been offered to him in 1960?”