3 ms·

I don't know too much about it. But I knew somebody who said they had it and it turned out to be a more ordinary psychosis that they eventually had treatment fo

I don't know too much about it. But I knew somebody who said they had it and it turned out to be a more ordinary psychosis that they eventually had treatment for. Seems to me that if you are correct that it doesn't exist, that there can still be people who genuinely believe they have it and may have another illness. Those people deserve better than to be dismissed as crackpots. Like maybe to approach it as one would schizophrenia may help. From there I may say that a more accepted diagnosis like "schizophrenia" still has imprecision and wiggle room, owing in part to the fact that we don't fully understand mental illness.

caymanjim 6y ago
Let me clarify that I wasn't referring to the patient as a crackpot. I fully believe that there are people suffering from mental illnesses with frightening and confusing symptoms, including auditory hallucinations and hearing voices. I do think that the idea of multiple personalities is a "crackpot theory" that some mental health professionals are proponents of. I don't think a plurality of psychiatrists accept the notion of independent personalities. Some of them do, and push the notion, to the detriment of their patients. I'm referring to that when I say "crackpot". Maybe I'm wrong; I'm no professional. But I'm in good company in being critical of the idea. Hyperbolic, to be fair.
thanatropism 6y ago
Up to the mid-70s psychoanalysis was one of the core clinical practices in American psychiatry (the evidence is the shift between the DSM-II in 1974 and the DSM-III in 1980), and what psychoanalysis means by "schizophrenia" is something entirely different from what the modern approach means. This was a wildly serious problem. Psychoanalysis was really only practiced at scale in the US and Argentina, so people made up theories of why New Yorkers were more psychotic than Londoners (this is somewhere in "Listening to Prozac"). I think what has happened in the mental health field (and I've been a psychiatric patient-consumer for 15 years) is that the DSM movement has finally fixed definitions in place. But defining something doesn't mean it exists (except as a cluster of symptoms that front-line clinicians treat out of "data science" type knowledge). It's possible that the only clear-cut differential diagnostic is the one made by Kraepelin in the 1890s between what's now called bipolar and "precocious dementia" (more or less schizophrenia, but who knows what schizophrenia IS rather than IS NOT). And even this is challenged in the literature. How could it not -- looking at an episode and not doing the elegant analyses made possible to Kraepelin from working in a psych ward full of unmedicated bipolars -- how could you distinguish manic and schizophrenic hallucinations? My doctors have kept me reading the academic journal literature over the years (abeit literature about bipolar, not dissociative disorders); but by the same token I figure it's difficult to place someone's multiple-personality story in any one of the available boxes (dissociative disorders, together with amnesias and fugues; schizophrenia; malingering). What the bleep do we know.
- asveikau 6y ago
  This is a good comment, thanks. I have one thing I would like to highlight: > people made up theories of why New Yorkers were more psychotic than Londoners (this is somewhere in "Listening to Prozac"). Maybe I need to read your source for more context. But I could see this being a very alluring theory in prior decades, before New York and urban areas in general started seeing massive crime drops, gentrification, etc. In the 70s and 80s many talked about New York as an ugly place, somewhere to escape from. It's pretty different now. Then I wonder about some other uniquely American problems, like the extent of our gun violence, or poor health care. And I wonder what people may say about mental illness rates compared to other developed counties. (Surely someone has looked.)

caymanjim 6y ago

Let me clarify that I wasn't referring to the patient as a crackpot. I fully believe that there are people suffering from mental illnesses with frightening and confusing symptoms, including auditory hallucinations and hearing voices. I do think that the idea of multiple personalities is a "crackpot theory" that some mental health professionals are proponents of. I don't think a plurality of psychiatrists accept the notion of independent personalities. Some of them do, and push the notion, to the detriment of their patients. I'm referring to that when I say "crackpot". Maybe I'm wrong; I'm no professional. But I'm in good company in being critical of the idea. Hyperbolic, to be fair.

thanatropism 6y ago

Up to the mid-70s psychoanalysis was one of the core clinical practices in American psychiatry (the evidence is the shift between the DSM-II in 1974 and the DSM-III in 1980), and what psychoanalysis means by "schizophrenia" is something entirely different from what the modern approach means. This was a wildly serious problem. Psychoanalysis was really only practiced at scale in the US and Argentina, so people made up theories of why New Yorkers were more psychotic than Londoners (this is somewhere in "Listening to Prozac"). I think what has happened in the mental health field (and I've been a psychiatric patient-consumer for 15 years) is that the DSM movement has finally fixed definitions in place. But defining something doesn't mean it exists (except as a cluster of symptoms that front-line clinicians treat out of "data science" type knowledge). It's possible that the only clear-cut differential diagnostic is the one made by Kraepelin in the 1890s between what's now called bipolar and "precocious dementia" (more or less schizophrenia, but who knows what schizophrenia IS rather than IS NOT). And even this is challenged in the literature. How could it not -- looking at an episode and not doing the elegant analyses made possible to Kraepelin from working in a psych ward full of unmedicated bipolars -- how could you distinguish manic and schizophrenic hallucinations? My doctors have kept me reading the academic journal literature over the years (abeit literature about bipolar, not dissociative disorders); but by the same token I figure it's difficult to place someone's multiple-personality story in any one of the available boxes (dissociative disorders, together with amnesias and fugues; schizophrenia; malingering). What the bleep do we know.

asveikau 6y ago
This is a good comment, thanks. I have one thing I would like to highlight: > people made up theories of why New Yorkers were more psychotic than Londoners (this is somewhere in "Listening to Prozac"). Maybe I need to read your source for more context. But I could see this being a very alluring theory in prior decades, before New York and urban areas in general started seeing massive crime drops, gentrification, etc. In the 70s and 80s many talked about New York as an ugly place, somewhere to escape from. It's pretty different now. Then I wonder about some other uniquely American problems, like the extent of our gun violence, or poor health care. And I wonder what people may say about mental illness rates compared to other developed counties. (Surely someone has looked.)