Discussion を少し書き直したが、だいぶ考え方が変わってきた。DIDというネーミングそのものが間違っている可能性があると考えるようになった。
So far, I take a
second look at how personalities in DID are conceptualized in modern
psychiatric diagnostic criteria such as DSM-5 and ICD-11 and delineated current
trend of regarding the identities in DID as partial and fragmentary.
Presumably, DID is
characterized as having a disruption of identity (DSM-5,
ICD-11), which is cogently expressed in the name of the “dissociative identity
disorder”, a diagnostic nomenclature which first appeared in 1994 (DSM-IV,
American Psychiatric Association) and seems to have gained its citizenship well
enough afterward. If we trace the way the diagnostic naming is switched from
MPD (multiple personality disorder) to DID, the rationale for the change was to
remind clinicians with this name that patients’ problem is not having many real
personalities as MPD connotes, but having identity disorder with inability to
have a wholesome personality (i.e.,) as a result of the failure of integration.
David Spiegel, who
chaired the committee for DSM-IV dissociative disorder spoke the rationale for
the change from MPD to DID, with a rather pejorative tone, as follows:
Indeed, the
problem is not having more than one personality, it is having less than one (Spiegel,
2006 p567.)
Spiegel, D. (2006) Editorial. Am
J Psychiatry 163:566-568.
It might be a surprise
for those who are used to this diagnostic name DID that it implies that personalities
are parts or fragments as this view might not altogether consistent with their
clinical manifestations. I imagine that many clinicians including myself are
treating these personalities as a regular and wholesome human being until we have
a chance to be reminded of their experiences reflecting disruption of identity
in one way or other.
I would venture and
ask if it is really a problem for a person to have more than one mind so long
as he is coping with it well? Imagine that there is a population of people who
happen to have two or more personalities while possessing a shared body? Some
might argue that it is a problem, or “disorder”, but this is equivalent to the
state of Siamese twins, a comparison that I already made to the state of DID
earlier in this paper. In fact, example of Hensel sisters look quite healthy
and normal although they share a single body (Russell, Cohn, 2012). This topic even goes back to
the question of whether the condition of DID is an illness or a normal variant.
Russell,
J,., Cohn, R.
(eds.)(2012) Abigail and Brittany Hensel. Book on Demand Ltd.
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