BASIC CONCEPTS

— When novelists claim they do not invent it, but hear voices and find stories in their head, they are neither joking nor crazy.

— When characters, narrators, or muses have minds of their own and occasionally take over, they are alternate personalities.

— Alternate personalities and memory gaps, but no significant distress or dysfunction, is a normal version of multiple personality.

— normal Multiple Personality Trait (MPT) (core of Multiple Identity Literary Theory), not clinical Multiple Personality Disorder (MPD)

— The normal version of multiple personality is an asset in fiction writing when some alternate personalities are storytellers.

— Multiple personality originates when imaginative children with normal brains have unassuaged trauma as victim or witness.

— Psychiatrists, whose standard mental status exam fails to ask about memory gaps, think they never see multiple personality.

— They need the clue of memory gaps, because alternate personalities don’t acknowledge their presence until their cover is blown.

— In novels, most multiple personality, per se, is unnoticed, unintentional, and reflects the author’s view of ordinary psychology.

— Multiple personality means one person who has more than one identity and memory bank, not psychosis or possession.

— Euphemisms for alternate personalities include parts, pseudonyms, alter egos, doubles, double consciousness, voice or voices.

— Multiple personality trait: 90% of fiction writers; possibly 30% of public.

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Monday, March 30, 2020

Schizophrenia: A Controversial Diagnosis

Almost all psychiatrists see schizophrenia as a biological mental illness. Their empirical proof is its successful treatment with anti-psychotic medication; and that, when patients don’t take the medicine, the results can be tragic. As a practicing psychiatrist for more than thirty years, I agreed with that point of view.

However, since anti-psychotic medication does not cure schizophrenia, and is often only partially effective, its proof of the nature of schizophrenia is, at best, partial.

Moreover, conceptually, schizophrenia is a very problematic diagnosis. It does not have even one symptom that is unique to it (pathognomonic). For example, auditory hallucinations are just as common in the nonpsychotic, dissociative disorder, dissociative identity disorder (multiple personality disorder), and voices are heard by many people who are well.

One dissenting view as to the nature of at least some cases of schizophrenia comes from psychiatrists and psychologists who see symptoms like auditory hallucinations as evidence that some people diagnosed with schizophrenia have a posttraumatic, dissociative disorder related to multiple personality (1).

1. Andrew Moskowitz PhD, Martin J. Dorahy PhD, Ingo Schäfer MD, MPH (Editors). Psychosis, Trauma and Dissociation: Evolving Perspectives on Severe Psychopathology, Second Edition. Hoboken NJ, Wiley Blackwell, 2019.

 Added April 3, 2020: The new April issue of The American Journal of Psychiatry addresses the fact that psychiatric treatment of schizophrenia does reasonably well in reducing its psychotic symptoms, but cognitive impairment, not psychosis, is the basic problem:  https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20020147
My question: Are many patients diagnosed with schizophrenia who do not have its basic cognitive impairment, and who are diagnosed only on the basis of psychotic symptoms, misdiagnosed? And if they do not really have schizophrenia, what do they have?
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