• Conférence du Dr Colin Ross - Transcription

     

    https://www.youtube.com/watch?v=HEABQUggDXQ

    0:00
    >> I'll give you a quick introduction,
    0:01
    I'll tell you quickly what I'm gonna go over,
    0:03
    and it's divided into three sections,
    0:06
    so I've got three sets of slides,
    0:08
    and we'll take a break between
    0:09
    each of those sections.
    0:11
    And we're finishing at...
    0:13
    9:00 or 9:15?
    0:18
    9:15-- it's a little loose?
    0:19
    >> We could go later if you-- >> 11:15, 12:00?
    0:22
    (audience laughing)
    0:24
    Uh, so, I'm a psychiatrist, born in Canada,
    0:27
    grew up in Canada, went to medical school
    0:29
    in Canada from '77 to '81.
    0:32
    Did my psychiatry training in Canada
    0:34
    from '81 to '85.
    0:36
    Then, I was an academic psychiatrist
    0:38
    in Canada, '85 to '91.
    0:41
    And then, in '91, I moved to Dallas
    0:43
    where I've been since, running a hospital-based trauma program.
    0:47
    In '98, we opened a trauma program
    0:50
    here at Forest View, and then, in 2000,
    0:53
    I kind of inherited a pre-existing trauma program
    0:56
    at a hospital in LA.
    0:58
    And in Dallas, I've-- I'm now at my third hospital.
    1:03
    So the first hospital I was at is closed--
    1:05
    the corporation went out of business.
    1:07
    Second hospital I was at closed temporarily,
    1:10
    so we moved to a sister hospital
    1:12
    in the Dallas area.
    1:13
    So basically, I...
    1:16
    help with oversight, overview,
    1:20
    educating the staff, consulting to the staff.
    1:25
    I do lots of writing, lots of talking,
    1:29
    and I do, in Dallas, three groups a week in person.
    1:35
    Here in Michigan, I do two groups a week
    1:37
    by video conference.
    1:39
    I come up once a month for two days.
    1:41
    And in LA, I do two groups a week
    1:43
    by video conference, and go kind of intermittently to LA.
    1:48
    So I'm actually hands-on involved
    1:50
    in clinical work, not just a theory guy,
    1:52
    sits at his desk and smokes cigars
    1:54
    and plays golf sort of thing.
    1:58
    I decided to be a psychiatrist way back,
    2:00
    and then kind of did a life detour
    2:03
    around and about, got to medical school in '77,
    2:08
    100% intending to be a psychiatrist.
    2:12
    But I learned fairly quickly in medical school
    2:14
    that it's best to keep that a little bit quiet,
    2:17
    because the surgeons and the internists
    2:20
    generally didn't have a whole lot of respect
    2:21
    for psychiatry, and were all disappointed
    2:23
    if they heard you're going to psychiatry.
    2:27
    Didn't really have any particular thoughts about trauma,
    2:30
    dissociation, multiple personality disorder,
    2:33
    anything kind of in that ballpark
    2:35
    at the beginning of medical school.
    2:38
    Then in...
    2:39
    early in...
    2:42
    Hey.
    2:43
    For some reason, when you phoned me,
    2:45
    I answered, I said, "Hello," but you weren't there.
    2:48
    >> I was standing outside too long-- my phone fell asleep.
    2:50
    (laughing) >> Oh, not to mention you.
    2:52
    This is Jessica, who's the program director
    2:54
    at the Forest View hospital.
    2:56
    >> Hello.
    2:57
    >> Feel free to sit somewhere. >> Okay.
    3:01
    >> And so, early in the third year medical school,
    3:04
    you start doing rotations, and...
    3:07
    you do surgery, internal medicine,
    3:10
    pediatrics, obstetrics, gynecology,
    3:12
    and psychiatry.
    3:13
    And your basic job as a medical student
    3:15
    is to get harassed by the nurses,
    3:18
    try and stay out of the way,
    3:20
    and do some kind of menial task that nobody else
    3:23
    wants to do.
    3:24
    And that involves taking a history, for one thing.
    3:27
    So somebody comes in, and you have to go take a history
    3:30
    and write it up in great detail,
    3:31
    because the psychiatrists don't want to spend
    3:33
    all that time asking all those questions
    3:34
    or writing that stuff out.
    3:36
    And as you're doing that, of course,
    3:38
    then you learn, by asking questions,
    3:40
    talking to people, finding out what's going on.
    3:43
    And so...
    3:45
    kind of like a third of the way into the rotation,
    3:47
    which was eight weeks,
    3:49
    I was assigned to do an intake history on a woman
    3:51
    who had been referred in by her family doctor.
    3:55
    And she was late-ish 20s, and her story was--
    4:01
    so this is in Edmonton, in Canada-- her story was,
    4:05
    a week previous to my talking to her,
    4:08
    she had all of a sudden come to at the airport,
    4:10
    and she had a blank spell of a week,
    4:12
    and didn't know where she'd been.
    4:14
    Not even what city she was in, for a week.
    4:17
    Then, from that point in time, going back,
    4:19
    she had normal memory for a month,
    4:22
    and at that point in time, she had come to at the airport,
    4:26
    but that time she was missing a whole month.
    4:28
    So that was kind of the puzzle
    4:30
    of what's going on with this woman,
    4:32
    and I'd read a little bit about hypnosis,
    4:35
    so I was kind of practicing my hypnosis techniques
    4:38
    with people who are...
    4:41
    not really trauma people, just general adults,
    4:43
    psychiatric in-patients
    4:45
    for help for sleep, help for relaxation,
    4:48
    maybe a little anxiety reduction.
    4:50
    Basically just practicing the rigmarole
    4:52
    of hypnotizing somebody.
    4:54
    So since she had amnesia, I thought,
    4:56
    "Well, maybe I'll try hypnotizing her,
    4:58
    "see if she can remember."
    5:01
    She's very easy to hypnotize, and immediately
    5:04
    she remembered that she had been in eastern Canada--
    5:09
    she was separated from her husband,
    5:10
    she was in eastern Canada visiting her kids,
    5:12
    on both occasions,
    5:14
    and she had bought them a whole lot of presents.
    5:18
    Well, where did she get the money from,
    5:19
    was the question.
    5:20
    Well, where she got the money from
    5:21
    was her pretty wealthy, high-spending
    5:25
    construction guy boyfriend.
    5:28
    And he wisely had decided to set up
    5:30
    a joint account with her,
    5:31
    and she had taken a whole bunch of money out of his account
    5:35
    and put it in four different accounts,
    5:37
    and then, during the period of time she didn't remember,
    5:40
    she'd emptied out those accounts,
    5:42
    used that to buy the plane ticket
    5:44
    and buy a whole bunch of presents for her kids.
    5:47
    So is that true or did that really happen?
    5:49
    So what we did is called the banks
    5:51
    and went through a procedure,
    5:53
    and a detective actually came in and interviewed her,
    5:56
    because she had bounced a couple of checks.
    5:59
    So all these bank accounts did in fact exist,
    6:01
    the money in fact was spent.
    6:03
    She was married-- or separated-- she did have kids.
    6:06
    And so, that was interesting,
    6:08
    as a third-year medical student.
    6:10
    And my supervising psychiatrist
    6:11
    was off on vacation for a couple of weeks,
    6:14
    so his replacement supervisor basically said,
    6:18
    "Oh, yeah, whatever you wanna do."
    6:20
    That was my supervision.
    6:22
    And...
    6:24
    after a couple of these hypnosis sessions,
    6:26
    she said, "You know, sometimes,
    6:27
    "I joke around with my boyfriend,
    6:29
    "and I tell him, 'That wasn't me you kissed,
    6:31
    "'that was Suzy,'" a different name.
    6:35
    I said, "Yeah, okay, whatever."
    6:37
    And then, I can't really remember why,
    6:39
    but I decided after I had hypnotized her
    6:41
    and she's all relaxed and everything,
    6:43
    to say, "Well, how are you feeling today, Suzy?"
    6:47
    All of a sudden, 11-year-old Suzy's talking to me.
    6:49
    She's the one who did all the money
    6:52
    and the bank accounts and bought the ticket
    6:53
    and went back and saw the kids,
    6:55
    and the grown-up regular person didn't remember.
    6:58
    So there I was with a case of multiple personality.
    7:04
    Third-year medical student, know nothing about nothing.
    7:07
    So my supervisor, by this point, had come back
    7:10
    from his period of vacation, so I said,
    7:12
    "Well, I've got this multiple personality case."
    7:14
    He's like, "Oh, yeah, okay."
    7:17
    "Well, what should I read about that?"
    7:19
    This is in 1979.
    7:21
    He says, "I don't know.
    7:25
    "Why don't you go to the library?"
    7:26
    Good suggestion.
    7:28
    So I go to the library.
    7:30
    Started looking around in textbooks,
    7:32
    and I find a couple of review papers,
    7:35
    one from the '70s and one from the '60s,
    7:39
    and I learn that this is the 200th case
    7:42
    of multiple personality disorder
    7:44
    ever diagnosed in the history of Western medicine.
    7:47
    Huh.
    7:48
    So that's a little bit weird.
    7:50
    And what are the odds of that?
    7:52
    And so, I end up writing that case up
    7:54
    and publishing it in the "International Journal
    7:58
    "of Clinical and Experimental Hypnosis" in 1984.
    8:01
    That was my first case-- that's how I got into it.
    8:04
    And I thought, "Well, that was really interesting,
    8:06
    "but obviously I'm never gonna see
    8:08
    "another case again.
    8:09
    "It's just a statistical fluke."
    8:11
    Then, finished medical school,
    8:14
    I'm in my residency program,
    8:16
    and we have a long-term psychotherapy program
    8:19
    where each resident follows two people
    8:21
    for as long as required.
    8:23
    And every year, on each of those cases,
    8:25
    you change supervisor.
    8:27
    So you get a bunch of different cases
    8:28
    and a bunch of different supervisors.
    8:30
    So I'm working with this woman
    8:32
    who's a pretty seriously battered spouse,
    8:35
    depressed, agoraphobic, anxious,
    8:38
    and lo and behold, she has a couple parts inside.
    8:43
    So now I've got two cases.
    8:45
    Then I finish my residency in 1985,
    8:48
    and, um, at the end of the academic year,
    8:51
    which is the end of June,
    8:53
    and in September, a woman comes to the emergency department,
    8:57
    is assigned to me as a general in-patient psychiatrist,
    9:00
    and lo and behold, I figure out that she has
    9:01
    multiple personality disorder.
    9:03
    So now, I've seen three cases.
    9:05
    So at this point, I'm the leading expert
    9:07
    in western Canada with the most publications
    9:10
    of any psychiatrist in western Canada.
    9:12
    Equals two.
    9:14
    Three cases, two publications.
    9:17
    So this is how I stumbled into this area.
    9:19
    I had no idea, no attitudes, no thoughts,
    9:23
    and so, now, the puzzle gets even bigger.
    9:25
    Well, wait a minute, if there's only been 200 cases,
    9:29
    how come now I've got three all by myself?
    9:31
    And the possible answers to this question are...
    9:34
    "There's something very weird about Colin Ross--
    9:36
    "he makes people act like they have multiple personality,
    9:39
    "and they just do that for whatever reason."
    9:41
    Or, it must be much more common
    9:44
    than just a couple hundred cases.
    9:47
    And so, I'm gonna talk about the epidemiology,
    9:49
    how common it is, how it can be diagnosed,
    9:52
    and, in '94, when "DSM IV" came out,
    9:56
    the name was changed from "multiple personality disorder,"
    9:59
    MPD,
    10:00
    to "dissociative identity disorder," DID,
    10:03
    but it's the same basic thing.
    10:06
    So multiple personality and dissociative identity disorder
    10:08
    are the same thing.
    10:11
    So jumping into some slides here,
    10:13
    I'm gonna show you some data now
    10:15
    and a little bit of the science of how all this works.
    10:19
    If I can.
    10:23
    Mmm.
    10:25
    Oh, okay, this one.
    10:28
    Okay.
    10:29
    So first of all, it's always good to define terms.
    10:32
    So if you read the general psychology literature,
    10:35
    psychiatry literature,
    10:37
    you'll quickly find that there's people out there
    10:39
    who don't believe in all this stuff.
    10:41
    Psychologists, psychiatrists.
    10:42
    And one of the things they say
    10:43
    is that dissociation's an extremely vague thing,
    10:46
    nobody knows what it is, nobody can define it,
    10:48
    nobody can measure it.
    10:50
    Well, that's true in their minds.
    10:52
    But not in my mind.
    10:53
    It's actually very clearly defined.
    10:56
    But the confusing point is that there's actually
    10:58
    four different meanings of the word "dissociation"
    11:01
    that are used in the literature,
    11:02
    and people aren't always clear which meaning they're using,
    11:06
    and people who are reading
    11:07
    aren't always clear which meaning they're intending,
    11:09
    so there is confusion.
    11:12
    But it can be sorted out quite easily.
    11:14
    So dissociation-- meaning number one
    11:17
    is it's a general systems meaning
    11:19
    of the word "dissociation."
    11:21
    General systems theory is just a theory
    11:23
    of how systems in the universe operate, in general.
    11:26
    Could be a solar system, could be a cell,
    11:29
    could be an atom, could be an organization.
    11:32
    So it's how systems operate.
    11:35
    And in the general systems meaning,
    11:37
    "dissociation" is the opposite of "association."
    11:41
    So if two things are associated,
    11:42
    they're connected, they're interacting,
    11:44
    they've got something to do with each other.
    11:46
    If they're dissociated, they're disconnected,
    11:49
    not interacting, out of relation, split apart.
    11:53
    So dissociation basically means the same
    11:55
    as "disconnected."
    11:58
    And I'll come back to all these meanings
    11:59
    as we go through it.
    12:01
    Second meaning is it's a technical term
    12:03
    in cognitive psychology.
    12:05
    So this is guys who do experiments with rats and mice
    12:08
    and all kinds of different animals.
    12:10
    And there's thousands and thousands of papers
    12:12
    published in psychology about all kinds
    12:14
    of learning experiments and so on.
    12:16
    So a typical experiment is, if you're looking at memory,
    12:20
    there's conscious memory, unconscious memory...
    12:23
    which is declarative memory, or procedural memory...
    12:28
    or explicit memory, implicit memory.
    12:31
    They all kind of mean conscious, unconscious.
    12:33
    And so, there's a famous guy who had brain damage,
    12:37
    who...
    12:39
    if you met him 50 times in the last month,
    12:43
    every single time, he has no idea
    12:45
    that he's met you before, it's a brand new thing,
    12:48
    because he can't record any memories and store them.
    12:51
    They just disappear automatically
    12:53
    because of the damage to his brain.
    12:55
    And this guy's very well-studied and so on.
    12:57
    And so, there's a whole bunch of different tasks
    13:00
    that he was run through, and lo and behold,
    13:03
    the more he did a task--
    13:05
    like there's a task where there's three pegs like this,
    13:08
    and you stack blocks on them, and you have to re-stack them
    13:11
    in a certain pattern,
    13:12
    and like anything in life, the more you do it,
    13:14
    the better you get at it.
    13:17
    Well, his performance improved with practice
    13:19
    at the same rate as normal college students,
    13:22
    although he had no memory whatsoever
    13:24
    of ever being exposed to the task.
    13:27
    Which shows that his-- part of his memory's intact
    13:30
    and learning and recording,
    13:31
    he just has no conscious record of it,
    13:34
    which is part of piles of evidence
    13:36
    that procedural memory, declarative memory
    13:39
    are separate systems.
    13:40
    You can knock one out, and the other
    13:42
    can still be operating.
    13:44
    And then, in human experiments,
    13:48
    there's basically-- you take all these college students
    13:54
    who are guinea pigs who get course credit
    13:56
    and the professors crank out lots of papers,
    13:58
    so it's good for everybody.
    14:00
    And you run them through all these different tasks.
    14:02
    Well, one task is you memorize a list of word pairs,
    14:07
    which are homophonic word pairs,
    14:10
    meaning they sound the same, like R-E-E-D and R-E-A-D,
    14:16
    but they have different meanings.
    14:18
    So you have maybe 30 of these pairs of words,
    14:21
    and you memorize them, and then a week later,
    14:24
    you're asked to write down as many of them
    14:25
    as you can remember.
    14:27
    So pretty good chunk of people
    14:28
    are not going to remember reed/read, consciously--
    14:31
    they don't write it down.
    14:33
    So it's gone from their memory.
    14:35
    And then, what you do is you give them a cue.
    14:38
    So with spontaneous recall, the information isn't there.
    14:42
    You give them a cue.
    14:43
    "What's the name of a tall tubular plant
    14:48
    "that grows in marshes?"
    14:50
    And they're supposed to write down the answer.
    14:52
    So the first group, like you guys on this side--
    14:55
    your word list included reed/read.
    14:59
    Your word list did not.
    15:02
    So you guys, when you're asked that question,
    15:05
    you misspell R-E-E-D as R-E-A-D
    15:09
    much more frequently than you guys,
    15:11
    who are never exposed to reed/read.
    15:14
    Because the word read-- R-E-A-D--
    15:17
    is grumbling around in your brain somewhere.
    15:19
    You can't consciously access it,
    15:21
    you don't remember it was on the list,
    15:23
    but it's affecting your output,
    15:26
    your conscious verbal or written output,
    15:29
    showing that you can have information in your brain
    15:31
    that you can't access consciously,
    15:33
    but it's affecting your behavior.
    15:36
    And there's zillions of experiments like this.
    15:39
    So this means that the memory is dissociated.
    15:43
    It's not in conscious memory.
    15:46
    So the conscious-- I can remember my name
    15:48
    and my address and my parents, etcetera--
    15:51
    that system, the information isn't there,
    15:53
    it's dissociated and held in the other system.
    15:56
    So that's a technical meaning of dissociation,
    15:59
    and that kind of dissociation is experimentally proven
    16:02
    over and over and over and over.
    16:03
    It's a very rigorously proven thing.
    16:05
    That's just how the mind operates.
    16:09
    Which is just common human experience.
    16:12
    So there's all this controversy
    16:14
    about whether this kind of dissociation
    16:16
    and this kind of amnesia actually occurs...
    16:19
    but if you think about it for a second,
    16:21
    this is the way your mind operates all day every day.
    16:25
    "So, what was that movie, okay?
    16:27
    "Oh, yeah, yeah-- but what was the actor's name?
    16:30
    "Well, yeah, he was in that other movie with Kevin Bacon,
    16:32
    "and Kevin Bacon knew this guy
    16:33
    "who knew that guy-- oh yeah, that's his name."
    16:36
    So we're constantly doing these little...
    16:40
    various mind tricks with ourselves,
    16:43
    or we're just repeating the recall effort,
    16:45
    and then the information's there.
    16:47
    It wasn't there, and now it is there.
    16:50
    So it's just an everyday universal human experience,
    16:53
    that information can be in your brain,
    16:55
    you can't find it, but with some sort of procedure or effort,
    16:59
    it pops back.
    17:00
    And there's lots of evidence showing that hypnosis
    17:03
    and other research,
    17:06
    that the memory that you can't access initially,
    17:09
    and then it gets cued and you do remember it,
    17:12
    has the same rate of memory error
    17:14
    as just memory-- regular memory
    17:16
    you've remembered all along.
    17:18
    So it's not more accurate, it's not less accurate.
    17:21
    Then, there's a phenomenological meaning
    17:23
    of dissociation.
    17:24
    So when I went to medical school,
    17:26
    I was taught if you use a bunch of big words,
    17:28
    you sound really smart.
    17:29
    So phenomenological meaning.
    17:32
    That just means the symptoms that people report
    17:36
    that are in all these different questionnaires
    17:38
    and symptom measures that we'll get into in a bit.
    17:40
    So that's the actual symptoms that people experience
    17:43
    are dissociative symptoms.
    17:45
    Then, there's anxiety symptoms, there's depression symptoms,
    17:47
    etcetera.
    17:50
    There's nothing mysterious about it,
    17:51
    it's just symptoms that people report
    17:52
    that kind of cluster into this group,
    17:55
    just like depression symptoms cluster into a group.
    17:58
    And then, there's a postulated intrapsychic
    18:00
    defense mechanism.
    18:02
    So this is a theory about a dissociative defense mechanism
    18:06
    that's operating in your brain.
    18:09
    So the funny thing is that this meaning of dissociation--
    18:15
    some sort of theory about what's going on in your brain,
    18:17
    how your defense mechanisms work,
    18:20
    is actually only one possible cause
    18:23
    of the phenomenological symptom form of dissociation.
    18:28
    So there may or may not be this defense mechanism
    18:30
    called "dissociation"... but it's only one
    18:34
    of many possible causes of the phenomenon
    18:36
    of dissociation.
    18:38
    You can see where we can get really confused really fast.
    18:40
    One person's talking about this defense mechanism,
    18:43
    another person's talking about a symptom.
    18:47
    But if you sort these meanings out
    18:48
    and you keep them clear, here they are.
    18:52
    There's also a lot of confusion about
    18:53
    the difference between repression and dissociation
    18:56
    that I'll come back to in the third segment.
    18:59
    And "repression" being a Freudian term.
    19:02
    And the best way to, uh, explain that
    19:05
    is a guy named Hilgard who created something
    19:09
    called "Neodissociation Theory."
    19:11
    He talks about horizontal splitting
    19:13
    and vertical splitting.
    19:14
    So this is just a diagram for the difference
    19:17
    between repression and dissociation.
    19:19
    Because people talk about repressed memories.
    19:22
    It's sort of the same but not really the same
    19:24
    as dissociative amnesia.
    19:27
    So if there's a horizontal barrier in your mind,
    19:32
    the theory of repression, as stated by Freud,
    19:35
    is you have information in your conscious mind, your ego,
    19:39
    and it's upsetting, you have conflict about it,
    19:42
    you don't like it, so you push it down
    19:44
    into your unconscious mind, or your id.
    19:47
    And there's a horizontal barrier.
    19:49
    Your conscious mind's up here,
    19:50
    your unconscious mind's down there.
    19:53
    And when stuff is pushed into the unconscious mind,
    19:57
    then it gets all involved with dreams and fantasy
    20:00
    and unconscious mental processes
    20:02
    and get it all elaborated and distorted,
    20:04
    and things can happen to that memory
    20:07
    that don't happen if the information's
    20:08
    just stored in your conscious mind.
    20:12
    And there's actually two subtypes of repression.
    20:16
    One subtype of repression is called "repression proper,"
    20:21
    where it's in your conscious mind,
    20:22
    like something traumatic or conflictual happens...
    20:25
    you can't deal with it and you push it down.
    20:29
    Primal repression is nothing to do
    20:31
    with experience or memory--
    20:33
    that's where you have some impulse
    20:35
    coming from your unconscious mind or your id,
    20:38
    and it's trying to come up into your conscious mind--
    20:42
    say, some sexual impulse--
    20:43
    your conscious mind is all hung up about it
    20:45
    and uneasy about it so it just keeps it squashed down.
    20:50
    It never actually makes it up into consciousness.
    20:53
    So there's these two subtypes of repression.
    20:55
    That's Freudian Repression Theory.
    20:59
    Dissociation is different-- it's vertical splitting.
    21:03
    In dissociation, nothing is pushed down
    21:06
    into the unconscious, into this mysterious place
    21:09
    that you can never exactly pinpoint or find.
    21:13
    It's in a different compartment of the conscious mind.
    21:17
    So the barrier, the split, is this way.
    21:19
    There's conscious mind here, which doesn't remember,
    21:23
    and conscious mind there that does remember.
    21:25
    So it's kind of a different model and different theory.
    21:28
    A lot of people who don't believe in dissociation,
    21:31
    who attack dissociation,
    21:33
    and say you can't have repressed memories
    21:35
    of massive trauma-- it's not possible,
    21:36
    the mind doesn't work that way,
    21:38
    also say that the dissociative disorders
    21:41
    are based on all this bogus Freudian theory
    21:43
    about repression.
    21:46
    Which is just a scholarly error.
    21:49
    Dissociation theory is a completely different thing
    21:51
    from repression theory.
    21:53
    It's a different set of mechanisms,
    21:55
    even at the theory level.
    21:58
    And in early Freud, like his studies on hysteria
    22:01
    published in-- just before the end of the 19th century,
    22:05
    he, with his co-author Breuer, describes classical, classical
    22:09
    multiple personality kind of cases.
    22:11
    Whole series of women, tons of childhood sexual trauma,
    22:15
    they come into therapy 30 years later,
    22:17
    they've got all kinds of different symptoms,
    22:19
    including amnesia
    22:20
    and sometimes full or partial multiple personality.
    22:24
    And when he was writing like that,
    22:27
    he assumed that the memories were real and accurate
    22:30
    and the incest really did happen.
    22:33
    So when repression theory--
    22:36
    when early Freudian theory applies,
    22:39
    then it's really more dissociation he's describing,
    22:43
    and the assumption is the incest really happened,
    22:46
    the memories are accurate.
    22:48
    Not perfectly accurate, but basically accurate.
    22:51
    Then, in 1897-- so that's called the "seduction theory"--
    22:55
    they were seduced by adult pedophiles,
    22:59
    and that's why they've got all these symptoms
    23:00
    20 or 30 years later-- that's seduction theory.
    23:03
    In 1897, he repudiated the seduction theory.
    23:08
    He decided that the memories were false.
    23:11
    In order to explain to himself
    23:13
    why the memories are false, he developed repression theory.
    23:18
    So repression theory is all based on the idea
    23:20
    that these are false memories.
    23:23
    Not maybe 100.0%, but substantially, mostly.
    23:28
    So the people who attack the dissociative disorders
    23:30
    make a couple of conceptual errors.
    23:33
    They say that dissociation and repression are the same thing,
    23:36
    which is not true.
    23:37
    And then, they say that these are false memories,
    23:41
    because the therapists are basing their therapy
    23:45
    on repression theory, which is completely bogus,
    23:47
    and that's why they're cooking up all these false memories.
    23:51
    Which is completely wrong and backwards.
    23:53
    If you follow repression theory as stated by Freud,
    23:56
    you assume the memories are false.
    23:59
    You don't believe them.
    24:01
    So the people who don't believe in dissociative disorders
    24:03
    are accusing the therapists of believing false memories
    24:05
    because they're making their therapy
    24:09
    based on repression theory.
    24:10
    It's all just a big huge mix-up.
    24:14
    So this is what goes on in my field.
    24:18
    So now, we're gonna talk about the phenomenological
    24:21
    meaning of dissociation, and symptoms.
    24:24
    So there's the-- so I'm gonna guess this is the pointer.
    24:29
    There we are.
    24:31
    So there's the dissociative disorders interview schedule
    24:33
    that I developed, that's a structured interview--
    24:35
    a bunch of standardized questions.
    24:37
    And you'll see the dissociative experiences scale,
    24:40
    which is a 28-item measure you fill out yourself,
    24:43
    you score it, and the total score
    24:45
    can go from zero to 100.
    24:48
    And then, there's the SCID-D,
    24:50
    which is another structured interview
    24:52
    for dissociative disorders
    24:53
    developed by a woman named Marlene Steinberg.
    24:56
    So in this project, in general adult psychiatric patients
    25:01
    in a hospital in Dallas, we excluded anybody
    25:04
    who already had a dissociative diagnosis,
    25:06
    which is only like one or two people.
    25:08
    So these are all people who don't think
    25:11
    they have a dissociative disorder,
    25:13
    never been treated for a dissociative disorder,
    25:15
    never been told they have a dissociative disorder.
    25:22
    And what we do is we give them
    25:24
    the dissociative experiences scale,
    25:26
    and an interviewer gives them the one structured interview.
    25:30
    And then, a second interviewer who doesn't know the results
    25:34
    of the dissociative experiences scale, or the DDIS,
    25:37
    interviews them with the second structured interview.
    25:40
    And then, we look at, "Well, what's the agreement rate here?"
    25:44
    So this is just general adult psychiatric inpatients.
    25:48
    And lo and behold, in basically a one-hour research interview,
    25:52
    or even 45 minutes,
    25:56
    according to the one structured interview, 40%,
    25:59
    according to the SCID-D, 44%,
    26:03
    and then, the third arm of the study was...
    26:06
    after all these people had done two structured interviews,
    26:10
    I was randomly assigned 52 people
    26:13
    by the research assistant,
    26:15
    who are a combination of people who are negative
    26:17
    for a dissociative disorder
    26:18
    and positive for a dissociative disorder,
    26:20
    and I had to decide how many had dissociative disorders,
    26:23
    and I actually was the most conservative.
    26:27
    But if we look at DID...
    26:32
    it's not a rare thing.
    26:33
    So there's about-- there's 10 to 12 studies now
    26:37
    in eight or nine different countries
    26:40
    more or less set up like this.
    26:41
    You get general adult inpatients,
    26:44
    exclude anybody who has a dissociative diagnosis,
    26:46
    give them the dissociative experiences scale,
    26:49
    one or other of these structured interviews,
    26:51
    sometimes a clinical interview,
    26:53
    and the overall average of all these studies is 4.4%
    26:58
    of general adult inpatients in psychiatric hospitals
    27:02
    have previously undiagnosed DID--
    27:04
    dissociative identity disorder.
    27:07
    They don't think they have it, they don't claim they have it,
    27:09
    they've never been told they have it,
    27:10
    they've never had treatment for it,
    27:12
    and it can be detected
    27:14
    in a fairly simple research interview.
    27:17
    So that's kind of the epidemiology of it.
    27:21
    And then, in the mental health field,
    27:25
    there's a thing called "inter-rater reliability."
    27:28
    So it's-- if two psychiatrists, or 100 psychiatrists,
    27:33
    absolutely cannot agree who's depressed and who isn't,
    27:36
    like it's game over, right?
    27:38
    Doesn't matter what treatment you believe in
    27:40
    or what genetic research you wanna do.
    27:43
    If you can't degree who is and who is not depressed,
    27:45
    it's just chaos.
    27:48
    So the statistic for the rate of agreement
    27:50
    is called "Cohen's kappa."
    27:53
    Which varies from plus 1 to minus 1.
    27:56
    So if Cohen's kappa is 1.0,
    27:59
    then two different raters agree 100% of the time
    28:02
    who's depressed, who is not.
    28:04
    If it's minus 1, they disagree 100% of the time.
    28:09
    So it's perfect agreement, perfect disagreement.
    28:11
    And then, random is right in the middle at zero.
    28:14
    So here's the Cohen's kappas for DID.
    28:18
    If we compare one structured interview to the other,
    28:22
    my structured interview to the clinician,
    28:24
    for some reason this number's a little low,
    28:27
    using the dissociation scale,
    28:28
    and there's a sort of sub-scale within it that you can analyze.
    28:32
    So these are kappas ranging from 0.71 to 0.81.
    28:38
    In the "DSM V" field trials--
    28:41
    so "DSM V" came out in 2013--
    28:43
    in the "DSM V" field trials, which is a lot of money spent,
    28:48
    we're getting a large number of people
    28:49
    to interview lots and lots and lots of patients,
    28:54
    and they look at the Cohen's kappa
    28:55
    for the different diagnoses,
    28:58
    Cohen's kappa for depression was 0.28.
    29:01
    Cohen's kappa for schizophrenia was 0.40.
    29:05
    So psychiatrists are really lousy
    29:08
    at deciding and agreeing on who is clinically depressed
    29:11
    and who isn't,
    29:12
    and the top of the scale in the DSM field trials
    29:14
    was actually PTSD, which was in the--
    29:17
    I forget the exact number, it was around 0.72.
    29:21
    So DID and PTSD actually have higher Cohen's kappas
    29:26
    than most...
    29:29
    of the major, well-known, regularly talked about
    29:31
    psychiatric diagnoses.
    29:33
    So that's good to know.
    29:38
    And in my structured interview,
    29:39
    there's all these different sub-sections.
    29:42
    So...
    29:44
    there's psychosomatic symptoms, Schneiderian psychotic symptoms,
    29:48
    secondary features of DID,
    29:50
    which is dissociative borderline personality disorder,
    29:53
    ESP paranormal experiences,
    29:55
    and then total score.
    29:58
    So, like on this scale, there's 16 items here.
    30:02
    There's 11 here.
    30:03
    There's 33 here.
    30:05
    There's nine here.
    30:07
    So all I did was just take the average score here
    30:10
    and divide it by 9, multiply it by 100.
    30:13
    Take this one, divide by 16, multiply by 100.
    30:16
    So I converted them all to scales that go from 0 to 100.
    30:20
    And then, I put them on this graph.
    30:22
    And what we have here is DID.
    30:25
    I don't know if we can-- oh, here we are.
    30:27
    So this is DID.
    30:29
    This is dissociative disorder not otherwise specified,
    30:33
    which is basically partial DID.
    30:36
    And this is schizophrenia, and then we have...
    30:40
    psychiatric adolescence, chemical dependency,
    30:43
    GI clinic-- gastrointestinal clinic-- population,
    30:46
    and the general population.
    30:48
    So...
    30:50
    I'll come back-- I'm gonna talk about this thing here.
    30:56
    If I can get the pointer to show up.
    30:58
    Well, I'm gonna talk about this
    31:02
    in the next section.
    31:04
    Why do people with DID have more psychotic symptoms,
    31:09
    more symptoms of schizophrenia,
    31:10
    than people with schizophrenia?
    31:12
    But leaving that aside, clearly, this structured interview,
    31:16
    this kind of walking through all these symptoms,
    31:19
    clearly differentiates people with DID
    31:23
    from almost DID, and then from other groups.
    31:27
    Which is part of showing the validity
    31:29
    and the reliability of any disorder.
    31:30
    You wanna be able to do that.
    31:35
    Okay, so one of the conundrums is...
    31:37
    what's the relationship between dissociative identity disorder
    31:41
    and borderline personality disorder?
    31:43
    There's all kinds of controversy about it,
    31:44
    all kind of attitudes, all kinds of academic fighting.
    31:49
    Basically, the academic world is a bunch of--
    31:52
    it's like the Bloods and the Crips, basically.
    31:54
    It's gang warfare at the intellectual level.
    31:57
    So there's guys stabbing each other in the back,
    31:59
    attacking each other, discrediting each other,
    32:02
    blocking promotions, intriguing.
    32:08
    Except, again, not here at GRCC, right?
    32:13
    So BPD and DID-- borderline personality disorder--
    32:17
    are really embroiled in a lot of controversy.
    32:20
    And one of the skeptical things is, "Oh, those people with DID--
    32:22
    "they're just a bunch of borderlines."
    32:26
    Well, so I did some research comparing
    32:29
    a large sample of people with DID
    32:30
    to a large sample of people with BPD,
    32:34
    and what do we find?
    32:37
    "Comorbidity" means all the other mental health problems
    32:40
    that go along with your main problem,
    32:43
    and what gets to be the main problem's
    32:44
    kind of arbitrary.
    32:46
    So comorbidity's basically a whole mess of depression,
    32:49
    anxiety, substance abuse, all kinds of different things.
    32:52
    And lo and behold, the comorbidity profile
    32:54
    of these two things are pretty similar.
    32:58
    Basically everybody with DID and BPD,
    33:01
    if you're in a psychiatric hospital,
    33:03
    either is or has been depressed,
    33:05
    has some kind of mood disorder.
    33:08
    Lots of anxiety, lots of panic, lots of PTSD.
    33:13
    So it's very similar, but the DID people
    33:15
    are just a little bit more.
    33:17
    That's the general pattern.
    33:23
    In terms of their dissociative disorders,
    33:25
    well, amazingly, 100% of the people with DID have DID
    33:30
    on the structured interview. (audience chuckling)
    33:31
    But that's good to know that the structured interview
    33:33
    is picking all these people up, not missing them.
    33:37
    So the interesting thing, though,
    33:38
    is the people with BPD, 11% also have DID.
    33:45
    So the borderline personality disorder people
    33:50
    have said in "DSM IV" and "DSM V,"
    33:54
    that dissociative symptoms in BPD are kind of minor.
    33:58
    But actually, in fact, they're complex, chronic, and major.
    34:02
    And there's lots of 'em.
    34:06
    Lots of eating disorders.
    34:07
    A little bit more in the DID group.
    34:10
    And this is what we see clinically all the time.
    34:12
    When you're treating DID, you're always treating
    34:14
    a whole bunch of other stuff at the same time.
    34:18
    And then, in terms of the personality disorders,
    34:20
    again, astoundingly, 100% of the borderlines
    34:22
    are borderline.
    34:23
    But so are over half of the people with DID.
    34:26
    And they have lots of these other personality disorders as well.
    34:30
    So personality disorders are very overlapping things.
    34:33
    They're not clear, simple, discrete categories.
    34:37
    And if you have borderline personality disorder,
    34:40
    you're likely to meet criteria
    34:41
    for two or three others, at least.
    34:44
    But, yet again, the patterns, they're very similar,
    34:48
    but overall, the DID people tend to be more.
    34:51
    So they're more similar than they are different.
    34:56
    Well, I wasn't satisfied with that,
    34:57
    so I did another study.
    35:00
    With inpatients again, and now we've--
    35:03
    using the structured interview, we've divided them
    35:05
    into people who have both DID and BPD,
    35:08
    only DID, only BPD,
    35:11
    and neither.
    35:12
    And the data-- like if I decided I was gonna fake
    35:15
    some data so it would look good,
    35:18
    I'd just make it look like this.
    35:20
    It doesn't get any better.
    35:21
    It's perfect-- it fits with exactly what I predicted.
    35:26
    Which the people who have both are the most severe.
    35:30
    The people who have neither are the least severe.
    35:32
    And these two groups are in between.
    35:35
    So there's a total trauma score,
    35:39
    and then duration of sexual abuse in years,
    35:41
    number of different abusers, number of types of sexual abuse,
    35:44
    duration of physical abuse in years,
    35:46
    number of physical abusers.
    35:48
    It just goes down, down--
    35:50
    I mean, it's not perfect, it bumps up and down a little bit.
    35:52
    But basically, it's just a line like this.
    35:56
    So when you have both, you're worse off
    35:57
    than if you have only one of those two diagnoses,
    36:00
    and if you have either one, you're worse off
    36:03
    than somebody who has neither.
    36:08
    In terms of different diagnoses... same thing.
    36:12
    You're more depressed, you're more substance abuse,
    36:15
    more psychosomatic symptoms, more amnesia,
    36:18
    fugue-- that's another dissociative diagnosis--
    36:20
    depersonalization dissociative disorder,
    36:23
    now, though I specified.
    36:24
    So not surprisingly, these guys have the most,
    36:27
    these guys have not so much,
    36:29
    and these guys are in between.
    36:32
    But the people with just DID--
    36:34
    this is supposed to be under here--
    36:36
    have more dissociation than the people who have just BPD,
    36:41
    which makes sense, which fits, which is logical.
    36:45
    So basically, the message here is--
    36:47
    we've got lots of research on this.
    36:48
    We're not just walking around with opinions.
    36:51
    And then, uh...
    36:54
    all these different symptoms clusters
    36:55
    that were on that graph--
    36:58
    so the people with DID have the most,
    37:00
    these guys are intermediate, these guys are the least.
    37:04
    And all these different symptoms clusters
    37:06
    are serious mental health trouble.
    37:11
    Okay, well, that's sort of interesting.
    37:13
    So we actually have a whole body of literature showing--
    37:17
    using the same rules that you use for depression,
    37:20
    dissociation, psychosis, substance abuse, anxiety,
    37:25
    so same rules, same sort of methodology,
    37:29
    we've shown that our diagnoses perform as well,
    37:32
    are as reliable, are as valid, hang together as well,
    37:35
    as any other set of diagnoses.
    37:38
    Which is cool, but who cares?
    37:41
    Because the only thing that really counts is treatment.
    37:44
    So I'm gonna show you a couple of treatment outcome studies
    37:47
    now, where we give a bunch of questionnaires
    37:49
    on admission to the program--
    37:50
    this is in Dallas.
    37:53
    Then, we repeat the questionnaires at discharge.
    37:55
    And then, one study at three months,
    37:57
    another study, that's just an analysis now,
    37:59
    at up to 10 months, another study two years.
    38:04
    So what happens when all these dissociative people
    38:06
    come into the hospital and we treat them?
    38:10
    This is a typical sample, so most-- it's 90% women,
    38:15
    average age is usually in the 30s.
    38:17
    You can't be an adolescent in our program.
    38:19
    The federal government won't let adolescents
    38:21
    be mixed in with adults.
    38:23
    Average length of stay,
    38:25
    which is a combination of inpatient
    38:27
    and stepping down to the day program--
    38:29
    average length of stay in the program overall is 18 days.
    38:33
    What happens to their symptoms?
    38:36
    Well, before I tell you that.
    38:37
    So they have lots and lots of sexual abuse.
    38:44
    Lots of depression, lots of borderline personality disorder,
    38:47
    lots of psychosomatic symptoms,
    38:49
    half are DID, half have substance abuse problems.
    38:52
    Very typical of our population.
    38:55
    So it's a typical sample.
    38:58
    And lo and behold, in this 18 days,
    39:01
    the Beck depression inventory's the most used
    39:03
    depression inventory.
    39:05
    Drops by close to 50%.
    39:07
    The "how suicidal they are" drops to close to 50%.
    39:10
    How hopeless they are, pushing 50%.
    39:13
    And the dissociation score doesn't significantly change.
    39:16
    So this is the targets that we address
    39:19
    in the inpatient setting.
    39:21
    "You're here basically because you're suicidal."
    39:23
    It's more or less a suicide program.
    39:27
    We could call it all kinds of things.
    39:29
    The best name would actually be
    39:30
    the "Dealing with Your Feelings" program,
    39:33
    but that doesn't quite have the marketing ring to it.
    39:37
    And I don't think the manage care companies
    39:38
    would be thrilled by that name.
    39:41
    But the depression, the hopelessness, and the suicide--
    39:43
    those are the targets of the treatment.
    39:46
    And that's a very nice drop in scores,
    39:49
    and the dissociation takes much longer to treat.
    39:52
    So we take the dissociation into account,
    39:56
    and we work with it, but we're not really targeting it--
    39:58
    that's not our main treatment target.
    40:03
    Uh, another study.
    40:05
    Same concept.
    40:06
    50 people this time, admission and discharge.
    40:09
    The SCL-90 is a whole hodgepodge of different symptoms,
    40:12
    all across the board.
    40:14
    The Beck score goes down, suicide, hopelessness.
    40:17
    Dissociation doesn't change.
    40:19
    So we got several replications of this.
    40:24
    And, um, what you see--
    40:27
    this is just a list of the references here,
    40:29
    which, if any of you want copies of the slides,
    40:31
    you can provide, right? >> Say that again?
    40:33
    >> You can provide these slides to anybody who wants them?
    40:35
    >> I could, if that's all right with you.
    40:36
    >> Yeah, yeah, absolutely. >> I'll post them on--
    40:39
    >> They're only 50 bucks a set, so it's a pretty good deal.
    40:41
    (audience laughing)
    40:42
    So this is just showing that, you know, I've published
    40:45
    a bunch of outcome studies.
    40:49
    And what happens at three months
    40:52
    is it's not that-- okay, it's nice to be in the hospital,
    40:55
    we give you some TLC, you improve,
    40:57
    and then, two weeks later,
    40:58
    you're right back to where you were.
    41:00
    Those gains are sustained at three months,
    41:03
    10 months, two years, and, in fact,
    41:07
    the symptom levels keep going down, down, down.
    41:11
    So here's a study I did, published in the '90s,
    41:16
    where we interviewed a bunch of people
    41:17
    in the program in '93.
    41:19
    They're there for a few weeks.
    41:21
    Then, we re-interview them two years later in '95.
    41:24
    And here, we're asking about, this point in time,
    41:26
    going back for a year.
    41:28
    Here, we're asking two years later
    41:30
    going back for a year.
    41:32
    Using standardized diagnostic interviews here.
    41:34
    And the number of active diagnoses--
    41:39
    depression, substance abuse, eating disorders,
    41:41
    schizophrenia, etcetera, DID--
    41:45
    is dropped by 50%,
    41:46
    and the number of personality disorders
    41:48
    active in the preceding year has dropped by 50%.
    41:51
    And all these people meet criteria
    41:53
    for borderline personality disorder.
    41:56
    But they're a sub-group.
    41:59
    Everybody in this study met criteria
    42:01
    for multiple personality disorder.
    42:03
    I just pulled out the 25 who met criteria
    42:06
    for borderline, as well.
    42:09
    And what we have is really nice treatment outcome,
    42:11
    two years later.
    42:12
    Their psychosomatic symptoms are dropping,
    42:14
    their psychotic symptoms, dissociative symptoms,
    42:17
    their borderline has dropped by a third, basically.
    42:21
    Paranormal experiences, which we can talk about more
    42:23
    if anybody's interested.
    42:25
    How suicidal they are, how many suicide attempts.
    42:32
    Their dissociation score now, in two years,
    42:34
    has dropped substantially.
    42:36
    Their depression score--
    42:38
    and this is just another depression measure.
    42:40
    So lots of different kinds of problems
    42:42
    dropping down substantially.
    42:45
    And this is an interesting thing,
    42:47
    in terms of their abuse histories.
    42:49
    So there's-- the people who hate dissociative disorders
    42:52
    and think they're all bogus are always accusing us
    42:56
    of cooking up all these false memories out of nowhere.
    42:59
    So this is the duration of physical abuse in years--
    43:02
    child physical abuse, up to age 18.
    43:06
    Number of perpetrators, duration of sexual abuse in years,
    43:09
    number of perpetrators,
    43:10
    and number of types of sexual abuse.
    43:12
    So that's a whole list of different sexual things
    43:14
    one person can do to a kid.
    43:17
    And lo and behold, when we asked them
    43:19
    exactly the same questions two years later,
    43:22
    there's no statistically significant increase.
    43:25
    There's a little bit of an increase
    43:26
    in a couple of 'em, not really here,
    43:28
    not really here, not really there.
    43:31
    So two years later, after more of this "false memory therapy,"
    43:36
    they're not reporting more trauma memories
    43:37
    than two years previously.
    43:39
    Which is pretty good evidence that we're not just
    43:42
    pulling fake memories out of nowhere.
    43:48
    So that's...
    43:51
    the first talk.
    43:55
    Thank goodness for water.
    43:58
    And so, the summary point here is--
    44:01
    and so, this whole thing could be extended
    44:03
    to a half day.
    44:05
    And I could go into so much detail
    44:06
    you'd all probably be suicidal yourselves.
    44:09
    (scattered chuckling)
    44:10
    But basically, the point is,
    44:12
    there's a whole bunch of research,
    44:14
    it's a substantial body of literature,
    44:15
    it's replicated in many different countries.
    44:18
    There's good psychometrics to it, so...
    44:22
    there's all these different statistics that are used
    44:23
    to see how solid and strong a measure is.
    44:25
    We've used all of those.
    44:27
    One of the studies I did was actually a series of six
    44:30
    or seven papers--
    44:32
    one's called "Trauma and Dissociation in China,"
    44:35
    in the "American Journal of Psychiatry,"
    44:37
    which was the official journal
    44:39
    of the American Psychiatric Association.
    44:41
    So I worked with people in Shanghai,
    44:43
    at Shanghai Mental Health Center.
    44:45
    Basically, I talked to them and they did all the work.
    44:50
    And so, multiple personality is never diagnosed,
    44:53
    it's not in their diagnostic manual,
    44:55
    it's not taught, it's not in their popular culture,
    44:58
    it's not in movies or on TV or...
    45:01
    they don't have soap operas with people
    45:02
    with multiple personality.
    45:04
    And it was quite readily detected
    45:08
    in our research protocol.
    45:09
    And that's important, because that's a culture
    45:12
    where the multiple personality can't be explained
    45:14
    by contamination, or "I picked it up from the radio,"
    45:17
    or "I picked it up from TV,"
    45:18
    or "I picked it up from my therapist."
    45:21
    So just a lot of research,
    45:23
    and the quantity of research is smaller
    45:27
    than for depression or schizophrenia,
    45:29
    but the quality is about equal.
    45:32
    I rest my case.
    45:33
    Here is the stereotype that dominates the field--
    45:37
    "Schizophrenia is a biological brain disease.
    45:40
    "It's genetic."
    45:42
    Of course, the environment can sort of color the symptoms
    45:44
    a little bit, so if you have schizophrenia
    45:47
    and you're somewhere in the jungles of New Guinea,
    45:50
    you're not gonna think that the CIA or the FBI are after you,
    45:52
    because you've never heard of them.
    45:55
    But the basic form of the disease,
    45:56
    how common it is, it's a universal genetic brain disease.
    46:02
    Hear that from the American Psychiatric Association,
    46:05
    National Alliance for the Mentally Ill.
    46:08
    If you just search schizophrenia on the web,
    46:10
    you'll get told over and over and over
    46:12
    it's a genetic brain disease.
    46:16
    Not all the time, but a fair bit of the time,
    46:19
    they'll explain-- (clearing throat) excuse me--
    46:21
    that schizophrenia is not split personality.
    46:25
    Not multiple personality.
    46:26
    There's people out there who are confused.
    46:29
    And they think that schizophrenia
    46:31
    and split personality are the same thing.
    46:32
    But we professionals who are physicians,
    46:35
    who treat biological brain diseases,
    46:37
    know that that's not the case.
    46:39
    It's very clear.
    46:40
    It's a totally separate category.
    46:42
    And it's kind of this fluffy, neurotic light thing
    46:45
    that's highly suspicious, maybe not even genuine at all.
    46:49
    Schizophrenia... it's just like cancer.
    46:52
    And schizophrenia is not caused by bad parenting.
    46:58
    Just like arthritis or cancer are not caused
    47:01
    by bad parenting.
    47:04
    And dissociative identity disorder
    47:06
    is a reaction to the environment.
    47:09
    So everybody's agreed on this.
    47:11
    People who don't believe in it
    47:13
    think it's a reaction to bad therapy.
    47:16
    People who do believe in it
    47:17
    think it's a reaction to childhood trauma.
    47:19
    But everybody's agreed--
    47:20
    it's not an internal biological disease
    47:23
    that you're genetically born with.
    47:25
    It's a reaction to the environment.
    47:27
    And you don't treat it with medication.
    47:31
    Although people with DID are frequently on medication
    47:32
    because they're also depressed and also anxious and so on.
    47:37
    But the DID, the dissociation itself--
    47:39
    there's no medication for that.
    47:41
    And everybody's agreed on that point.
    47:44
    So you treat it with an environmental intervention,
    47:47
    not with medication.
    47:49
    And if you believe in it, you treat it with psychotherapy.
    47:51
    If you don't believe in it, you treat it with "benign neglect,"
    47:55
    which, if you don't feed into it,
    47:57
    you don't reinforce it, you don't talk about it,
    47:58
    it just kind of fizzles out.
    48:01
    And this you get stated in professional journals
    48:05
    and books and so on.
    48:08
    So totally separate compartments.
    48:11
    Genetic brain disease, reaction to the environment.
    48:14
    Never the twain shall meet.
    48:15
    They have nothing to do with each other.
    48:19
    So if I was a regular biological psychiatrist,
    48:22
    I would've just cleared that up for you,
    48:24
    end of discussion.
    48:27
    I actually just got back from this year's
    48:30
    American College of Psychiatrists meeting,
    48:32
    which also, funnily, was also in Puerto Rico.
    48:35
    Sad to say I was stuck on the beach for two afternoons.
    48:38
    >> (faux concern) Ohh! (audience laughing)
    48:40
    >> So each year, there's a Dean award lecture,
    48:43
    where some top researcher in schizophrenia
    48:46
    gets an award for his lifetime work--
    48:47
    or her lifetime work on schizophrenia.
    48:51
    And they basically give a talk
    48:53
    describing their lifetime work on schizophrenia.
    48:56
    So this guy Kenneth Kendler got that award,
    48:58
    and he's pretty well "top dog" guy in schizophrenia
    49:01
    and genetics.
    49:03
    And it's kind of a catchy talk
    49:05
    with a catchy title.
    49:07
    "The Genetics of Schizophrenia--
    49:08
    "Toward the Identification
    49:09
    "of Individual Susceptibility Loci."
    49:12
    That sounds kind of scientific.
    49:14
    Kind of like some big shot talking.
    49:17
    And he is a big shot.
    49:20
    And, oh...
    49:22
    whoop...
    49:25
    Oh, there it goes, okay.
    49:27
    A little tricky.
    49:29
    He doesn't look like Dr. Evil, right?
    49:31
    He's a kindly academic looking kind of guy.
    49:36
    And this is a quote from the talk
    49:38
    based on his lifetime of research on genetics.
    49:42
    "Most, if not all of the reason
    49:45
    "why schizophrenia runs in families
    49:47
    "is due to shared genes and not shared environment."
    49:51
    Most, if not all,
    49:55
    of the reason why schizophrenia runs in families
    49:56
    is genetics.
    49:58
    It may not be all... but it could be all.
    50:01
    But if it's not all, it's most, if not all.
    50:03
    So in other words, it's predominantly,
    50:05
    "major big league" a genetic disorder.
    50:08
    That's his conclusion from his lifetime of research.
    50:11
    So... what are the facts?
    50:14
    What's the research that supports this conclusion?
    50:18
    Well, there's a methodology called
    50:20
    "twin concordant studies."
    50:24
    Which are a little bit old-fashioned now.
    50:26
    The reason they're old-fashioned now
    50:28
    is because of what the data are, which we'll get to in a second.
    50:31
    So basically, there's identical twins,
    50:33
    non-identical twins.
    50:35
    Identical is MZ-- monozygotic-- one egg.
    50:39
    Fraternal, non-identical twins are DZ--
    50:41
    dizygotic-- two eggs.
    50:44
    And what you wanna look at is concordance.
    50:47
    So if the first identical twin is female,
    50:50
    how often is the second-- this is a quiz question.
    50:53
    If the first identical twin is female,
    50:56
    how often is the second identical twin female?
    50:59
    100% of the time, right?
    51:01
    If the first identical twin has red hair,
    51:05
    always red hair.
    51:06
    Etcetera.
    51:07
    So some traits clearly are purely genetically controlled.
    51:12
    And if you take one of these identical twins--
    51:16
    let's say you have a set of Chinese identical twins,
    51:20
    you take one out of the family at birth
    51:22
    and put 'im in an English-speaking family,
    51:24
    they're gonna grow up speaking English.
    51:26
    Whereas the one that stayed in the Chinese
    51:28
    Chinese-speaking family is gonna speak Chinese.
    51:31
    So from that, we know that what language you speak
    51:34
    isn't coming from your genes,
    51:36
    it's coming from your environment.
    51:38
    But incredibly, when you're-- a Chinese kid
    51:41
    is adopted into a Caucasian family,
    51:43
    they don't become Caucasian.
    51:45
    So now we know that being Caucasian,
    51:47
    or being female, or having dark hair,
    51:49
    is genetic, and it's not modified by the environment.
    51:53
    So the first thing you wanna do is look at the concordance rate.
    51:57
    If the concordance rate is very, very low,
    52:00
    then you know that it's not really genetic.
    52:04
    If it's purely genetic, then the concordance rate's
    52:08
    going to be 100%.
    52:10
    But what's the concordance rate for speaking Chinese
    52:12
    versus speaking English in identical twins?
    52:15
    It's almost 100%, right?
    52:17
    So you, the concordance rate doesn't prove it's genetic,
    52:21
    it just means it very well could be.
    52:23
    Then, you've gotta go look at adoption
    52:24
    and do some other strategy.
    52:26
    So the concordance rate is kind of the first pass.
    52:31
    So you wanna look at the concordance rate
    52:32
    for cystic fibrosis in identical twins.
    52:37
    It's 100%.
    52:38
    If the first twin has cystic fibrosis,
    52:40
    other twin always has it.
    52:41
    First twin doesn't have it, other twin never has it.
    52:44
    It's a purely genetic disease,
    52:46
    totally proven medically, nobody doubts it.
    52:50
    So what's the story with schizophrenia?
    52:52
    Which is mostly, if not all, genetic?
    52:57
    Well...
    52:58
    to find out, we should go to the expert, Kenneth Kendler.
    53:01
    So in this same talk, he's presenting his data,
    53:05
    which supported the conclusion
    53:06
    that schizophrenia's mostly, if not all, genetic.
    53:09
    And he looked at this 16,000 pair of twins,
    53:12
    and he looked at the concordance rate for schizophrenia.
    53:17
    So what do we think-- like if I was gonna take a poll here,
    53:22
    to support the conclusion it's mostly genetic,
    53:25
    what kind of concordance do you think we would want?
    53:29
    It's not likely to be 100%,
    53:31
    because the mental health field's kind of like fuzzy.
    53:34
    But we'd want some kind of high number, right?
    53:36
    So if the concordance rate was 90%,
    53:39
    then I'd go, "Yeah, it very well could be
    53:40
    "mostly, if not all, genetic."
    53:43
    80%?
    53:45
    Eh, that's still mostly, if not all.
    53:47
    70%-- well, that's getting away from "if not all,"
    53:49
    but still mostly.
    53:50
    60%-- well, that's just barely mostly.
    53:54
    So what was the actual concordance rate
    53:56
    that he observed and published in his research
    53:59
    that got him the award for demonstrating
    54:02
    that schizophrenia is mostly genetic?
    54:06
    Anybody wanna take a guess?
    54:08
    >> 32. >> (laughing).
    54:11
    That's a good guess.
    54:15
    In his own sample--
    54:17
    and this is actually higher than the real actual average number,
    54:21
    if you add together all the best studies.
    54:24
    In his own data set, when the first twin has schizophrenia,
    54:28
    the other identical twin does not have it 70% of the time.
    54:34
    That simple fact, by itself,
    54:37
    proves conclusively, scientifically,
    54:39
    medically, biologically, beyond a shadow of a doubt,
    54:43
    no other possibility,
    54:45
    that schizophrenia could be at most only a little bit genetic.
    54:49
    And this result-- which the numbers bounce around
    54:52
    from study to study, but when you add together
    54:54
    the best-designed studies, and the most recent studies,
    54:57
    it actually comes out more in the low 20s, like 22%.
    55:03
    So what's up with my field?
    55:06
    How, how does this myth get perpetuated?
    55:10
    So you go to these academic meetings,
    55:12
    and the top expert in the world,
    55:14
    comes and gives his award speech
    55:16
    and says it's mostly genetics, 31%,
    55:19
    and everybody goes... (scattered laughing)
    55:21
    "Good talk."
    55:23
    There's something really wrong.
    55:24
    I mean, it's just absolutely not possible.
    55:28
    So I have a letter in press, letter to the editor,
    55:32
    at a journal called "Psychosis,"
    55:34
    which is edited by a friend of mine who's very skeptical
    55:37
    about all these "genetic biological schizophrenia" guys.
    55:40
    So he liked my letter.
    55:41
    So the letter is...
    55:46
    Something like January 29th, or something like that.
    55:48
    There's, in the journal "Nature," which is--
    55:52
    "Nature" and "Science" are the two top science journals
    55:54
    in the world.
    55:55
    So if you're-- if you figure out the structure of DNA
    55:59
    for the first time in human history...
    56:04
    and your name is Watson or Crick,
    56:06
    where do you publish your paper?
    56:07
    "Nature."
    56:09
    I mean, it is top, top journal.
    56:10
    So in this journal "Nature,"
    56:13
    there's a paper published in January,
    56:16
    and there's a write-up--
    56:18
    I just talked about the write-up in the "New York Times."
    56:21
    There's numerous other write-ups in many other media outlets.
    56:26
    This is the biggest, most important,
    56:30
    fundamental advance in the study
    56:32
    of the biology of schizophrenia ever.
    56:34
    We've really, for the first time,
    56:37
    started to tap into the underlying genetic causation
    56:42
    of schizophrenia.
    56:43
    We're really starting to figure it out.
    56:44
    We've really got our hands on something for the first time.
    56:48
    That's what the author said, all these different commentators.
    56:54
    What was the research?
    56:56
    So there's like 39-- some huge number--
    56:59
    39,000 people with schizophrenia,
    57:01
    28,000 controls.
    57:04
    And this is a schizophrenia genetics consortium,
    57:07
    which has pulled together all of these studies
    57:10
    where they do genome-wide analysis,
    57:13
    which is they-- they can just basically
    57:15
    throw your blood in a machine,
    57:17
    and it'll scan your entire genome.
    57:19
    Because now, thanks to the Human Genome Project--
    57:23
    and this is getting cheap enough now
    57:25
    that they can do these gigantic numbers.
    57:27
    So that's millions of dollars of research money.
    57:31
    And what they zoned in on
    57:34
    was a single nucleotide polymorphism,
    57:38
    which means little variations in one ATGC base pair.
    57:44
    And they looked at a specific gene
    57:46
    called the "C4 complement gene."
    57:49
    And they looked at four-- out of all these genes
    57:51
    that they scanned, they finally found one somewhere
    57:55
    that had some sort of statistical significance to it,
    57:58
    and it turned out to be the C4 complement gene.
    58:01
    And there's four variations
    58:03
    of this single nucleotide polymorphism.
    58:06
    For the first three they looked at,
    58:09
    there was no increased risk of schizophrenia at all.
    58:11
    But the fourth one,
    58:13
    this is where they found this fundamentally new insight
    58:18
    into the underlying genetic biology of schizophrenia.
    58:21
    Which is now gonna open up this revolution in psychiatry.
    58:26
    So if you have this gene variant...
    58:33
    how much does your risk of schizophrenia go up?
    58:37
    This fundamental breakthrough finding.
    58:40
    The most significant, profound finding
    58:43
    in the history of schizophrenia and genetics.
    58:44
    What would you think it might be?
    58:48
    The answer is your odds of developing schizophrenia
    58:51
    sometime in your life go up from 1% to 1.27%.
    58:57
    That's it!
    58:59
    It's just--
    59:01
    it's like being at the Mad Hatter's tea party or something.
    59:04
    I mean, it's just ridiculous.
    59:05
    It doesn't make any sense.
    59:06
    It's massive over-hyping of this result,
    59:11
    which then generates more grants, more motions,
    59:14
    more interests, more excitement,
    59:15
    and diverts money away
    59:18
    from studying maybe something in environment
    59:21
    that's causing people to go crazy.
    59:23
    Like child abuse, for instance.
    59:26
    So this is dominating the field all the time,
    59:29
    this kind of thinking.
    59:31
    Okay, so, just jumping over to DID now,
    59:34
    just to refresh you a little bit.
    59:37
    What is DID?
    59:38
    What's a typical description of it?
    59:40
    Well, here's-- this is the--
    59:42
    so we're in the category now of neurotic reaction
    59:45
    to the environment,
    59:46
    totally different box from genetic brain disease,
    59:50
    which isn't even, in fact, a genetic brain disease,
    59:51
    which we've known scientifically for decades,
    59:53
    but we keep saying that it is.
    59:58
    Little side detour-- back to the American College
    60:00
    of Psychiatrists meeting in Puerto Rico last week,
    60:03
    the mood disorders award was a lecture
    60:07
    given by a woman who's actually in University in Galveston,
    60:11
    not too far away from me.
    60:13
    Top handful of childhood depression experts in the world,
    60:19
    presenting all her research.
    60:21
    And she's talking about how effective
    60:24
    anti-depressants are for children.
    60:26
    And she's very pro-anti-depressants.
    60:29
    Because genetic brain disease, medication,
    60:32
    are all part of a package.
    60:34
    That package is promoted as a package.
    60:38
    Okay, so we can diagnose depression in children.
    60:42
    So this is an hour talk.
    60:45
    It turns out that the FDA has only approved
    60:47
    two anti-depressants for kids under 18.
    60:50
    Fluoxetine, which is Prozac, and escitalopram.
    60:55
    For Prozac, there's two studies.
    60:57
    For escitalopram, there's one.
    60:59
    Showing positive results.
    61:01
    She didn't mention how many studies there are
    61:04
    where there's no difference between drug and placebo.
    61:06
    In the FDA, you could have 10 different studies of Prozac.
    61:11
    They only require that two show a difference
    61:13
    between the drug and a placebo.
    61:15
    If there's eight other studies
    61:17
    that show no difference at all,
    61:18
    they don't care, doesn't matter, gets approved,
    61:21
    goes to market.
    61:22
    That's how the whole thing operates.
    61:25
    Then, there's a whole bunch of other anti-depressants
    61:27
    on the list where all of the studies
    61:30
    failed to show any other-- any difference at all
    61:34
    between the drug or the anti-depressant
    61:35
    and the placebo for depressed kids.
    61:38
    But we got two drugs, a total of three studies.
    61:42
    So then, she averages together all the literature
    61:45
    on anti-depressants in kids.
    61:48
    Thousands and thousands and thousands
    61:50
    and thousands of kids.
    61:52
    And she says, "How many kids respond to anti-depressants
    61:56
    "compared to placebo?"
    61:59
    Where "response" is defined as your depression score
    62:01
    drops by 50% or greater.
    62:04
    So being a responder doesn't mean you're better,
    62:07
    it just means you're at least half better.
    62:09
    So not a very tough definition of "responder."
    62:14
    Overall, when you add the whole world's literature
    62:17
    on anti-depressants in children,
    62:19
    you add it together, 60% respond
    62:22
    to the anti-depressants and 50% respond to placebo.
    62:26
    That's it.
    62:27
    It's not too impressive.
    62:29
    And so, there's this whole room full of 500 psychiatrists,
    62:32
    and they're all, "Uh-huh, yeah, good,
    62:34
    "great talk, here's your award."
    62:39
    There's something fundamentally wrong here.
    62:42
    Okay.
    62:43
    But at least we know that dissociative identity disorder
    62:45
    and schizophrenia are separate things.
    62:48
    So here's a classical-- it's a little bit older text.
    62:50
    You'll see the language is a little bit archaic,
    62:52
    but, you know, typical case description
    62:55
    of dissociative identity disorder.
    62:57
    "The delusion of being possessed is very commonly seen
    62:59
    "as a specific type of 'double personality.'
    63:03
    "Single emotionally charged ideas or drives
    63:05
    "attain a certain degree of autonomy,
    63:08
    "so that the personality falls to pieces.
    63:10
    "These fragments can exist side by side,
    63:13
    "and alternately dominate the main part
    63:14
    "of the personality, the conscious part of the patient.
    63:17
    "However, the patient may also become
    63:18
    "a definitely different person from a certain moment onwards."
    63:24
    It's completely consistent with the entire DID literature.
    63:27
    "Naturally, such patients must speak of themselves
    63:29
    "in one of their two versions,
    63:31
    "or they may speak in the third person of the other two,
    63:33
    "usually he designates himself by one of his several names.
    63:37
    "The splitting of the psyche into several souls
    63:39
    "always leads to the greatest inconsistencies.
    63:42
    "In a few cases, the 'other' personality
    63:44
    "is marked by use of different speech and voice.
    63:47
    "Thus, we have here two different personalities
    63:49
    "operating side by side."
    63:53
    Extremely clear definition of DID.
    63:56
    "When specific 'persons' speak through the patients
    63:58
    "in various cases of automatic speech,
    64:00
    "each person has his own special voice
    64:02
    "and distinct manner of speech.
    64:04
    "Thus, the patient appears to be split
    64:05
    "into as many different persons or personalities
    64:08
    "as they have complexes."
    64:10
    Complexes is not talked about that much now.
    64:13
    It's a late 19th, early 20th century term.
    64:16
    "The blocking of the recall of memories
    64:18
    "is a common occurrence during the examination
    64:20
    "of these patients."
    64:21
    So they have lots of amnesia.
    64:26
    Okay.
    64:28
    So this would be from some classical textbook
    64:30
    on dissociative identity disorder, right?
    64:32
    This is clearly not schizophrenics.
    64:35
    This is people with split personalities.
    64:36
    Different voices, names, ages, amnesia.
    64:39
    What book is this from?
    64:45
    There we go.
    64:49
    This is a book by Eugen Bleuler,
    64:50
    published in 1911.
    64:53
    He's the guy who coined the term "schizophrenia."
    64:56
    It used to be called "dementia praecox" before that,
    64:59
    which means "early onset dementia."
    65:02
    This is the guy who invented the term "schizophrenia,"
    65:05
    writing one of the classical 20th century's textbooks
    65:08
    on schizophrenia,
    65:10
    describing a substantial chunk of his caseload.
    65:15
    It's exactly the same thing as "DSM IV," "DSM V"
    65:18
    dissociative identity disorder.
    65:20
    In great minute detail.
    65:22
    And he says that splitting is the fundamental thing
    65:26
    going on in schizophrenia.
    65:28
    And he says that splitting is exactly the same thing
    65:31
    as dissociation, which is Pierre Janet's term
    65:34
    for the same thing as he calls splitting,
    65:37
    and Pierre Janet is kind of the father
    65:39
    of dissociation theory.
    65:41
    So the guy who originally coined the term "schizophrenia"--
    65:45
    every psychiatrist knows that--
    65:47
    most psychiatrists, of course, don't read the book--
    65:51
    is completely confused about the difference
    65:52
    between DID and schizophrenia.
    65:55
    And many people that he's calling "schizophrenic"
    65:57
    clearly have DID.
    65:59
    So there's actually, in fact, mass confusion
    66:02
    in the profession...
    66:05
    I'm sad to say.
    66:09
    I might turn around and chortle for a second but...
    66:11
    I'm very sad to say that.
    66:13
    Okay, so let's look at this relationship
    66:15
    between dissociation, psychosis, and some research.
    66:19
    Genetic brain disease.
    66:21
    Oh, by the way, the woman who was giving
    66:23
    the talk about anti-depressants in children
    66:26
    for an hour didn't mention child abuse,
    66:30
    childhood trauma, PTSD, or anything like that, once.
    66:35
    In an hour.
    66:37
    That's how relevant all that stuff is
    66:38
    to childhood depression.
    66:40
    Which we're treating with anti-depressants
    66:42
    that don't work any better than placebo
    66:43
    because it's a biological disease.
    66:48
    Okay, so this is general population in Canada.
    66:51
    Team knocked on people's doors and interviewed them
    66:53
    with the standardized dissociative disorders
    66:56
    interview schedule, dissociative experiences scale.
    66:59
    So this is people in the general population.
    67:02
    Not in treatment.
    67:03
    And I divided them into 397 people
    67:06
    who had no psychotic symptoms at all
    67:09
    and 35 who reported three or more.
    67:14
    Simple.
    67:15
    I mean, this is not rocket science, right?
    67:17
    And look at the difference in their abuse histories.
    67:20
    Physical or sexual abuse, or both,
    67:22
    8.1% if you have no psychotic symptoms.
    67:25
    45% if you have three or more.
    67:29
    From this, you might consider the possibility
    67:34
    that physical and sexual abuse have got something to do
    67:36
    with psychosis.
    67:37
    You would think.
    67:40
    So...
    67:42
    your rate of having psychosis goes up from 8% to 45%,
    67:46
    not 1% to 1.27%.
    67:49
    I mean, that's a massive finding
    67:51
    compared to the strongest finding
    67:53
    in all of schizophrenia genetics ever
    67:56
    after they've spent literally a billion dollars
    67:58
    or whatever they've spent.
    68:04
    Same people.
    68:06
    Much higher dissociative experiences scale scores,
    68:08
    more somatic symptoms, secondary features of DID,
    68:11
    more borderline criteria, more ESP paranormal.
    68:14
    This is starting to look like the same pattern
    68:16
    as when I compared DID to borderline personality disorder.
    68:21
    It's all the same kind of comorbidity.
    68:26
    Okay, different study.
    68:29
    This is 83 people in Canada.
    68:32
    Long, stable, clinical diagnoses of schizophrenia.
    68:36
    Most of them have been diagnosed
    68:38
    as having schizophrenia for 10 years or more.
    68:42
    Same dissociative experiences scale score,
    68:45
    same dissociative disorders interview schedule,
    68:47
    I divide them into people say they were abused physically
    68:51
    or sexually or both in childhood,
    68:53
    and people who say they were neither physically
    68:55
    nor sexually abused.
    68:57
    Lo and behold, if you have a longstanding stable diagnosis
    69:00
    of schizophrenia, and you answer "yes"
    69:03
    to a very simple question--
    69:04
    "Yes, I was either physically or sexually abused or both,"
    69:08
    you have much more dissociation,
    69:10
    more somatic symptoms-- this is another set
    69:12
    of dissociative symptoms.
    69:13
    You're more borderline.
    69:15
    You have more of all this stuff.
    69:17
    You have more schizophrenia.
    69:19
    You're twice as many psychotic symptoms
    69:22
    as the person with schizophrenia without an abuse history.
    69:26
    And those Schneiderian symptoms--
    69:27
    named after Kurt Schneider, a German psychiatrist--
    69:30
    are the hardcore symptoms that are everywhere
    69:33
    in the schizophrenia literature and in the DSM criteria.
    69:41
    Whole different measure of standardized thing
    69:43
    that's used in tons of research.
    69:45
    Whole list of different types of psychotic symptoms.
    69:48
    Lo and behold, the abused schizophrenics
    69:49
    has way more of those than the non-abused schizophrenic.
    69:53
    Ideas of reference is...
    69:56
    uh, "That message on the side of the bus
    69:59
    "is deliberately meant for me.
    70:01
    "They put it on the bus to let me know."
    70:04
    That's an idea of reference.
    70:07
    Voices, paranoid ideation,
    70:09
    thought insertion is thoughts being stuck in your mind
    70:10
    that aren't your own.
    70:12
    Hallucinations, reading someone else's mind.
    70:20
    So in schizophrenia, the symptoms
    70:22
    are divided into positive symptoms and negative symptoms.
    70:26
    The positive symptoms-- and they're measured by
    70:29
    this thing called the PANSS, "positive and negative syndrome scale,"
    70:32
    and by lots of other scales.
    70:33
    They're everywhere in the entire schizophrenia literature.
    70:37
    Negative symptoms are the things you should have
    70:39
    that you're missing.
    70:41
    So that's kind of burned out, empty,
    70:44
    no social connectedness, no life, no spontaneity,
    70:47
    no desire for anything.
    70:48
    The positive symptoms are things that are there
    70:51
    that you shouldn't have, like being agitated,
    70:53
    mixed up, jumbled up thoughts, hallucinations, delusions.
    70:59
    And lo and behold, the abused schizophrenics
    71:01
    got more positive symptoms and fewer negative symptoms.
    71:05
    And the composite score is just when you add the two together.
    71:09
    So now, we're starting to see that "Wait a minute..."
    71:11
    we can see-- take a whole bunch of--
    71:12
    say everybody in this room has schizophrenia,
    71:15
    I go, "All you guys who have physical and sexual abuse
    71:17
    "in childhood sit on this side,
    71:19
    "all you guys who don't sit on this side."
    71:21
    You guys over here are gonna have way more
    71:23
    negative symptoms, fewer positive.
    71:25
    You guys are gonna have more positive, fewer negative.
    71:28
    And these symptoms have a lot to do
    71:31
    with how well you respond to medication,
    71:33
    what your treatment needs are, what your housing needs are,
    71:36
    what your relationship qualities are like,
    71:38
    and what your prognosis is like.
    71:41
    We can make this major differentiation
    71:44
    into a much more treatable treatment response group,
    71:48
    much more difficult, simply by asking a couple of questions.
    71:53
    But that is nowhere
    71:54
    in the standard schizophrenia literature,
    71:56
    until the last few years.
    71:58
    Starting to creep in now.
    72:00
    Okay, so now we've got 160 people
    72:03
    with multiple personality,
    72:05
    83 people with schizophrenia.
    72:08
    Let's compare them.
    72:10
    So they're not matched demographically
    72:12
    so it's not perfect research.
    72:14
    Ideally, it should be the same average age,
    72:15
    same percentage of female, and so on.
    72:18
    But this is a first look.
    72:25
    Oh, wow... what do you know?
    72:26
    People with multiple personality have twice as much
    72:28
    childhood abuse as people with schizophrenia.
    72:31
    But people with schizophrenia have way more
    72:33
    than the base rate in the general population.
    72:39
    People with MPD have--
    72:41
    by all these different indicators,
    72:43
    much more severe abuse.
    72:44
    They don't just have more "yes" answers,
    72:46
    they have much more severe abuse.
    72:52
    They have more dissociative disorders.
    72:53
    Not surprising.
    72:55
    But wait a minute here,
    72:57
    these are people with schizophrenia,
    73:00
    25% of them are coming up meeting criteria for MPD, DID,
    73:05
    on a standardized interview.
    73:08
    So it's not like these are really clear,
    73:10
    distinct separate groups.
    73:11
    They're all overlapping, confusedly mish-mashed together.
    73:15
    Substance abuse about the same.
    73:18
    More depression, more borderline personality.
    73:20
    So by and large, this is the same pattern,
    73:23
    whether you compare abused schizophrenics
    73:25
    to non-abused schizophrenics,
    73:27
    people with DID to people without DID.
    73:32
    And the common theme is the trauma.
    73:36
    Some more dissociative symptoms.
    73:41
    Higher dissociation score, more somatic symptoms,
    73:44
    dissociative symptoms, borderline.
    73:47
    Here we are again.
    73:50
    Well, that's interesting, but take a look at this line.
    73:54
    Yet again, the people with multiple personality
    73:56
    have more symptoms of schizophrenia, on average,
    73:59
    than people with schizophrenia.
    74:01
    So these symptoms of schizophrenia
    74:03
    cannot possibly be specific to schizophrenia.
    74:07
    They may not even have anything to do
    74:09
    with brain disease at all.
    74:10
    They might be trauma dissociation symptoms
    74:13
    that the person wouldn't have if they weren't abused as a kid.
    74:18
    Okay.
    74:21
    Well, we've got all these clinicians out there
    74:22
    who can tell the difference between schizophrenia
    74:24
    and dissociative identity disorder--
    74:26
    they never diagnosed dissociative identity disorder,
    74:28
    they just know it's rare and iffy.
    74:31
    So if that was actually true,
    74:34
    what would we think we would see in large series of people
    74:37
    who have a diagnosis of multiple personality
    74:40
    or are in psychotherapy for it?
    74:42
    We wouldn't see previous clinicians
    74:44
    saying they had schizophrenia.
    74:47
    But in these two series, 40%, a quarter,
    74:51
    had previous diagnoses of schizophrenia
    74:53
    from other clinicians,
    74:54
    half had been treated with antipsychotics,
    74:56
    and a bunch had had electroconvulsive therapy,
    74:59
    shock therapy.
    75:01
    Which tells us that the previous clinicians
    75:03
    thought these people were seriously, seriously,
    75:06
    seriously mentally ill,
    75:08
    needed the most heavy-duty treatments
    75:11
    for major serious mental illness that we had,
    75:14
    and a half of the time, or a quarter of the time,
    75:18
    got an actual diagnosis of schizophrenia,
    75:20
    proving that most clinicians cannot tell the difference.
    75:23
    And these are people who are participating in,
    75:26
    you know, high-level, hardworking,
    75:28
    cognitively functioning psychotherapy.
    75:36
    This is the PANSS, that positive and negative syndrome scale.
    75:39
    This is the norms for schizophrenia in the manual.
    75:42
    And this is the DID series.
    75:44
    Yet again, DID people are more positive, less negative.
    75:48
    So...
    75:49
    This is just my research.
    75:51
    These findings have been replicated in multiple samples
    75:54
    with multiple different measures.
    75:57
    Okay, so we all know that hearing voices is...
    76:00
    a sign of psychosis and very typical of schizophrenia.
    76:05
    So...
    76:07
    This is the Schneiderian symptoms of schizophrenia,
    76:09
    which include several different forms of hearing voices.
    76:13
    What's the percentage of people with schizophrenia
    76:18
    who have at least one Schneiderian symptom?
    76:23
    This guy Kurt Schneider said, "These are the hardcore symptoms
    76:25
    "of schizophrenia."
    76:28
    Well...
    76:30
    this is published series in the literature.
    76:32
    Only a third of the people in this published series
    76:35
    of schizophrenia cases had any of the core symptoms
    76:39
    of schizophrenia.
    76:40
    That's a little weird.
    76:44
    So if you total these 12 or so series,
    76:47
    there's 2,500 people, only just over half
    76:50
    had any of these Schneiderian symptoms,
    76:53
    which are the core, defining symptoms
    76:54
    of schizophrenia, in theory.
    76:58
    On the other hand, if you have multiple personality,
    77:00
    87% have one or more symptoms.
    77:04
    So again, there's like multiple ways
    77:05
    of looking at it, multiple sources of data,
    77:08
    same pattern over and over and over.
    77:11
    What gets called "psychosis"
    77:13
    is actually more typical of people who are dissociative
    77:15
    than of people who are psychotic.
    77:18
    So I took this same series-- 1993, '95--
    77:21
    now, I pulled out the people who had psychotic diagnoses
    77:24
    on the structured interview.
    77:26
    Schizophrenia or schizoaffective,
    77:29
    which are the two major, heavy duty psychotic diagnoses.
    77:32
    So these people all, in fact, had multiple personality,
    77:34
    all were getting treated with psychotherapy.
    77:38
    But...
    77:39
    36 of them met standardized DSM
    77:42
    structured interview criteria for psychotic diagnosis
    77:46
    in '93.
    77:48
    In '95, they're on fewer medications and lower doses,
    77:53
    and their primary treatment's been psychotherapy,
    77:55
    and now instead of 100% met criteria
    77:57
    in the previous year, only a quarter did.
    78:01
    Their Axis I diagnoses are dropping.
    78:03
    Same pattern as we saw when we pulled out
    78:05
    the borderline people.
    78:08
    And the same thing over and over.
    78:10
    Their thought disorder scores,
    78:12
    this other measure, the-- (mic cuts out).
    78:17
    Thought disorder, psychosis, depression's dropping down,
    78:21
    all different things are dropping down.
    78:28
    Another measure of psychotic symptoms,
    78:30
    in my structured interview-- dropping, dropping,
    78:33
    dropping, dropping, dropping.
    78:34
    So all kinds of symptoms,
    78:35
    including the psychotic symptoms, are going down,
    78:39
    which is a good thing.
    78:41
    The positive symptoms are going down.
    78:43
    Also the negative symptoms are going down.
    78:45
    The dissociation score dropped dramatically.
    78:47
    Depression, Hamilton depression,
    78:51
    the SCL-90s-- the all across the board
    78:53
    different symptoms.
    78:54
    Then, there's a psychosis sub-scale.
    78:56
    So we've got four different measures of dissociation--
    78:59
    of psychosis, rather, all following the same pattern.
    79:04
    So we're successfully treating--
    79:06
    "oh, wait a minute, what are we treating again?
    79:08
    "Oh, yeah, borderline personality disorder.
    79:10
    "No, no, no, schizophrenia.
    79:11
    "No, I mean, actually we're treating depression.
    79:13
    "No, no, we're treating anxiety disorder.
    79:16
    "Wait a minute, we're treating..."
    79:18
    We're treating this whole pot of different diagnoses.
    79:21
    And the typical clinician who sees these people,
    79:24
    says they have schizophrenia, schizoaffective,
    79:26
    bipolar, some heavy duty diagnosis,
    79:28
    gives them meds, maybe ECT, and no psychotherapy.
    79:32
    This is just the way the field operates.
    79:36
    Which I think is a sad story.
    79:43
    There's probably, I actually just read a paper
    79:46
    this morning-- or this afternoon,
    79:48
    while I was sitting at the airport,
    79:49
    waiting for three hours... (scattered chuckling)
    79:52
    which was handy, because I got lots of emails done and stuff.
    79:56
    Um, it's a summary article,
    79:58
    and they were talking about 15 different studies published.
    80:02
    None of these existed 10 years ago.
    80:04
    Mostly in the last five years.
    80:06
    They're studies with like 5,000 people,
    80:08
    7,000 people, 3,000 people in the general population.
    80:13
    Or large collections of schizophrenia patients,
    80:15
    psychotic patients, like, hundreds and hundreds,
    80:18
    and there's multiple studies like this.
    80:20
    Just asking about childhood physical abuse,
    80:23
    sexual abuse, neglect, bullying, family violence,
    80:27
    a whole bunch of different forms of trauma,
    80:30
    and lo and behold, it's way up there
    80:32
    in people with psychosis.
    80:34
    So having a history of severe, chronic childhood trauma
    80:38
    increases your risk for psychosis
    80:40
    in many, many, many studies, in many different samples,
    80:44
    by like, 20-fold, 40-fold.
    80:49
    There's a study called the "Adverse Childhood Experiences" study,
    80:53
    which is done in a Kaiser Permanente population
    80:56
    in San Diego.
    80:57
    So they had 17,000 people
    80:59
    who were all in the Kaiser Permanente system,
    81:02
    and they gave 'em this adverse childhood experiences scale,
    81:05
    and then they reviewed all of their medical psychiatric records,
    81:08
    because they owned them all.
    81:11
    And the adverse childhood experiences scale
    81:13
    has 10 different questions, and you either say "yes" or "no,"
    81:18
    and the total score ranges from zero to 10.
    81:21
    So, "Yes, I was sexually abused,
    81:23
    "Yes, I was physically abused, family violence,
    81:26
    "parent with substance abuse, parent went to jail,"
    81:29
    different forms of childhood trauma.
    81:32
    And one of the guys who's the core guy in the study,
    81:36
    is an epidemiologist from the CDC,
    81:39
    so he's spent his whole life looking at the statistics
    81:42
    of disease at the Center for Disease Control.
    81:46
    And this guy says in talks, and says in papers,
    81:50
    "Most epidemiologists never get a finding like this
    81:54
    "in their entire careers."
    81:57
    What was the specific finding?
    81:59
    The specific finding is, if your ACE score--
    82:02
    "adverse childhood experience" score--
    82:03
    is 4 or higher, compared to zero,
    82:08
    your risk of IV drug use goes up 1,400 times.
    82:16
    That's kind of a big finding.
    82:17
    That's a little bigger than 1% to 1.27%.
    82:21
    And so, ACE scores go up dramatically...
    82:27
    in conjunction with all kinds of different physical
    82:29
    and mental health problems.
    82:30
    The higher your ACE score,
    82:32
    the more psychotic symptoms you have.
    82:34
    More suicide attempts.
    82:35
    More depression.
    82:38
    Hearing voices.
    82:39
    Being admitted to psych hospitals.
    82:41
    Okay, that's all kind of understandable.
    82:43
    But other things that go up dramatically with ACE score
    82:46
    include cardiovascular disease,
    82:52
    funnily enough, having Cesarean sections,
    82:56
    cancer,
    82:58
    lung disease.
    83:00
    There's a whole bunch of health outcomes
    83:03
    that go up dramatically with childhood trauma.
    83:06
    Childhood trauma is driving
    83:09
    a lot of billions of dollars of healthcare costs
    83:12
    in the United States per year.
    83:14
    What is one of the things-- so when you see the graph,
    83:16
    it's like, "ACE score, 1 through 10,"
    83:20
    what's your likelihood of having a body mass index
    83:23
    above 30, which is the low end of being obese?
    83:27
    People who are obese in our program,
    83:29
    they have BMIs like 45 and 50.
    83:33
    A score of 1, 2, 5.
    83:36
    It goes just like this-- (whooshing noise).
    83:40
    So what's the healthcare costs
    83:42
    of cardiovascular disease, high blood pressure,
    83:45
    high glucose, on and on and on and on,
    83:48
    heart attacks, in our culture?
    83:51
    Billions of dollars per year.
    83:53
    That's just the financial cost, let alone the human cost.
    83:57
    And a significant, major driving contributing factor
    84:01
    is childhood trauma.
    84:03
    So we did a study which...
    84:06
    we're just doing the analysis on now,
    84:08
    but we got kind of, like, the preliminary analysis--
    84:11
    67 people admitted to the hospital in Dallas
    84:16
    for, basically, for being suicidal.
    84:18
    So they're admitted to a psych hospital.
    84:20
    But they've all had bariatric surgery,
    84:23
    weight loss surgery.
    84:25
    And most of them are kind of like a couple years out...
    84:29
    and so we looked at-- number one,
    84:31
    they're all inpatients,
    84:32
    they all have serious mental health problems,
    84:33
    they're obviously not doing well psychiatrically.
    84:35
    Most of them have lost a ton of weight.
    84:39
    What are their depression scores,
    84:41
    their dissociation scores?
    84:43
    And we did several different eating disorder measures.
    84:46
    Nothing really stood out that much
    84:49
    except their ACE scores.
    84:52
    These people had amazing ACE scores,
    84:54
    these 67 people.
    84:56
    There's many, many people with 6, 7, 8, 9.
    85:01
    Whereas the general population is like zero, 1.
    85:04
    And so, that's one sample.
    85:06
    But what we're looking at is
    85:07
    people who've had bariatric surgery,
    85:09
    they've lost a ton of weight, but they're still
    85:11
    doing horribly psychiatrically.
    85:14
    And what is the one thing that stands out about them?
    85:17
    Their massive amount of childhood trauma.
    85:21
    Clinically, we have people in the program all the time.
    85:24
    So, it's not like in psychoanalysis
    85:26
    where you've gotta spend like 30,000 hours digging down
    85:29
    into the unconscious and interpreting stuff.
    85:32
    People just tell you.
    85:34
    And I don't know how many dozens and dozens
    85:37
    and dozens and dozens of--
    85:39
    like, 250- to 350-pound women I've talked to
    85:43
    who consciously, deliberately,
    85:46
    are keeping themselves overweight
    85:48
    so that perpetrators won't be interested in them.
    85:51
    And then, when they have either big weight loss
    85:53
    or they have bariatric surgery,
    85:55
    and their weight goes down, they get overwhelmingly terrified,
    85:59
    because guys start hitting on them,
    86:01
    and perpetrators are going to come after them.
    86:04
    It's-- you don't have to dig around, you just ask.
    86:07
    "What's going on?
    86:08
    "Why do you keep your weight up there?"
    86:10
    In combination with, it's basically comfort food.
    86:14
    They're self-soothing-- that's their drug of choice.
    86:17
    They eat, they eat, they feel full.
    86:19
    They're distracted, they're focused on that.
    86:21
    All the bad feelings are gone.
    86:24
    So this is...
    86:26
    obviously not the total cause of obesity,
    86:28
    but it's a significant, major contributing factor,
    86:33
    with costs of billions of dollars.
    86:36
    And it's the same thing--
    86:37
    you read the obesity literature or general medical literature,
    86:40
    child abuse just doesn't get mentioned.
    86:42
    Like it doesn't exist.
    86:45
    So the analogy I came up with is...
    86:48
    this is like being an expert on lung cancer
    86:50
    and giving a one-hour talk on lung cancer
    86:53
    and never mentioning cigarette smoking once.
    86:56
    It's just-- "wait a minute."
    86:57
    Cigarette smoking's kind of an important topic
    87:00
    in the causation of lung cancer.
    87:01
    It doesn't cause every case,
    87:03
    but if we could stop the cigarette smoking,
    87:06
    we would drop off so many cases of lung cancer.
    87:09
    That's the one thing we know can make a difference.
    87:13
    Same thing with childhood trauma
    87:15
    in the mental health field.
    87:17
    So try actually accomplishing it.
    87:19
    But if you could wave a magic wand
    87:21
    and there was no more physical abuse,
    87:23
    sexual abuse, family violence,
    87:25
    the amount of mental health would drop down--
    87:27
    (whooshing noise).
    87:29
    So I was kind of hemming and hawing about whether
    87:31
    I should go into this in exhaustive detail or not,
    87:35
    or...
    87:37
    do a short version of this and just wander through
    87:39
    other mental health issues, so I'm still kind of undecided.
    87:43
    So I'll probably compress it down some.
    87:46
    So basically...
    87:48
    this is like the drive-by shooting bullets
    87:51
    that get sent my way in the gang war in academia.
    87:54
    This is the stuff that skeptical people say about DID,
    87:59
    and the main point is-- it's just a really, really,
    88:03
    really low-level of logic and scholarship.
    88:06
    I mean, just basic errors of logic, discourse, analysis.
    88:14
    In a philosophy department,
    88:16
    you'd just get laughed out of the department
    88:17
    if you did this kind of stuff.
    88:19
    So... very commonly, arguments are applied to DID
    88:23
    that could just as well be used against
    88:25
    all other psychiatric disorders.
    88:26
    So DID is not real because...
    88:29
    and fill in the blank.
    88:33
    But the same thing applies to all the other psychiatric disorders,
    88:35
    but that's never said about them.
    88:37
    So it's this kind of double standard,
    88:39
    goes on all the time.
    88:40
    Which I'll give you some examples of.
    88:43
    Skeptics also over-generalize from biased samples.
    88:47
    So in cognitive therapy, which is a very well-studied,
    88:52
    tons of outcome studies,
    88:53
    method of therapy, originally for depression,
    88:56
    and then expanded to a lot of other stuff.
    88:59
    In cognitive therapy, you look for cognitive errors.
    89:02
    So people who have been abused as kids,
    89:04
    kids always blame themselves, so they think,
    89:06
    "I'm bad, I'm unworthy, I'm causing it, I deserve it,
    89:09
    "it's my fault," and then that gets reinforced
    89:11
    and ingrained, reinforced and ingrained.
    89:13
    30 years later, they come to our program.
    89:16
    "I'm bad, I deserved it, I caused it, it's my fault.
    89:19
    "I deserved to be abused by my husband.
    89:21
    "I deserved to be abused by myself.
    89:23
    "I'm not even a member of the human race.
    89:24
    "I'm a disgrace," etcetera.
    89:27
    All the time, all the time, all the time, all the time.
    89:30
    So one of the methods of therapy we applied to this
    89:33
    is cognitive therapy, so we look at this
    89:36
    as a cognitive error, an incorrect belief,
    89:40
    because no child deserves to be abused or causes abuse.
    89:43
    So it's an error in thinking.
    89:45
    And then, we have a whole bunch of strategies
    89:46
    and techniques we do to try and get them to see that,
    89:50
    "No, that's not true.
    89:51
    "It's never true of any human being.
    89:52
    "You deserve to be treated well.
    89:54
    "The only reason you weren't was just bad luck.
    89:57
    "It's all about your parents, not about you."
    90:01
    So...
    90:02
    in the cognitive therapy literature--
    90:03
    I'll take your question just in a second--
    90:05
    there's some basic sort of categories of cognitive error.
    90:08
    There's "all or nothing," "black and white" thinking.
    90:12
    So...
    90:14
    that dominates presidential debates.
    90:16
    You see this "all or nothing," "black and white" thinking.
    90:18
    "This guy's gonna destroy America!"
    90:20
    "This guy's the only hope for America!"
    90:22
    So it's extreme, polarized "black and white,"
    90:25
    without looking at all the subtleties in between.
    90:28
    And it dominates discussion in the culture
    90:30
    of all kinds of different issues all the time.
    90:33
    But "all or nothing," "black and white" thinking
    90:38
    is supposed to be typical of borderline personality disorder.
    90:41
    So it's a form of mental illness
    90:43
    that we treat with psychotherapy.
    90:46
    Another cognitive error is catastrophization.
    90:50
    So the example I use when I'm teaching it to a patient
    90:53
    or client is... woman's upstairs,
    90:55
    she's in her bedroom, she's about to go to sleep.
    90:57
    All of a sudden, she hears a sound downstairs.
    91:00
    She thinks to herself, "If that dog knocks over his water bowl
    91:04
    "one more time, I'm really gonna be mad at him."
    91:06
    Then, she goes to sleep.
    91:09
    Down the street, there's another woman
    91:10
    who's upstairs in her house.
    91:12
    She hears exactly the same sound.
    91:14
    She goes, "I think a serial killer
    91:16
    "just broke into the house."
    91:18
    Okay, so, the thinking that you have is going to generate
    91:21
    some very different emotional reactions, right?
    91:24
    The woman-- the woman's who's kind of,
    91:25
    "Eh, hmm," go to sleep.
    91:27
    The other woman's in full panic.
    91:29
    So your thinking kicks up all this "fight/flight,"
    91:34
    catastrophe, adrenaline,
    91:36
    and then the counter to that is to de-escalate,
    91:38
    talk yourself down.
    91:41
    So this is catastrophization.
    91:43
    Another cognitive error that mental patients
    91:45
    do all the time is over-generalization.
    91:49
    So, "My uncle abused me,
    91:51
    "therefore all men are pedophiles."
    91:54
    Well, unfortunately, our colleagues do that all the time.
    91:56
    They over-generalize from biased samples.
    91:58
    So they might see one case
    92:01
    of DID diagnosed by somebody else
    92:04
    where there was lousy treatment
    92:06
    and the person got worse,
    92:07
    and then they conclude that all the treatment is 100% harmful.
    92:10
    This happens all the time.
    92:13
    "DID is not valid because its treatment
    92:15
    "has not been proven effective."
    92:18
    Okay, well, so, we just got rid of cancer of the pancreas.
    92:22
    There's no effective treatment for cancer of the pancreas,
    92:24
    so therefore, it's not a valid disorder, right?
    92:27
    You can't say this in general medicine.
    92:29
    Everybody'd just look at you like, "What?"
    92:33
    But you can say it about DID.
    92:36
    So if it was true that the treatment of DID
    92:39
    has never-- has no evidence basis,
    92:41
    never been proven to be helpful,
    92:43
    that would tell us zero about whether
    92:45
    it's a legitimate disorder or not.
    92:48
    Go back 200 years, we didn't-- there's no effective treatments
    92:51
    for hardly anything in all of medicine.
    92:53
    That doesn't mean all the diseases were not real.
    92:55
    So the absence of an effective treatment
    92:57
    tells you nothing about the validity of the disorder.
    93:01
    But on top of it, there in fact is
    93:02
    a bunch of treatment outcome evidence.
    93:06
    So that's an example of you can say that about DID,
    93:09
    but you couldn't possibly say it
    93:11
    about cancer of the pancreas,
    93:12
    because everybody would just think
    93:14
    you should have your license removed.
    93:16
    Sorry, you were gonna ask something?
    93:18
    >> Yeah, um, I was...
    93:20
    when we were talking about childhood abuse,
    93:23
    now, things like-- I don't know, like, uh,
    93:27
    parents divorced, or other experiences that,
    93:31
    you know, you could qualify as psychological trauma,
    93:35
    but it was not intended.
    93:38
    Is that something you guys keep in account
    93:40
    when you guys do your research, like,
    93:42
    "Oh, we asked this question-- have you ever--
    93:45
    "were you abused as a child?"
    93:47
    The person might not think about it as,
    93:49
    "I was not abused," but, you know,
    93:51
    there was certain experience that would, uh,
    93:55
    be considered as trauma.
    93:56
    You know, think like, "Oh, my parents got divorced,"
    93:59
    but, you know, it's not--
    94:01
    >> So this was an excellent question.
    94:03
    And, of course, it's really complicated.
    94:06
    Nobody's got all the answers.
    94:07
    Because...
    94:10
    there aren't really any measures
    94:11
    that ask about every single kind of upsetting or traumatic thing
    94:15
    that can happen.
    94:17
    And so, the focus is often on physical abuse,
    94:19
    sexual abuse-- you know, big, obvious clear stuff.
    94:22
    But actually in the patients who come to the program,
    94:25
    half the trauma comes from good things
    94:29
    that should have happened that didn't.
    94:31
    Namely, bonding, connecting, loving,
    94:34
    unconditional love, nurturing, protection.
    94:37
    And so, they felt very scared, small, sad, lost, lonely.
    94:41
    But nothing happened.
    94:43
    Nobody fired a gun.
    94:44
    Nobody hit you.
    94:45
    So a lot of trauma is actually things
    94:48
    that never even happened.
    94:49
    And then, there's kind of like mild trauma,
    94:52
    and then medium trauma, and obvious, huge trauma,
    94:55
    and then there's...
    94:56
    some people can run faster,
    94:58
    some people are better at math,
    94:59
    some people are a little tougher at surviving trauma.
    95:02
    Maybe two people have the same amount of trauma,
    95:05
    but one's got a fairly okay parent
    95:07
    and one's got two not-okay parents.
    95:10
    So the one with the one okay parent
    95:12
    got the same amount of sexual abuse,
    95:14
    or they had a good aunt, or they had something
    95:16
    to counterbalance the effect of the trauma.
    95:19
    So there's all these different things
    95:20
    that kind of come into play.
    95:24
    And measuring it all is like pretty complicated
    95:26
    and hard to do.
    95:28
    But there's-- like a recent literature started to grow
    95:31
    showing very clearly that childhood bullying
    95:34
    has lots of serious mental health consequences.
    95:36
    10 years ago, there was nothing about bullying
    95:38
    in the mental health literature.
    95:42
    And then, divorce, it all depends,
    95:44
    because sometimes, the amount of family pathology
    95:48
    and the amount of trauma goes down because of divorce,
    95:50
    because you got rid of the not-so-good parent.
    95:54
    Other times, it goes up.
    95:56
    So there's not just one pattern.
    96:01
    I don't know if that answers your question.
    96:02
    >> No, yeah-- yeah, definitely.
    96:04
    Makes sense-- so you would think that in your field,
    96:07
    that's probably one good area where more research
    96:11
    could build up on, like, trying to measure
    96:14
    some of these variables, like-- >> Yeah, absolutely.
    96:17
    We always need more research.
    96:19
    So of course, my opinion is, we should take a billion dollars
    96:21
    from all this genetic research that's going nowhere
    96:24
    and put it into this kind of research.
    96:26
    Because there isn't an infinite pot of money.
    96:28
    And so, being able to study all this stuff,
    96:31
    we're getting robbed by all the money
    96:34
    being diverted over in that direction.
    96:40
    You look like you still have another thought there.
    96:41
    >> No, no, no, I'm fine. >> Okay. (chuckling)
    96:44
    So, uh, "DID is not a disease
    96:47
    "because it is influenced by culture."
    96:49
    So this gets published in psychiatry journals.
    96:54
    Okay, so...
    96:57
    hold on a second here, so you're telling me
    96:59
    that there's actually psychiatric disorders
    97:00
    that are not influenced by culture?
    97:02
    It's an absurd proposition.
    97:05
    Every anthropologist in every anthropology department
    97:08
    in the whole planet would laugh his head off at you,
    97:10
    or her head.
    97:11
    It's ridiculous.
    97:12
    There's no culture-free psychiatric disorder at all.
    97:16
    So the fact that something is influenced by culture...
    97:21
    tells you nothing about nothing,
    97:22
    in terms of the validity of the disorder.
    97:24
    But sort of lurking in behind there
    97:26
    is this idea that, "Oh, it's not influenced by culture,
    97:29
    "because it's a biological brain disease."
    97:34
    "The absence of cases outside North America
    97:36
    "proves DID is a North American artifact."
    97:38
    So we've accumulated lots of cases
    97:40
    from outside North America,
    97:41
    so that one's kind of starting to drop off now.
    97:46
    But let's just say it-- well, it was a fact,
    97:49
    if we go back 30 years, 25 years.
    97:52
    There's a lot more cases being diagnosed
    97:54
    in North America than outside North America.
    97:57
    So what does that prove?
    97:59
    Well, there's two competing hypotheses to explain it.
    98:03
    So I'm talking about DID here,
    98:05
    but I'm actually illustrating kind of the logic
    98:09
    of how the mental health system works,
    98:10
    and what arguments are, and how you prove things
    98:12
    and disprove things, and...
    98:15
    which could be applied to all kinds
    98:16
    of different disorders.
    98:18
    So the two competing hypotheses are--
    98:21
    well, it's just being diagnosed more often in North America
    98:23
    because the clinicians have become aware of it
    98:25
    in North America, and everybody else hasn't got up to speed yet.
    98:28
    That's one hypothesis-- and it's a real, legitimate disorder,
    98:31
    and if we do research in other countries,
    98:33
    we'll find lots of DID all over the place.
    98:36
    The second hypothesis is...
    98:38
    it's just a hysterical fad kicked up
    98:40
    by these crazy therapists...
    98:43
    one of whom is me.
    98:46
    And that's why it doesn't occur outside of North America,
    98:48
    because they aren't as hysterical
    98:49
    in the rest of the world.
    98:52
    So the fact that in the '80s, DID was being diagnosed
    98:57
    a lot more inside North America, was a fact.
    99:01
    But it's equally consistent with both hypotheses.
    99:06
    But the skeptical people use the fact
    99:09
    to prove their theory.
    99:12
    But that's not how science works.
    99:14
    What you do is you have an observation, a fact,
    99:16
    then you construct a theory to explain the fact,
    99:19
    and then you have to test your theory
    99:20
    to see if it's right or not.
    99:22
    You don't just go, "Well, here's the fact,
    99:24
    "here's my theory, the fact proves my theory."
    99:27
    No scientist operates like that.
    99:29
    So what you have to do is do some research
    99:31
    and do some studies and find out, "Okay,
    99:34
    "are there no cases outside North America?
    99:36
    "Yes or no?"
    99:39
    So it's this completely unscientific
    99:41
    kind of intellectual function.
    99:45
    "Increase of diagnoses of DID in the '90s
    99:47
    "is evidence of its artifactual nature"-- same idea.
    99:52
    Also, going back in time, DID was rarely diagnosed--
    99:55
    (mic cuts out)
    99:56
    and that proves it's just a fad in the 20th century,
    99:59
    which is unfortunately persisting into the 21st century.
    100:03
    But it's the same two theories.
    100:06
    It's always been around, going back for thousands of years,
    100:09
    we just haven't gotten up to speed on it until...
    100:13
    into the 20th century,
    100:15
    versus, "no, we've created a fad in the 20th century."
    100:18
    So the fact that there's more cases
    100:20
    diagnosed 1980 to '90 than all of the 18th and 19th centuries
    100:25
    doesn't prove which theory is correct.
    100:27
    But the skeptics use the fact to prove their own theory.
    100:32
    "Skeptics make appeals to authority."
    100:34
    So appeal to authority is...
    100:37
    "Oh, by the way, I know this is true, because Freud said so."
    100:40
    So you just-- "Freud, you can't argue with Freud."
    100:43
    That's an appeal to authority.
    100:44
    Or if you're a philosopher, "Wittgenstein said so."
    100:49
    Or if you're an English literature person,
    100:52
    you might say something about Dickens.
    100:54
    So the skeptics prove that they're correct
    100:57
    by referencing their friends and their co-authors.
    101:01
    Over and over and over and over and over.
    101:03
    So there's a little group of guys
    101:04
    who belong to the club, and everybody in the club agrees,
    101:06
    therefore the club is correct.
    101:08
    It's just not science.
    101:11
    Validity can be inferred from anecdotal
    101:13
    short-term treatment outcome, which I measured--
    101:15
    talked about before.
    101:17
    So if you find a couple of cases
    101:20
    that did poorly...
    101:22
    you can then conclude that all treatment of all cases
    101:26
    of DID is bad and wrong.
    101:28
    You just, you couldn't say this about schizophrenia.
    101:32
    You know, a couple of people with schizophrenia
    101:33
    came to the hospital and they got some sort of crazy treatment
    101:36
    and they did badly, therefore schizophrenia is not real?
    101:39
    You just cannot say that anywhere
    101:41
    in the mental health field.
    101:42
    But you can say it about DID.
    101:45
    Bad therapeutic practices call the validity
    101:47
    of DID into question.
    101:49
    Okay, so you go to Mexico to get Laetrile for cancer
    101:53
    and you die at exactly the same date as you would've
    101:56
    if you didn't go to Mexico, proving that cancer's not real.
    102:00
    It just doesn't make any sense.
    102:05
    "Diagnostic criteria for DID are vague,
    102:08
    "therefore DID is not valid."
    102:11
    Okay.
    102:13
    That could be true.
    102:14
    If it was true, that the diagnostic criteria are vague.
    102:18
    But how are we gonna find out if the diagnostic criteria
    102:20
    are vague?
    102:21
    Well, we've got to do inter-rater reliability studies
    102:24
    and look at the Cohen's kappa.
    102:26
    So we actually have evidence
    102:28
    that the criteria for DID are less vague--
    102:31
    like they're-- the DID--
    102:35
    depending on if you wanna go up or down on the scale,
    102:38
    either the criteria for depression
    102:40
    are twice as vague as the criteria for DID,
    102:43
    or the criteria for DID are half as vague
    102:45
    as the depression criteria, based on the Cohen's kappas.
    102:50
    So why are we saying that DID is vague
    102:53
    when it's actually demonstrably much less vague
    102:55
    than depression?
    102:59
    And what is the--
    103:02
    how do you diagnose substance abuse,
    103:03
    according to the "DSM V"?
    103:06
    Well, obviously you've got to take a bunch
    103:07
    of some kind of substances.
    103:09
    But you have-- all the wording is things like
    103:13
    "clinically significant."
    103:16
    So what's "clinically significant"?
    103:18
    There's no number for that.
    103:20
    It's kind of a vague term.
    103:22
    To be depressed, you have to be depressed, down, sad, blue,
    103:27
    most of the time for at least two weeks.
    103:30
    Yeah, but how much most of the time?
    103:32
    It's completely undefined.
    103:33
    It's literally just "most of the time."
    103:37
    So this is one of the reasons why
    103:38
    the agreement level is so low.
    103:40
    So we're applying this argument of vagueness to DID,
    103:44
    which applies more to other diagnoses.
    103:48
    "Lack of proven physiological differences
    103:50
    "between alters invalidates DID."
    103:54
    There's no proven physiological difference
    103:57
    between any mental disorder and any other mental disorder.
    104:01
    So this applies to all mental disorders.
    104:03
    We don't have-- and this is according to "DSM V"--
    104:05
    we don't have a blood test, we don't have a brain scan,
    104:08
    for diagnosing any "DSM" disorder.
    104:13
    "If repression is not proven, DID is not real."
    104:15
    Did that earlier.
    104:17
    "Diagnosis of DID encourages irresponsible behavior."
    104:21
    It could.
    104:23
    It doesn't in my treatment programs.
    104:25
    I hold people with DID responsible
    104:27
    for all their behavior, and they get the natural consequences
    104:30
    of their behavior just like anybody without DID.
    104:33
    So just because-- you can use DID to go,
    104:36
    "Oh, I can't help it-- little Joey inside did it,"
    104:40
    but you don't have to.
    104:43
    So if we had a rule in the mental health system
    104:46
    that if you're depressed,
    104:48
    you get half as long a prison sentence
    104:49
    as somebody who's not depressed,
    104:51
    how many people would be depressed all the time?
    104:53
    Everybody.
    104:54
    If we had a rule that said depressed people
    104:56
    get double the sentence, everybody would be,
    104:59
    "I'm not depressed."
    105:00
    So you can totally manipulate it by the rules of the system.
    105:03
    It's not inherent in the disorder or the diagnosis.
    105:08
    Uh...
    105:10
    "They're really just borderlines"-- went over that.
    105:12
    "It's an artifact of suggestibility
    105:13
    "and highly hypnotizable individuals."
    105:16
    So this is one of the common things.
    105:18
    You just hypnotize these people and suggest to them
    105:21
    that they have a canary living in their left ear.
    105:23
    All of a sudden, they have a canary
    105:24
    living in their left ear.
    105:26
    It's a very chauvinistic, demeaning,
    105:29
    belittling view of women, because most of the people
    105:32
    in treatment are women, that they're "so impressionable,"
    105:35
    you just tell them, "Oh, you have somebody inside."
    105:37
    "Oh, yes, I have somebody inside!"
    105:39
    I mean, it's like women don't even know their own minds.
    105:42
    It's a very belittling model.
    105:45
    And we actually have all kinds of research.
    105:47
    People with DID who've never been hypnotized
    105:51
    don't really differ in their symptom profiles
    105:52
    from people who have been hypnotized.
    105:55
    "It's impossible to have more than one personality
    105:57
    "in the same body, therefore it's not a real disorder."
    106:01
    Well, of course it's impossible to have
    106:02
    more than one personality in the same body.
    106:03
    Nobody's saying there's literally different people
    106:05
    living in there.
    106:07
    And I explain this to patients all the time.
    106:10
    I call it the "central paradox of DID."
    106:13
    So it took a while to figure this out.
    106:15
    Because if you say this the wrong way,
    106:18
    the person goes, "Oh, you're telling me it's not real?
    106:20
    "I'm just making it up, it's all in my head?
    106:21
    "I might as well go kill myself right now."
    106:23
    So you've gotta be careful how you deliver it.
    106:25
    So it took me a while to figure out
    106:27
    how to state the central paradox of DID,
    106:30
    which is it's both real and not real at the same time.
    106:33
    And I've given this explanation to hundreds
    106:34
    and hundreds of people with DID.
    106:37
    What do I mean by that?
    106:39
    Well, on the one hand, it's not literally concretely real.
    106:44
    So if we took an X-ray of your head,
    106:46
    we wouldn't see all these little skeletons in there.
    106:48
    And if there really were little skeletons
    106:50
    running around inside your brain,
    106:51
    your brain would be just all mashed up and you'd be dead.
    106:54
    And nobody goes, "Oh, yeah, there's skeletons in there."
    106:56
    Everybody goes, "Oh, that's cute-- little skeletons."
    106:59
    So nobody debates the point.
    107:01
    So it's not literally, concretely true (indistinct)
    107:03
    people, personalities in there.
    107:06
    But on the other hand, it's completely
    107:08
    psychologically true.
    107:09
    And very subjectively compelling.
    107:11
    And people really do open up their closets,
    107:14
    and there's like three outfits--
    107:16
    so this was a...
    107:18
    very conservative 39-year-old married housewife,
    107:21
    and there's like 16-year-old party girl stuff.
    107:25
    She doesn't remember buying it.
    107:27
    There's the receipt, her credit card,
    107:30
    sort of like her signature,
    107:31
    and she can't remember from 2 PM to 4 PM yesterday,
    107:35
    because her teenage alter went shopping.
    107:38
    These experiences actually happen.
    107:39
    They're very psychologically real.
    107:41
    They're just not literally real.
    107:43
    So this whole thing about it's not possible
    107:45
    to have more than one personality is,
    107:47
    like, completely irrelevant.
    107:52
    "A few clinicians are making all the diagnoses."
    107:56
    Uh, that was true...
    107:59
    in 1980.
    108:01
    It's not true today.
    108:02
    But so what?
    108:05
    At one point in time, a small number of clinicians
    108:07
    were making all the AIDS diagnoses.
    108:09
    What does that prove?
    108:12
    There's people who see-- have clinics
    108:14
    every week where numerous people
    108:17
    with cystic fibrosis come to see them,
    108:20
    and there's other pediatricians
    108:21
    who don't see any cases at all.
    108:24
    Well, that's because these guys specialize in cystic fibrosis.
    108:27
    It's completely ordinary.
    108:28
    It's unsurprising.
    108:29
    Nobody says, "Oh, a few clinicians are seeing
    108:32
    "most of the cases of this disorder,
    108:34
    "therefore it's not real."
    108:35
    They just go, "Oh, those guys specialize in that."
    108:39
    "Incorrect references are indicative of careless research
    108:43
    "in the skeptical literature."
    108:44
    So the skeptical guys do a really lousy job
    108:48
    on their references.
    108:49
    They even get like the wrong references.
    108:51
    Or they quote a reference
    108:54
    supporting a point that doesn't even support that point.
    108:57
    So just lousy scholarship.
    108:59
    "DID has been created experimentally,
    109:01
    "which proves it's not valid."
    109:04
    Hmm... okay.
    109:06
    So there's nothing worse in medicine
    109:09
    than having an animal model of a disorder.
    109:12
    Right?
    109:13
    So biological cancer researchers
    109:16
    never want to study mice that have cancer.
    109:21
    Well, of course they do.
    109:22
    These are called "animal models."
    109:24
    All of medicine is based on things in test tubes
    109:28
    and things in animals that are a model
    109:30
    of the disease in humans, so we can study how it works,
    109:33
    whether it's the immune system or arthritis or cancer.
    109:36
    So animal models,
    109:39
    or experimental models of something,
    109:40
    don't disprove it.
    109:42
    They help us to study how it works.
    109:44
    So nowhere else in medicine
    109:46
    is an experimental version of the disorder
    109:49
    used to invalidate the disorder.
    109:51
    What are the experiments where people created DID
    109:56
    that proves it's not valid?
    110:00
    It's so preposterous.
    110:02
    You wouldn't believe that this stuff
    110:03
    could get in the literature
    110:05
    if it wasn't in almost all of the major psychology textbooks
    110:09
    as evidence that DID is not valid.
    110:12
    So the experiment is, you get a whole bunch
    110:14
    of undergraduates, such as you guys.
    110:17
    I bring you in.
    110:19
    I give you a...
    110:21
    little bit of training for an hour or two
    110:23
    about what DID is, what it looks like.
    110:28
    I teach you about child alter personalities.
    110:30
    And then, I ask you to come back next week
    110:32
    and act as if you have multiple personality,
    110:36
    and a little girl comes out and talks and she's so cute,
    110:38
    and she doesn't remember what happened a long time ago.
    110:43
    So you do that.
    110:44
    The reason you do that is, you get course credit for it.
    110:49
    And this is the proof that multiple personality
    110:51
    can be created experimentally-- literally.
    110:54
    They get college students
    110:55
    to act as if they have multiple personality,
    110:57
    after they give them a little training
    110:58
    on how to do the acting.
    111:02
    That's it.
    111:04
    Do any of these people have multiple personality
    111:06
    for another year?
    111:08
    Or go to the counseling center and say,
    111:10
    "I can't remember what happened yesterday?"
    111:12
    None.
    111:14
    So what if we got you guys together
    111:16
    and we said, "Okay, I'm gonna teach you about back pain.
    111:20
    "You're all gonna act like you've got lumbar disc pain,
    111:23
    "and you're gonna be going, 'Oh, oh,'
    111:25
    "and you're gonna ask the doctor for some painkillers,
    111:28
    "and maybe you need to take a week off of school.
    111:31
    "And you can't hand in your paper this week."
    111:34
    And so, you all start going, "Oh, oh, oh."
    111:39
    This proves that disc pain isn't a real thing?
    111:43
    So teaching people to fake something temporarily
    111:47
    in order to get course credit tells us nothing
    111:50
    about whether the thing they're faking
    111:51
    actually happens in the world or not.
    111:54
    But it's-- I'm not kidding, like the majority
    111:56
    of undergraduate psychology textbooks
    111:58
    cite these experiments as compelling, conclusive evidence
    112:03
    that DID is a fake disorder.
    112:06
    Which, again, if you did that with depression,
    112:09
    everybody'd just go, "Well, they're just faking depression.
    112:11
    "They don't actually have it.
    112:12
    "It stops as soon as the experiment's over."
    112:17
    >> What about "BLUEBIRD"?
    112:21
    (indistinct).
    112:24
    >> This guy's read too many of my books here
    112:25
    for his own good.
    112:27
    So another line of argument, which I was not gonna get into,
    112:31
    but it's a whole 'nother half-day talk,
    112:34
    is one of my books originally was called "BLUEBIRD,"
    112:37
    but I reissued it as "The CIA Doctors."
    112:41
    It's about 15,000 pages of documents
    112:44
    that were declassified in the '70s, plus a ton of papers
    112:47
    from medical journals from the '50s and '60s
    112:49
    about CIA mind control experimentation,
    112:51
    all totally documented, done at major institutions,
    112:56
    Ivy league schools.
    112:59
    Closest place where MKUltra top secret experimentation was done
    113:04
    to here would be Ionia State Hospital in Michigan.
    113:08
    The experiment there was five or six
    113:11
    military psychiatrists
    113:14
    who had severed in the Vietnam war
    113:15
    who were now back working at the state mental hospital
    113:18
    in Michigan, cleared at top secret by the CIA,
    113:23
    knowing it was CIA funding, were interviewing
    113:25
    incarcerated sex offenders,
    113:29
    and giving them barbiturates, marijuana, and hallucinogens,
    113:34
    to see if they could get them to confess to crimes
    113:37
    they'd never been charged with.
    113:40
    That seems a little dicey.
    113:43
    That doesn't, no, I don't think that would exactly pass
    113:45
    the proper ethical review board.
    113:47
    You've got incarcerated sex offenders,
    113:49
    you're giving them street drugs
    113:51
    to see if you can get them to confess to things,
    113:53
    and then you're not going to bother reporting that
    113:54
    to the police at all.
    113:56
    And it's cleared at top secret.
    113:58
    So these are the documented types of experiments
    114:00
    that were done, including creating Manchurian candidates,
    114:06
    which is artificial multiple personality,
    114:08
    which is the movie "The Manchurian Candidate."
    114:10
    This is fact, not fiction,
    114:12
    described extensively in documents,
    114:15
    that if you take somebody,
    114:18
    you don't just go, "Hey"--
    114:19
    it's the same as creating a suicide bomber.
    114:22
    You don't just walk up to somebody on the street
    114:24
    and go, "Hey, would you like to blow yourself up next week?"
    114:27
    You've gotta recruit them, you've gotta work on them,
    114:29
    you've gotten soften them up a little,
    114:31
    you've gotta give them some rewards.
    114:33
    72 virgins in heaven-- pretty good reward.
    114:36
    Not sure if it's a real reward.
    114:39
    So to get somebody to kill themselves,
    114:41
    I mean, it's a project.
    114:43
    You've got to have a susceptible person,
    114:46
    and you can't choose like the head of the government's son,
    114:50
    and they've gotta be kind of desperate,
    114:52
    and they've gotta be kind of adrift in life,
    114:53
    and then you've gotta work on them,
    114:54
    work on them, work on them.
    114:56
    If you take somebody such as a marine
    115:00
    and you work on them for a period of months
    115:02
    with all kinds of interrogation techniques
    115:05
    and brainwashing techniques,
    115:07
    you can create artificial multiple personality,
    115:09
    and use the person in the background
    115:12
    to go on missions, and the person out front
    115:14
    doesn't remember, and this is described
    115:16
    in great detail in documents
    115:18
    going back to the second World War.
    115:21
    So what I do with that is, I say,
    115:24
    "That proves the reality of civilian
    115:27
    "clinical multiple personality."
    115:29
    If you control somebody, traumatize them,
    115:31
    threaten them, manipulate them enough,
    115:33
    this is how the human mind reacts.
    115:36
    Not in all people.
    115:38
    But a sub-group of people.
    115:40
    So if you react to brainwashing
    115:42
    by creating a new alter personality,
    115:45
    why wouldn't you react to childhood abuse
    115:47
    by creating a new alter personality?
    115:55
    Oh, "DID must be completely unconscious to be genuine."
    116:00
    I don't know where these guys even came up with this.
    116:01
    They say that people like me
    116:05
    believe that DID is totally unconscious.
    116:10
    Nobody in the DID field has ever said that.
    116:12
    They just kind of invent that out of nowhere,
    116:14
    and then they argue that, "Well,
    116:15
    "since it's not completely unconscious, it's not genuine."
    116:18
    Which doesn't make any sense-- I mean,
    116:20
    who ever comes in and says, "I'm here, doctor,
    116:22
    "because I'm completely unconscious
    116:24
    "of being depressed." (audience chuckling)
    116:26
    It just doesn't make any sense.
    116:30
    Uh, "Satanic ritual abuse and alien abductions
    116:32
    "are not real, so neither is DID."
    116:35
    Okay, so...
    116:36
    wait a minute, what's that got to do with anything?
    116:41
    Only two or three people with DID
    116:43
    who describe alien abduction experiences...
    116:46
    out of thousands.
    116:48
    So...
    116:49
    so a few people with schizophrenia
    116:51
    think they were abducted by aliens,
    116:53
    therefore schizophrenia's not real?
    116:55
    It's just not-- again, absolutely makes no sense whatsoever.
    116:58
    Satanic ritual abuse-- well, let's assume
    117:01
    that all the Satanic ritual abuse memories,
    117:03
    which is a sub-group of people with DID,
    117:05
    are not real.
    117:08
    Well, okay, so, hello, these people are psychiatric patients
    117:11
    in a mental hospital-- they're a little mixed up.
    117:14
    Who's surprised by that?
    117:16
    Nobody says, "Oh, these schizophrenics have delusions,
    117:19
    "therefore their schizophrenia isn't real."
    117:22
    It just...
    117:23
    over and over and over, this logic
    117:24
    just doesn't make any sense.
    117:26
    And then, the "extreme case escalation tactic"
    117:29
    is just a term I invented.
    117:30
    So they'll take the most extreme, out-there case,
    117:35
    and use that to be typical of the entire population of DID.
    117:40
    And so they-- they'll always do that--
    117:42
    escalate up to the extreme situation.
    117:43
    So if you go to...
    117:46
    I don't know the exact percentage,
    117:47
    but over three-quarters of undergrad-- (mic cuts out)--
    117:50
    or even graduate abnormal psychology textbooks,
    117:53
    you get the anti-DID approach,
    117:57
    and you'll hear them talking about
    117:58
    the Hillside strangler case in Los Angeles
    118:01
    in the 1970s.
    118:03
    Which is a serial killer who was convicted,
    118:06
    who...
    118:07
    not 100% for sure, but probably was faking DID.
    118:13
    And that is overwhelming, powerful evidence
    118:15
    that DID is not a legitimate disorder.
    118:19
    One case of one guy who's a serial killer--
    118:21
    we're gonna rely on them?
    118:24
    Who tried to get out of responsibility by faking DID
    118:27
    proves what about everybody else?
    118:30
    It's just so far in outer space, it's hard to believe,
    118:32
    but it's in the majority of abnormal psychology textbooks
    118:37
    as powerful evidence that DID is not real.
    118:41
    Textbooks written by, like, the top professors.
    118:44
    This is what I deal with.
    118:47
    Okay, so this is now my favorite part of the whole thing.
    118:50
    So...
    118:52
    and so, this book was not published that long ago.
    118:57
    Well, let me skip that one-- sorry.
    118:59
    I'll just-- because we're a little short on time.
    119:03
    Here we are at my favorite one.
    119:05
    So this book was not published all that long ago.
    119:10
    "Sibyl Exposed."
    119:12
    By this woman Debbie Nathan, who sees herself as a feminist,
    119:16
    she's a journalist.
    119:17
    And Shirley Mason was-- is the real person
    119:23
    who was in the novel and the movie, "Sibyl."
    119:26
    So the two big books and novels
    119:29
    before "DSM III" came out in 1980
    119:33
    where multiple personality got an official slot,
    119:37
    the two big books and movies were "The Three Faces of Eve"
    119:40
    and "Sibyl."
    119:42
    And...
    119:43
    Chris Seizmore, who's the real Eve
    119:45
    from "The Three Faces of Eve,"
    119:46
    I know personally-- amazing woman--
    119:48
    has been integrated since 1975,
    119:51
    highly gifted artist, wonderful person.
    119:54
    Has been well for decades.
    119:57
    Shirley Mason, who's Sibyl, I never met, and she died.
    120:01
    But in this book, this Debbie Nathan uses
    120:04
    the Sibyl case to establish conclusively
    120:08
    that Sibyl really didn't have DID--
    120:10
    it was just a crazy therapist, Cornelia Wilbur,
    120:12
    which then makes us know pretty well for sure
    120:14
    that all the cases are ridiculous and not real.
    120:17
    But let's look at her analysis here.
    120:19
    This is all from her book.
    120:23
    So...
    120:24
    she's born in 1923, died in 1998.
    120:27
    She had five sessions with Dr. Cornelia Wilbur--
    120:30
    who I knew, who is now deceased--
    120:33
    in 1945.
    120:35
    So five sessions.
    120:36
    She functioned well with no signs of DID
    120:39
    from 1945 until she started seeing her again in 1954.
    120:44
    So these are the facts according to Debbie Nathan.
    120:47
    The symptoms of DID began after the therapy re-started,
    120:51
    and were caused by the bad therapy by Cornelia Wilbur.
    120:56
    Okay, but in the book, Debbie Nathan
    120:59
    describes symptoms prior to first contact with Dr. Wilbur,
    121:04
    described to her by many people in Shirley Mason's hometown,
    121:08
    who she interviewed directly.
    121:10
    Many different people.
    121:12
    Family members and non-family members.
    121:14
    The symptoms from before first contact
    121:19
    included fugue states, which means going somewhere
    121:23
    and not remembering who you are for a period of time.
    121:26
    Blank spells-- so clearly defined chunks of missing time.
    121:30
    Spending hours playing with imaginary companions with names
    121:33
    far beyond the age that this occurs
    121:35
    in non-traumatized children.
    121:37
    Pretending to be Vickie,
    121:39
    one of her imaginary companions at times.
    121:42
    Her mother calling her by the names
    121:44
    of alter personalities later identified in adult therapy.
    121:48
    Talking in a high, childish voice
    121:50
    when she was no longer a child.
    121:52
    Numerous symptoms consistent with somatoform dissociation,
    121:55
    which means psychosomatic symptoms.
    121:58
    Going to bars to drink with men,
    121:59
    and not remembering afterwards,
    122:01
    although she hadn't consumed that much alcohol.
    122:03
    Suddenly going comatose in public.
    122:05
    Suddenly acting dramatically out of character.
    122:08
    All of these behaviors,
    122:10
    described by many observers in her hometown,
    122:13
    going back into her childhood for years
    122:15
    before first contact with Cornelia Wilbur.
    122:19
    Yet, the analysis is all the DID symptoms
    122:22
    were caused by the therapy.
    122:24
    This is a huge... amount of symptomatology
    122:29
    consistent with pre-existing DID.
    122:32
    But then, she goes on to say that all these symptoms
    122:36
    that existed before contact with Cornelia Wilbur,
    122:40
    were caused by pernicious anemia,
    122:42
    a form of anemia.
    122:46
    Well, a little minor problem...
    122:49
    pernicious-- she never had a pernicious anemia diagnosis.
    122:51
    No doctor ever diagnosed her with that.
    122:54
    It's just made up out of nowhere.
    122:57
    If the symptoms were caused by pernicious anemia--
    123:00
    which she didn't have--
    123:02
    why did those symptoms go into remission from 1945 to 1954?
    123:07
    So Debbie Nathan says she had all these symptoms here
    123:10
    before seeing Cornelia Wilbur,
    123:12
    caused by pernicious anemia,
    123:14
    which doesn't cause those symptoms anyway
    123:16
    and which she didn't have.
    123:18
    And then, all those symptoms stop for nine years,
    123:22
    although she wasn't diagnosed or treated,
    123:23
    and pernicious anemia never goes away,
    123:25
    and then they suddenly started up again
    123:28
    and were caused by Cornelia Wilbur.
    123:31
    Like, who's gonna believe this?
    123:34
    This book gets published,
    123:36
    gets reviewed favorably all over the places,
    123:39
    it's cited by all the skeptics.
    123:40
    It'll be in the psychology textbooks soon.
    123:43
    "Debbie Nathan wrote this compelling analysis."
    123:49
    And the...
    123:51
    final nail in the coffin of DID
    123:53
    is that Debbie Nathan points out
    123:59
    that Shirley Mason denied having MPD herself.
    124:07
    Once, in one letter.
    124:10
    Okay, so you treat somebody with chronic, severe alcoholism,
    124:14
    for a long period of time, and once they write you a letter
    124:17
    saying that they don't have a drinking problem,
    124:19
    that's it, they clearly don't have a drinking problem?
    124:22
    (audience laughing)
    124:24
    It's just-- again, it's just this outer space,
    124:26
    Mad Hatter's tea party...
    124:29
    doesn't make any sense.
    124:30
    It's impossible.
    124:32
    It's so far below any kind of...
    124:36
    high school debating clubs could do way better than this
    124:38
    in their level of scholarship,
    124:39
    argument, weighing the evidence.
    124:43
    So then, that raises the question, "Well, why?"
    124:47
    Why is this all going on in the field?
    124:49
    What's the deal here?
    124:51
    Why do all these, like, high-ranking professors
    124:53
    have all this bad attitude
    124:55
    and all these crazy arguments that make no sense?
    125:00
    And my answer is I don't know for sure.
    125:03
    But I think there's multiple sort of factors
    125:06
    contributing to this.
    125:09
    One is, uh, "My professors never taught me about that.
    125:13
    "I was taught that it's rare.
    125:15
    "My professors can't be wrong.
    125:16
    "I can't be wrong.
    125:18
    "It'd be too shameful to admit that we've all been wrong
    125:19
    "for all these decades."
    125:21
    So there's this sort of egotism, professional reputation.
    125:24
    Another thing is if it's actually true,
    125:27
    then in the ballpark of 1 out of 25 inpatients
    125:30
    in all the psych hospitals in the country has undiagnosed DID,
    125:35
    and we're missing all those cases?
    125:37
    That doesn't make us look like very sharp diagnosticians.
    125:40
    So therefore, we have to say it's not real.
    125:42
    Another thing is, if there's all these people with DID--
    125:46
    full DID-- plus a whole bunch of people with kind of half,
    125:49
    three-quarters, a quarter DID,
    125:52
    maybe a lot of us are a little more DID-ish
    125:54
    than we would like to admit to.
    125:56
    So maybe, "I don't wanna look at them
    125:57
    "because I don't wanna have to look at myself.
    125:59
    "Maybe my behavior's sometimes a little inconsistent
    126:02
    "and doesn't exactly mesh together in a healthy fashion."
    126:07
    Which doesn't mean that I have DID.
    126:09
    I'm talking "I" the skeptic.
    126:13
    "Maybe I, the skeptic,
    126:16
    "have an unresolved childhood trauma history
    126:18
    "and I don't want anybody talking about that stuff."
    126:21
    So therefore...
    126:23
    when Colin Ross goes to the American College
    126:24
    of Psychiatrists meeting, hears a whole hour talk
    126:27
    by a top expert on childhood depression--
    126:29
    not a mention of childhood abuse of any kind once.
    126:33
    Then, listens to another talk about another expert,
    126:36
    not a mention of childhood trauma once.
    126:39
    Another talk by another expert,
    126:40
    still no mention of childhood trauma.
    126:44
    Maybe they just don't wanna talk about it.
    126:45
    Maybe they're uncomfortable.
    126:47
    Maybe it's something to do with personal histories.
    126:49
    Next hypothesis.
    126:52
    Remember when sexual abuse was just kind of
    126:54
    coming out of the closet?
    126:55
    In 1980, the 3rd edition of the comprehensive textbook
    127:00
    of psychiatry was published,
    127:01
    that I used in my residency from '81 to '85.
    127:04
    There's three volumes, it's 3,300-and-something pages,
    127:08
    two columns each page.
    127:10
    Everything you need to know in psychiatry was in there.
    127:14
    Way at the back, after the important stuff,
    127:17
    like depression and schizophrenia,
    127:19
    and drugs, genetics,
    127:21
    was a section called "Topics of Special Interest."
    127:25
    Which really means irrelevant stuff
    127:26
    that we just stuck in at the end because,
    127:27
    you know, gotta be comprehensive.
    127:30
    In there was a short chapter called "Incest."
    127:33
    In the chapter on incest was one paragraph
    127:37
    talking about how common incest is,
    127:39
    with a reference to a 1955 study
    127:41
    saying it's one family out of a million
    127:43
    in the United States.
    127:45
    Those are the scientific, academic, medical facts
    127:48
    during my training.
    127:49
    That's the level of denial.
    127:52
    Institutional denial.
    127:53
    It's been in place in psychiatry for a century.
    127:56
    It's actually more than one family out of 100,
    127:59
    not one out of a million.
    128:02
    In this same era, the mid-'80s,
    128:04
    there's several surveys where,
    128:07
    surprisingly, female psychiatrists
    128:10
    got interested in childhood sexual abuse,
    128:12
    which is mostly, but not exclusively, girls.
    128:15
    It's about two to three times as much with girls as with boys.
    128:19
    And they did mail-out surveys to different types of physicians,
    128:23
    psychiatrists, psychologists, and I think in one survey,
    128:26
    social workers-- can't remember for sure.
    128:28
    But all different types of physicians.
    128:31
    Have you ever had sex with somebody
    128:34
    who's currently in treatment with you?
    128:37
    And a bunch of other questions.
    128:39
    They got back-- they described in their article,
    128:41
    published in a leading journal--
    128:43
    angry, scrawling, you know, F bombs and the whole works,
    128:48
    from physicians, swearing at them,
    128:51
    accusing of being this, that, and the other,
    128:54
    and not filling out the questionnaire.
    128:56
    And 10% of respondents said yes--
    129:01
    anonymous respondents, said, "Yes,
    129:03
    "I have had sex with somebody who's currently in treatment
    129:05
    "with me in my practice."
    129:07
    So 10% admitted.
    129:09
    So what do we think the real rate is?
    129:12
    So do we think there's pedophiles
    129:14
    in the Catholic church?
    129:16
    Do we think there's any in the Boy Scouts?
    129:18
    Do we think there's any in the medical profession?
    129:20
    Do we think there's any in psychiatry?
    129:22
    There has to be.
    129:23
    There's pedophiles everywhere.
    129:25
    So part of the whole deal is pedophiles
    129:27
    don't want anybody talking about that stuff.
    129:30
    Then, the other part of it is...
    129:32
    biological brain disease model.
    129:36
    If the genetics and the biology of the brain
    129:38
    are the big drivers of mental illness,
    129:41
    we can't allow it to be true that childhood trauma
    129:44
    that's the major driver.
    129:45
    It's just not allowed.
    129:47
    So you have to discredit it.
    129:48
    And any diagnoses that are linked to it,
    129:50
    discredit.
    129:52
    So to me, that's what's going on in the profession.
    129:56
    You look like you had a question.
    129:57
    >> Yeah.
    129:59
    Approximately, what's the ratio
    130:00
    of skeptics to, you know, clinicians who believe in DID?
    130:05
    >> There's actually surveys by skeptics,
    130:07
    funnily enough, who then conclude that DID is not valid,
    130:10
    should be taken out of the "DSM,"
    130:12
    and in those surveys, about, uh...
    130:17
    it's a little tricky how they word the question.
    130:20
    So sometimes the question is,
    130:22
    "Should the criteria be modified?"
    130:25
    And the answer is "yes," and then they say,
    130:27
    "Well, see, it's a bogus diagnosis."
    130:30
    Well, hello, the criteria for schizophrenia
    130:31
    just got modified between "DSM IV" and "DSM V."
    130:34
    So of course we have to fine-tune stuff,
    130:36
    and that proves nothing.
    130:38
    But it comes out about...
    130:41
    bouncing around from survey to survey,
    130:43
    hardcore skeptics are somewhere between 5% and 15%.
    130:48
    Half to two-thirds think it's a legitimate disorder,
    130:52
    needs more research, maybe needs some fine-tuning,
    130:54
    sometimes questionable.
    130:57
    That's kind of the ballpark.
    130:58
    So, but the very small group of really vociferous--
    131:02
    I mean, they're like the jihadists, right?
    131:04
    They're the anti-DID jihadists.
    131:06
    They're very vocal, very energized, very active.
    131:10
    And have control of undergrad psychology textbooks,
    131:12
    by and large.
    131:18
    >> What about the actual lit-- (clearing throat)
    131:20
    sorry, the actual literature?
    131:21
    Is there like a lot of literature-- you know,
    131:24
    you presented us a little of the literature
    131:26
    you've done on this topic,
    131:28
    but is there, like, a lot of literature
    131:30
    that says the opposite of what you're saying?
    131:33
    >> Well, the literature that says the opposite
    131:36
    just says it, but doesn't have any evidence.
    131:38
    So these guys, like the guys who do the experiments
    131:41
    to create multiple personality in college students,
    131:45
    they never once describe interviewing a single person
    131:48
    with a clinical diagnosis of DID.
    131:50
    So they do no treatment,
    131:52
    and they don't even talk to people to say, "Hey,
    131:54
    "tell me about your experience here."
    131:56
    So it's totally armchair quarterbacks,
    131:58
    and they don't have any solid designed research studies
    132:03
    proving any of their points.
    132:05
    >> So there's not, I mean, like,
    132:07
    actual, empirical research from their side?
    132:09
    It's mostly just reviews of-- >> Reviews and opinions.
    132:14
    And false reasoning.
    132:18
    >> And sometimes, stereotyped by inaccurate descriptions
    132:23
    of what they're even rejecting.
    132:25
    >> Yeah, right.
    132:26
    We were talking about this before,
    132:28
    so the stereotype of what somebody with DID
    132:31
    is supposed to look like.
    132:32
    "So they're like flamboyantly, extremely obvious.
    132:36
    "They're right in your face with it.
    132:38
    "They're claiming no responsibility for anything.
    132:40
    "They're trying to get all kinds of special treatment
    132:42
    "and privileges.
    132:44
    "And there's no evidence for any DID before from anywhere."
    132:48
    That's the stereotype.
    132:50
    Which simply is just not reality.
    132:54
    Of course, we know that everybody from Grand Rapids
    132:56
    is actually a Martian wearing a human costume.
    133:00
    Well, we don't really have evidence for that,
    133:01
    but we know it's true.
    133:03
    It's kind of like that.
    133:08
    Anyone else with a thought, comment, question?
    133:11
    About anything in the mental health field?
    133:17
    Or anything to do with college hockey,
    133:18
    that I know a lot about?
    133:19
    (all chuckling)
    133:22
    Okay, well, thanks for listening.
    133:23
    Thanks for spending some time.
    133:24
    (applause)