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)