Dissociative phenomena and the question of responsibility

There are many controversies regarding the prevalence, causation, possible iatrogenicity, and treatment of multiple personality disorder. Those who view the disorder as much more prevalent than has previously been suspected believe it is caused by experiences of severe child abuse and have used rather unorthodox techniques to help the patient relate the experience of abuse to current problems of dissociation. Other clinicians believe the disorder is overdiagnosed and that it may be created or made worse by therapists who unwittingly reinforce symptoms of dissociation. Many of the controversies about these issues can be clarified by considering the manner in which clinicians attribute responsibility for undesirable conduct associated with the disorder. In dealing with multiple personality patients, clinicians regularly must decide whether their therapeutic approach will emphasize the patient's responsibility for undesirable conduct or will minimize it. Practical and theoretical arguments can be made for both approaches. There are important consequences to patients using either approach, and particularly harmful consequences with inconsistent approaches. Clinical experience and wisdom dictate that until we have more objective data about the results of various forms of treatment, the preferred method of treatment of multiple personality patients should continue to focus upon maximizing their responsibility for any type of undesirable conduct.